Right heart failure causes most hospitalizations in pulmonary arterial hypertension

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The most common cause of intensive care unit (ICU) admission amongst patients with pulmonary arterial hypertension (PAH) is right heart failure, according to a study. Despite recent improvements in ICU care, 1-year mortality for patients with PAH remains high.

Data from 102 adult patients with PAH with 155 consecutive ICU hospitalizations were analyzed.

Right heart failure accounted for 53.3% of admissions, followed by infection (17.4%) and arrhythmia (11.0%). Overall, ICU mortality was 27.1%.

Mortality risk factors included:
-Na <136 mEq·mL-1
-Elevated pro-B-type natriuretic peptide
-Need for vasopressors/inotropes, mechanical ventilation, and renal replacement therapy.

At 3 months, 6 months, and 12 months, the mortality rates were 17.5%, 27.6%, and 39%, respectively.

The 1-year survival for patients with connective tissue disease-associated PAH is 51.4% compared with 79.8% in patients with idiopathic PAH.

“In-hospital and 1-year mortality remain exceedingly high despite improved ICU care,” the authors concluded. “Recognizing specific risk factors on admission can help identify patients at risk for poor outcomes.”

Naranjo M, Mercurio V, Hassan H, et al. Causes and outcomes of ICU hospitalisations in patients with pulmonary arterial hypertension. ERJ Open Res. 2022 May 16;8(2):00002-2022. doi: 10.1183/23120541.00002-2022. PMID: 35586454; PMCID: PMC9108967.