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Outcomes in World Health Organization Group II Pulmonary Hypertension: Mortality and Readmission Trends With Systolic and Preserved Ejection Fraction–Induced Pulmonary Hypertension
Abstract Background Heart failure with preserved ejection fraction (HFpEF) has been increasingly recognized as a leading cause of pulmonary hypertension (HFpEF-PH). It remains unknown how HFpEF-PH fares in relation to systolic HF (reduced ejection fraction)–induced PH (HFrEF-PH). Therefore, we sough...
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Published in: | Journal of cardiac failure 2014-07, Vol.20 (7), p.467-475 |
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creator | Salamon, Jason N., MD Kelesidis, Iosif, MD, MPH Msaouel, Pavlos, MD, PhD Mazurek, Jeremy A., MD Mannem, Santhosh, MD Adzic, Aleksandar, MD Zolty, Ronald, MD, PhD |
description | Abstract Background Heart failure with preserved ejection fraction (HFpEF) has been increasingly recognized as a leading cause of pulmonary hypertension (HFpEF-PH). It remains unknown how HFpEF-PH fares in relation to systolic HF (reduced ejection fraction)–induced PH (HFrEF-PH). Therefore, we sought to determine the long-term morbidity and mortality of HFpEF-PH and HFrEF-PH. Methods and Results We studied all patients over a 6-year period with symptomatic HF and severe PH (PASP ≥65 mm Hg) in The Bronx, New York. We classified patients as having either preserved (≥50%) or reduced (≤35%) left ventricular ejection fraction. Trends in mortality and HF readmission rates were defined in 650 patients (HFrEF-PH: n = 277; HFpEF-PH: n = 373). HFpEF-PH patients were older and more often female and white. HFrEF-PH patients were more often black, had ischemic cardiomyopathy, and were on typical HF drug regimens. Patients with HFpEF-PH had a significantly increased all-cause 5-year mortality (52% vs 42%; P = .024). HFpEF-PH was a significant predictor of mortality (adjusted hazard ratio 1.70; P = .012). Patients with HFrEF-PH had more HF readmissions (≥1) than patients with HFpEF-PH (28.6% vs 15%; P = .003), especially within the 1st year (9.1% vs 1.7%; P = .005). Conclusions Patients with HFrEF-PH and HFpEF-PH have a significantly elevated long-term mortality, with HFpEF-PH having a higher 5-year mortality rate. These findings testify to the overall poor prognosis of World Health Organization Group II PH, especially HFpEF-PH. |
doi_str_mv | 10.1016/j.cardfail.2014.05.003 |
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It remains unknown how HFpEF-PH fares in relation to systolic HF (reduced ejection fraction)–induced PH (HFrEF-PH). Therefore, we sought to determine the long-term morbidity and mortality of HFpEF-PH and HFrEF-PH. Methods and Results We studied all patients over a 6-year period with symptomatic HF and severe PH (PASP ≥65 mm Hg) in The Bronx, New York. We classified patients as having either preserved (≥50%) or reduced (≤35%) left ventricular ejection fraction. Trends in mortality and HF readmission rates were defined in 650 patients (HFrEF-PH: n = 277; HFpEF-PH: n = 373). HFpEF-PH patients were older and more often female and white. HFrEF-PH patients were more often black, had ischemic cardiomyopathy, and were on typical HF drug regimens. Patients with HFpEF-PH had a significantly increased all-cause 5-year mortality (52% vs 42%; P = .024). HFpEF-PH was a significant predictor of mortality (adjusted hazard ratio 1.70; P = .012). Patients with HFrEF-PH had more HF readmissions (≥1) than patients with HFpEF-PH (28.6% vs 15%; P = .003), especially within the 1st year (9.1% vs 1.7%; P = .005). Conclusions Patients with HFrEF-PH and HFpEF-PH have a significantly elevated long-term mortality, with HFpEF-PH having a higher 5-year mortality rate. These findings testify to the overall poor prognosis of World Health Organization Group II PH, especially HFpEF-PH.</description><identifier>ISSN: 1071-9164</identifier><identifier>EISSN: 1532-8414</identifier><identifier>DOI: 10.1016/j.cardfail.2014.05.003</identifier><identifier>PMID: 24858070</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Cardiovascular ; Cohort Studies ; diastolic dysfunction ; Female ; Heart Failure - diagnostic imaging ; Heart Failure - mortality ; Humans ; Hypertension, Pulmonary - diagnostic imaging ; Hypertension, Pulmonary - mortality ; Left heart failure ; Male ; Middle Aged ; Mortality - trends ; Patient Readmission - trends ; pulmonary hypertension ; Stroke Volume - physiology ; Systole - physiology ; Treatment Outcome ; Ultrasonography ; World Health Organization</subject><ispartof>Journal of cardiac