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
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)
Increase in Many PAH-related Comorbidities for 2001-2012
|Congestive heart failure||40.7%-56.1%||p<.001|
|Acute kidney injury||5.9%-20.1%||p<.001|
|Chronic kidney disease||1.1%-16.4%||p<.001|
|Acute respiratory failure||4.3%-20.8%||p<.001|
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
→ 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
“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