Abstract 11201: Earlier Treatment is Associated with Improved Survival in Pulmonary Hypertension
Introduction: Treatment of pulmonary hypertension (PH) with a disease-specific agent is typically reserved for patients with advanced symptoms and poor function class. This study compared the efficacy of therapy in patients with minimal symptoms (WHO class II) to those suffering from more advanced disease (WHO class III/IV).
Hypothesis: We hypothesized that earlier treatment will be associated with improved survival in patients with PH.
Methods: We examined a two-center prospective cohort of 214 consecutive patients referred for invasive PH evaluation prior to initiation of therapy. Treatment with a PH-specific therapy (endothelin antagonist, inhaled prostaglandin or phosphodiesterase inhibitor) was monitored via clinical follow up and long-term survival was confirmed using the social security death index.
Results: Mean age was 57±15 years, 71% were women, 63% were Dana Point Class I and WHO function class distribution was 33/51/17 (% II/III/IV). The mean pulmonary artery pressure (PAP) at baseline was 45±16 mm Hg. During follow-up 58% of patients were treated with at least one PH-specific therapy and 16% received combination therapy. There were 55 deaths (26%) over a mean follow-up period of 27 months. Kaplan-Meier analysis showed a significantly improved survival in WHO class II patients receiving therapy compared to those left untreated (p=0.04). This same benefit, however, was not seen in WHO class III/IV patients (p=0.36).
Conclusions: Treating PH earlier in the course of the disease with disease-specific therapy appears to significantly reduce all-cause mortality, whereas starting therapy in more symptomatic patients does not achieve the same mortality benefit.
- © 2010 by American Heart Association, Inc.