failure, 2014-07, Vol.20 (7), p.467-475</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c423t-71a4853e5d8a68771e4c9f4a2d696a761da3ca47cb1262ca5af785fd42fcd13</citedby><cites>FETCH-LOGICAL-c423t-71a4853e5d8a68771e4c9f4a2d696a761da3ca47cb1262ca5af785fd42fcd13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24858070$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Salamon, Jason N., MD</creatorcontrib><creatorcontrib>Kelesidis, Iosif, MD, MPH</creatorcontrib><creatorcontrib>Msaouel, Pavlos, MD, PhD</creatorcontrib><creatorcontrib>Mazurek, Jeremy A., MD</creatorcontrib><creatorcontrib>Mannem, Santhosh, MD</creatorcontrib><creatorcontrib>Adzic, Aleksandar, MD</creatorcontrib><creatorcontrib>Zolty, Ronald, MD, PhD</creatorcontrib><title>Outcomes in World Health Organization Group II Pulmonary Hypertension: Mortality and Readmission Trends With Systolic and Preserved Ejection Fraction–Induced Pulmonary Hypertension</title><title>Journal of cardiac failure</title><addtitle>J Card Fail</addtitle><description>Abstract Background Heart failure with preserved ejection fraction (HFpEF) has been increasingly recognized as a leading cause of pulmonary hypertension (HFpEF-PH). It remains unknown how HFpEF-PH fares in relation to systolic HF (reduced ejection fraction)–induced PH (HFrEF-PH). Therefore, we sought to determine the long-term morbidity and mortality of HFpEF-PH and HFrEF-PH. Methods and Results We studied all patients over a 6-year period with symptomatic HF and severe PH (PASP ≥65 mm Hg) in The Bronx, New York. We classified patients as having either preserved (≥50%) or reduced (≤35%) left ventricular ejection fraction. Trends in mortality and HF readmission rates were defined in 650 patients (HFrEF-PH: n = 277; HFpEF-PH: n = 373). HFpEF-PH patients were older and more often female and white. HFrEF-PH patients were more often black, had ischemic cardiomyopathy, and were on typical HF drug regimens. Patients with HFpEF-PH had a significantly increased all-cause 5-year mortality (52% vs 42%; P = .024). HFpEF-PH was a significant predictor of mortality (adjusted hazard ratio 1.70; P = .012). Patients with HFrEF-PH had more HF readmissions (≥1) than patients with HFpEF-PH (28.6% vs 15%; P = .003), especially within the 1st year (9.1% vs 1.7%; P = .005). Conclusions Patients with HFrEF-PH and HFpEF-PH have a significantly elevated long-term mortality, with HFpEF-PH having a higher 5-year mortality rate. These findings testify to the overall poor prognosis of World Health Organization Group II PH, especially HFpEF-PH.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiovascular</subject><subject>Cohort Studies</subject><subject>diastolic dysfunction</subject><subject>Female</subject><subject>Heart Failure - diagnostic imaging</subject><subject>Heart Failure - mortality</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - diagnostic imaging</subject><subject>Hypertension, Pulmonary - mortality</subject><subject>Left heart failure</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality - trends</subject><subject>Patient Readmission - trends</subject><subject>pulmonary hypertension</subject><subject>Stroke Volume - physiology</subject><subject>Systole - physiology</subject><subject>Treatment Outcome</subject><subject>Ultrasonography</subject><subject>World Health Organization</subject><issn>1071-9164</issn><issn>1532-8414</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNqFUstuFDEQHCEQCYFfiHzksoPt8TyWAwJFSXaloI3YSDlaHbsHPHjtxZ6JNDnxD_xLPihfgmc34YCQOLmlqq5yd3WWHTOaM8qqd12uIOgWjM05ZSKnZU5p8Sw7ZGXBZ41g4nmqac1mc1aJg-xVjB2ltBG0fpkdcNGUDa3pYXa_GnrlNxiJceTaB6vJAsH238gqfAVn7qA33pHz4IctWS7J5WA33kEYyWLcYujRxYS_J5996MGafiTgNPmCoDcmThC5Cuh0JNcmaa7H2Htr1I50GTBiuEVNTjtUO5uzALvi4eevpdODSti_DV9nL1qwEd88vkfZ-uz06mQxu1idL08-XcyU4EU_qxmkSQssdQNVU9cMhZq3Ariu5hXUFdNQKBC1umG84gpKaOumbLXgrdKsOMre7lW3wf8YMPYyDaXQWnDohyhZKQrecMEnarWnquBjDNjKbTCb9G3JqJwSk518SkxOiUlaypRYajx-9BhuNqj_tD1FlAgf9wRMc94aDDIqgy7txoS0Nqm9-b_Hh78klDXOKLDfccTY-SG4tEXJZOSSyvV0N9PZMEEpp3VR_Aa518Vf</recordid><startdate>20140701</startdate><enddate>20140701</enddate><creator>Salamon, Jason N., MD</creator><creator>Kelesidis, Iosif, MD, MPH</creator><creator>Msaouel, Pavlos, MD, PhD</creator><creator>Mazurek, Jeremy A., MD</creator><creator>Mannem, Santhosh, MD</creator><creator>Adzic, Aleksandar, MD</creator><creator>Zolty, Ronald, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140701</creationdate><title>Outcomes in World Health Organization Group II Pulmonary Hypertension: Mortality and Readmission Trends With Systolic and Preserved Ejection Fraction–Induced Pulmonary Hypertension</title><author>Salamon, Jason