Pulmonary Hypertension in Rural Minnesota

Abstract

<h3>Purpose</h3> Pulmonary arterial hypertension (PAH) is a progressive disease characterized by pulmonary vascular remodeling and right ventricular (RV) dysfunction. Pulmonary hypertension (PH) classification and prevalence at major urban centers is well described while natural history of rural patients (population < 20,000) with pulmonary hypertension evolves. <h3>Methods</h3> All consecutive patients at a rural outreach cardiology practice with mean pulmonary artery pressure (mPAP) ≥ 20 mmHg on right heart catheterization (RHC) were included. All patients had echocardiogram and RHC. Patients were grouped into PAH (group 1), combined pre- and post-capillary PH (group 1*), and non-group 1 PH (groups 2-5) using standard definitions. <h3>Results</h3> Of 229 patients, 56 patients had PAH, 41 patients had group 1* PH, and 132 patients had non-group 1 PH. Patients with PAH were younger compared to non-group 1 PH (69±14 vs. 73±11 years; p=0.02). Patients ≥80 at diagnosis had increased mortality at 2 years compared to patients < 80 (<b>Figure 1,</b> p=0.003). PAH patients had similar 2-year mortality to other PH groups (p=0.276). Moderate or severe left atrial enlargement on echo (OR 0.377; 95% CI: 0.195, 0.727), coronary artery disease (OR 0.52; 95% CI: 0.275, 0.982), and atrial fibrillation/flutter (OR 0.29; 95% CI: 0.149, 0.562) were predictive of non-group 1 PH. Male sex (OR 2.186, 95% CI: 1.158, 4.125) was predictive of PAH. <h3>Conclusion</h3> Group 1 and group 1* patients appear different at baseline. Age at diagnosis remains a critical factor in patient prognosis. PAH patients may have similar mortality to other PH groups. Contrary to prior literature, males were more likely to be diagnosed with PAH in this rural subset. Rural patients face different barriers to diagnosis than urban patients, and continued vigilant screening may impact patient morbidity and mortality.