PAH-related Hospitalizations: Trends, Outcomes 2001-2012

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

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