The Impact of Cardiopulmonary Comorbidities on the Economic Burden and Mortality of Pulmonary Arterial Hypertension in the United States

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Abstract Rationale Pulmonary arterial hypertension (PAH) is a rare form of pulmonary hypertension (PH). The 2022 ESC (European Society of Cardiology)/ERS (European Respiratory Society) guidelines recommend special treatment considerations for patients with cardiopulmonary comorbidities (CPCs): hypertension, obesity, coronary heart disease, and diabetes. The understanding of CPCs in PAH in the United States (US) is limited. This analysis assessed the impact of CPCs on healthcare resource utilization (HCRU) among patients diagnosed with PAH in the US. Methods This retrospective cohort study utilized electronic medical records data from TriNetX, with linkage to claims data from PurpleLabs for a subset of patients. Newly-diagnosed adult (18+) PAH patients were identified through having a new prescription of a PAH-targeted medication after a PAH diagnosis between 1/1/2015-12/1/2023. The index date was the date of the first qualifying prescription. Patients were required to have a right heart catheterization within six months prior to index date and no evidence of Group 2-5 PH between 1/1/2014-12/1/2023. Patients were followed from index date until the earliest of increase in number of CPCs, change in treatment, end of data availability, or death. Outcomes included all-cause HCRU by setting of care and all-cause mortality. A cost analysis is also underwayfor patients with linked claims. Results were stratified by number of CPCs measured in the 12 months prior to index date. Analyses were descriptive only; outcomes were assessed on a person-month basis. Results The sample consisted of 874 patients, and over 60% had at least one CPC. Length of follow-up was similar across patient groups. Patients with more CPCs were older, more likely to be on monotherapy and greater chance of being male. The rate of all-cause HCRU and outpatient visits was highest in patients with 3+ CPCs. However, the average length of hospitalization was shorter among patients with 3+ CPCs. The all-cause mortality rate overall was 1.9 per 100 person-month, and the rates were higher in patients with a higher number of CPCs. Conclusions This study found that over two thirds of patients diagnosed with PAH in the US have CPCs. Patients with more CPCs faced a higher burden of HCRU and mortality. The burden of HCRU and mortality increased with a higher number of CPCs, highlighting the need for multidisciplinary care to optimize outcomes.

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