PAH-related Hospitalizations: Trends, Outcomes 2001-2012

November 30, 2016

The first study using a national inpatient database finds PAH-related costs, comorbidities are increasing.

Hospitalizations for pulmonary arterial hypertension (PAH) are associated with increased rates of subsequent inpatient care and with decreased 3-year survival.1 Care for these patients is a significant financial burden on the healthcare system.2 Research to date on trends in and outcomes of PAH-related hospitalization have been small, single-center studies. Following is an overview of a recent study3 that analyzed a national database for all adult patients (≥18 years old) with PAH as the principal discharge diagnosis from January 1, 2001, through December 31, 2012. 

Nationally-Representative Study of Trends in PAH-Hospitalization

The study included adults with a discharge diagnosis of PAH

Covered period from January 2001 to December 2012

Used data from the National Inpatient Sample (NIS) database to examine time trends for hospitalization rates, hospital charges, inpatient mortality, length of hospitalizations, and comorbidities relate to PAH-related hospitalizations

Rates go down, costs go up>>

 

Decreased Rates, Increased Charges for 2001-2012

PAH-related hospitalizations per year decreased by 58%  (3177 vs 1345, p<.001 for trend)

75% were women

About 30% were 45-64 years, with a trend toward an increase in admissions for older patients aged 65-84 years

Mean hospital charge per admission increased by 2.7 fold ($29,507 vs $79,607, p <.001 for trend)

Medicare was the largest payer, followed by private insurance and then Medicaid

Hospitalziations paid for by Medicare significantly increased from 39.8% to 49.4% (p <.001 for trend)

PAH-related hospitalizations paid for by pricate insurance signicaintly decreased from 38% to 24.9% (p <.001 for trend)

Rise in comorbidites over time>>

 

Increase in Many PAH-related Comorbidities for 2001-2012

ComorbidityIncreasep value
Diabetes 4.6%-7.8%p=0.01
Hypertension5.1%-17.1%p<.001
CAD15.6%-22.3%p=0.002
COPD14.4%-20.1%p=0.003
Anemia12.4%-20.4%p<.001
Cardiac dysrhythmias21.7%-29.0%p<.001
Congestive heart failure  40.7%-56.1%p<.001
Acute kidney injury5.9%-20.1%p<.001
Chronic kidney disease1.1%-16.4%p<.001
Fluid/electrolyte imbalance18.9%-35.3%p<.001
Pneumonia 4.4%-6.3%p=0.007
Cardiogenic shock0.5%-1.5%p<.001
Acute respiratory failure 4.3%-20.8%p<.001

Morbidity ratchets up, mortality unchanged>>

 

Longer Stays, Unchanged Mortality Rates, 2001-2012

Increased length of hospitalization: mean 7.0 days vs 7.6 days in 2012 (p for trend = .009)

Unchanged Inpatient mortality: 7.8% vs 6.3% (p for trend = .54)

Factors related to increased length of stay and hospital mortality: Admission to a teaching hospital, cardiac dysrhythmias, acute kidney injury, acute cerebrovascular accident, and acute respiratory failure

Factors related to increased hospital mortality but not length of stay: Congestive heart failure, cardiogenic shock, and fluid and electrolyte imbalance

Conclusions

The decrease in PAH-related hospitalizations is probably related to improved outpatient management

Increased hospital charges may be related to admission of sicker patients with more comorbidities, or increased inpatient use of expensive PAH-specific vasodilators

Authors' comment, take-home points

 

Authors' comments

“These data highlight the increasing clinical and economic burden of PAH-related hospitalizations and should help identify patients with PAH who are at increased risk of prolonged hospitalization and in-hospital mortality.”

-- First author Bidhu Anand, MD, of the University of Minnesota School of Medicine (Minneapolis, MN), and colleagues.

Take Home Points

Nationally representative study found significantly decreased PAH-related hospitalizations, and significant increased hospital charges for 2001-2012.

Medicare bore a large brunt of the burden for increased hospital charges

Many PAH-related comorbidities increased from 2001-2012

PAH-related hospitalizations increased, while inpatient mortality remained unchanged from 2001-2012