Pulmonary hypertension associated with left heart disease among hospitalized patients: analysis of the Nationwide Inpatient Sample

Abstract

Abstract Background Pulmonary hypertension associated with left heart disease (PH-LHD) is the most prevalent PH class, however its prevalence ranges significantly across studies. Purpose To investigate the prevalence and prognostic influence of PH-LHD in a large nationwide sample. Methods Using the US Nationwide Inpatient Sample we calculated the prevalence of secondary PH across heart failure (HF) subtypes, cardiomyopathies, aortic, and mitral valve disease in hospitalized patients in 2018. In this context, we used logistic regression to assess the impact of PH on LHD, as well as to find significant contributors to in-hospital mortality in the PH-LHD population. Results Among 6,270,625 hospitalizations of patients with LHD, 801,535 were diagnosed with PH-LHD (12.8%). Prevalence of PH-LHD was 17.2% in HF with preserved ejection fraction (HFpEF) and 11.8% in HF with reduced ejection fraction (HFrEF). It was 16.8% in dilated cardiomyopathy, 12.6% in hypertrophic cardiomyopathy, 18.7% in mitral regurgitation, 28.5% in mitral stenosis, 13.5% in aortic stenosis, and 13.9% in aortic regurgitation hospitalizations (Figure 1). PH was associated with increased in-hospital mortality (reported odds ratios [OR] with corresponding 95% confidence intervals [CI]) in HFpEF (1.23; 1.17-1.28), hypertrophic cardiomyopathy (1.42; 1.06-1.89), mitral regurgitation (1.17; 1.07-1.28), and aortic stenosis (1.14; 1.04-1.26), but not in HFrEF (1.04; 0.99-1.10), or dilated cardiomyopathy (1.13; 0.99-1.29). Among patients with PH-LHD, significant predictors of all-cause in-hospital mortality included age, atrial fibrillation/flutter, cancer, and acute cardiac (acute right HF, myocardial infarction, ventricular arrhythmia), or extra-cardiac (stroke, sepsis, pneumonia, acute renal failure, venous thromboembolism) diagnoses (Figure 2). Conclusion In a nationwide analysis of hospitalized patients due to LHD the prevalence of PH was lower than previously reported indicating reduced recognition of this disease in real world clinical practice. The diagnosis of PH-LHD was associated with worse fatality rates across most forms of LHD. The findings should be further explored in future prospective studies.Figure 1Figure 2