Despite High Prevalence Pulmonary Hypertension is Infrequently Coded in EHR

Abstract

Introduction Pulmonary hypertension (PH) is a highly morbid condition most commonly secondary to co-morbid heart failure or hypoxic lung disease. The finding of PH has been associated with increased mortality, hospitalizations and financial burden. While PH is commonly diagnosed by echocardiogram (ECHO), further testing and referral to specialists has been reported to be infrequent. It is unknown if early identification and management by specialists improves outcomes. Despite advances in electronic health records (EHR), prevalence studies of PH remain limited. Using EHR data, we hope to set up a program for early identification of patients with PH to determine if these patients would benefit from additional therapies. With access to a large health system's EHR database, we have the ability to make this determination. As a first step, we need to learn how frequently PH is coded and by whom. Hypothesis Despite cardiac testing indicating the presence of PH, the outpatient diagnosis of PH is infrequently used as a billing diagnosis. Methods Retrospective analysis using EHR was performed to identify all patients from Jan 2, 2016 to Dec 31, 2016 at University of Pittsburgh Medical Center who met any of the following criteria for a diagnosis of PH: ECHO with pulmonary artery systolic pressure) greater than 36 mmHg, RHC with mean pulmonary arterial pressure greater than 25 mmHg, or ICD-10 coding for PH. Demographic data from this cohort was obtained including gender, age, and past medical history as documented in EHR. Outcomes including hospitalizations and mortality were obtained. Results There were 11,369 patients seen at University of Pittsburgh Medical Center from Jan 2, 2016 to Dec 31, 2016 who met criteria for a diagnosis of PH. PH was diagnosed by ECHO in 9,684 patients (85%), RHC in 394 patients (3%), and ICD codes in 1,291 patients (11%). The population had mean average age of 71 years and was 56% female and 44% male. PH was documented in 14% of patients. Past medical history showed coronary artery disease (27%), heart failure (28%), chronic obstructive pulmonary disease (17%), and pulmonary embolism (6%). Two-year outcomes demonstrated that 64% of patients had been hospitalized and mortality was high (Table 1). Discussion PH is frequently identified but rarely coded in the EHR. PH identification is associated with high morbidity and mortality. Echocardiography seems to be the primary modality for diagnosis. This descriptive analysis provides the foundation for future observations on the impact of identification of PH and early referral to subspecialists.