N., MD ; Kelesidis, Iosif, MD, MPH ; Msaouel, Pavlos, MD, PhD ; Mazurek, Jeremy A., MD ; Mannem, Santhosh, MD ; Adzic, Aleksandar, MD ; Zolty, Ronald, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c423t-71a4853e5d8a68771e4c9f4a2d696a761da3ca47cb1262ca5af785fd42fcd13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiovascular</topic><topic>Cohort Studies</topic><topic>diastolic dysfunction</topic><topic>Female</topic><topic>Heart Failure - diagnostic imaging</topic><topic>Heart Failure - mortality</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - diagnostic imaging</topic><topic>Hypertension, Pulmonary - mortality</topic><topic>Left heart failure</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality - trends</topic><topic>Patient Readmission - trends</topic><topic>pulmonary hypertension</topic><topic>Stroke Volume - physiology</topic><topic>Systole - physiology</topic><topic>Treatment Outcome</topic><topic>Ultrasonography</topic><topic>World Health Organization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Salamon, Jason N., MD</creatorcontrib><creatorcontrib>Kelesidis, Iosif, MD, MPH</creatorcontrib><creatorcontrib>Msaouel, Pavlos, MD, PhD</creatorcontrib><creatorcontrib>Mazurek, Jeremy A., MD</creatorcontrib><creatorcontrib>Mannem, Santhosh, MD</creatorcontrib><creatorcontrib>Adzic, Aleksandar, MD</creatorcontrib><creatorcontrib>Zolty, Ronald, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiac failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Salamon, Jason N., MD</au><au>Kelesidis, Iosif, MD, MPH</au><au>Msaouel, Pavlos, MD, PhD</au><au>Mazurek, Jeremy A., MD</au><au>Mannem, Santhosh, MD</au><au>Adzic, Aleksandar, MD</au><au>Zolty, Ronald, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes in World Health Organization Group II Pulmonary Hypertension: Mortality and Readmission Trends With Systolic and Preserved Ejection Fraction–Induced Pulmonary Hypertension</atitle><jtitle>Journal of cardiac failure</jtitle><addtitle>J Card Fail</addtitle><date>2014-07-01</date><risdate>2014</risdate><volume>20</volume><issue>7</issue><spage>467</spage><epage>475</epage><pages>467-475</pages><issn>1071-9164</issn><eissn>1532-8414</eissn><abstract>Abstract Background Heart failure with preserved ejection fraction (HFpEF) has been increasingly recognized as a leading cause of pulmonary hypertension (HFpEF-PH). It remains unknown how HFpEF-PH fares in relation to systolic HF (reduced ejection fraction)–induced PH (HFrEF-PH). Therefore, we sought to determine the long-term morbidity and mortality of HFpEF-PH and HFrEF-PH. Methods and Results We studied all patients over a 6-year period with symptomatic HF and severe PH (PASP ≥65 mm Hg) in The Bronx, New York. We classified patients as having either preserved (≥50%) or reduced (≤35%) left ventricular ejection fraction. Trends in mortality and HF readmission rates were defined in 650 patients (HFrEF-PH: n = 277; HFpEF-PH: n = 373). HFpEF-PH patients were older and more often female and white. HFrEF-PH patients were more often black, had ischemic cardiomyopathy, and were on typical HF drug regimens. Patients with HFpEF-PH had a significantly increased all-cause 5-year mortality (52% vs 42%; P = .024). HFpEF-PH was a significant predictor of mortality (adjusted hazard ratio 1.70; P = .012). Patients with HFrEF-PH had more HF readmissions (≥1) than patients with HFpEF-PH (28.6% vs 15%; P = .003), especially within the 1st year (9.1% vs 1.7%; P = .005). Conclusions Patients with HFrEF-PH and HFpEF-PH have a significantly elevated long-term mortality, with HFpEF-PH having a higher 5-year mortality rate. These findings testify to the overall poor prognosis of World Health Organization Group II PH, especially HFpEF-PH.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24858070</pmid><doi>10.1016/j.cardfail.2014.05.003</doi><tpages>9</tpages></addata></record> |
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subjects | Aged Aged, 80 and over Cardiovascular Cohort Studies diastolic dysfunction Female Heart Failure - diagnostic imaging Heart Failure - mortality Humans Hypertension, Pulmonary - diagnostic imaging Hypertension, Pulmonary - mortality Left heart failure Male Middle Aged Mortality - trends Patient Readmission - trends pulmonary hypertension Stroke Volume - physiology Systole - physiology Treatment Outcome Ultrasonography World Health Organization |
title | Outcomes in World Health Organization Group II Pulmonary Hypertension: Mortality and Readmission Trends With Systolic and Preserved Ejection Fraction–Induced Pulmonary Hypertension |
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