Abstract 19197: Cardiopulmonary Outcomes and Disparities in Long-Term Anticoagulant Use in Secondary Pulmonary Hypertension Patients: A Nationwide Analysis

Abstract

Introduction: The use of anti-coagulation in pulmonary hypertension patients has shown to improve mortality. Our aim was to characterize patient demographics, analyze disparities and investigate the effect of long-term anti-coagulant (AC) use on outcomes in secondary pulmonary hypertension (PAH) patients. Methods: This was a retrospective cohort study using the 2019 Nationwide Inpatient Sample database to identify admissions in adults with diagnoses of secondary PAH and long-term AC use. Multivariate linear and logistic regression models were adjusted for demographic variables and comorbid conditions. Primary outcome was all-cause mortality, and secondary outcomes were outcomes of long-term AC use in secondary PAH patients and length of stay (LOS). Results: Out of 1,141,870 secondary PAH patients, 287,940 had long-term AC use. The AC-PAH cohort when compared to the Non-AC-PAH cohort had lower in-hospital mortality (3.35% vs 5.18%, p<0.001) and shorter LOS (6.04 days vs 7.03 days, p<0.001). The AC-PAH cohort had older patients (mean age 74.46 vs 69.55 years, p<0.001), more White patients (73.10% vs 64.76%, p<0.001) and fewer Black patients (15.62% vs 20.10%, p<0.001). The AC-PAH cohort when compared to the Non-AC-PAH cohort had lower odds of pulmonary embolism (PE)(OR 0.92, 95% CI 0.86-0.98, P<0.05), acute respiratory failure (RF)(OR 0.73, 95% CI 0.71-0.75, p<0.001), ventilator dependence (OR 0.46, 95% CI 0.38-0.55, p<0.001), systemic HTN (OR 0.91, 95% CI 0.83-0.99, p<0.05), cardiac arrest (OR 0.65, 95% CI 0.59-0.72, p<0.001), ischemic cardiomyopathy (OR 0.94, 95% CI 0.90-0.98, p<0.005), STEMI (OR 0.31, 95% CI 0.22-0.42, p<0.001), NSTEMI (OR 0.52, 95% CI 0.49-0.55, p<0.001) and acute ischemic stroke (OR 0.71, 95% CI 0.66-0.77, p<0.001). The AC-PAH cohort had higher odds of chronic RF (OR 1.07, 95% CI 1.02-1.12, P<0.005) and atrial fibrillation (A.Fib)(OR 2.79, 95% CI 2.72-2.86, p<0.001). Conclusion In secondary PAH patients, the long-term use of AC was associated with lower in-hospital mortality, shorter LOS and lower odds of having PE, acute RF, ventilator dependence, systemic HTN, ischemic cardiomyopathy, STEMI, NSTEMI and acute ischemic stroke. More extensive research is required in this area to investigate outcomes further.