Elderly patients diagnosed with idiopathic pulmonary arterial hypertension: Results from the COMPERA registry

• Published in: International journal of cardiology Vol. 168; no. 2; pp. 871 - 880
• Main Authors: Hoeper, Marius M, Huscher, Doerte, Ghofrani, H. Ardeschir, Delcroix, Marion, Distler, Oliver, Schweiger, Christian, Grunig, Ekkehard, Staehler, Gerd, Rosenkranz, Stephan, Halank, Michael, Held, Matthias, Grohé, Christian, Lange, Tobias J, Behr, Juergen, Klose, Hans, Wilkens, Heinrike, Filusch, Arthur, Germann, Martin, Ewert, Ralf, Seyfarth, Hans-Juergen, Olsson, Karen M, Opitz, Christian F, Gaine, Sean P, Vizza, C. Dario, Vonk-Noordegraaf, Anton, Kaemmerer, Harald, Gibbs, J. Simon R, Pittrow, David
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 30.09.2013; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Elderly; Familial Primary Pulmonary Hypertension; Female; Heart; Hemodynamics; Humans; Hypertension; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - mortality; Male; Medical sciences; Middle Aged; Pneumology; Prospective Studies; Pulmonary; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Registries; Survival; Survival Rate - trends; Hypertension; Hemodynamics; Elderly; Survival; Pulmonary; Human; Prognosis; Respiratory disease; Lung; Idiopathic; Cardiovascular disease; Respiratory system; Artery; Pulmonary hypertension; Result; Register; Blood vessel; Circulatory system; Diagnosis; Cardiology
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2012.10.026

Abstract Background Originally reported to occur predominantly in younger women, idiopathic pulmonary arterial hypertension (IPAH) is increasingly diagnosed in elderly patients. We aimed to describe the characteristics of such patients and their survival under clinical practice conditions. Methods Prospective registry in 28 centers in 6 European countries. Demographics, clinical characteristics, hemodynamics, treatment patterns and outcomes of younger (18–65 years) and elderly (> 65 years) patients with newly diagnosed IPAH (incident cases only) were compared. Results A total of 587 patients were eligible for analysis. The median (interquartile, [IQR]) age at diagnosis was 71 (16) years. Younger patients (n = 209; median age, 54 [16] years) showed a female-to-male ratio of 2.3:1 whereas the gender ratio in elderly patients (n = 378; median age, 75 [8] years) was almost even (1.2:1). Combinations of PAH drugs were widely used in both populations, albeit less frequently in older patients. Elderly patients were less likely to reach current treatment targets (6 min walking distance > 400 m, functional class I or II). The survival rates 1, 2, and 3 years after the diagnosis of IPAH were lower in elderly patients, even when adjusted for age- and gender-matched survival tables of the general population (p = 0.006 by log-rank analysis). Conclusions In countries with an aging population, IPAH is now frequently diagnosed in elderly patients. Compared to younger patients, elderly patients present with a balanced gender ratio and different clinical features, respond less well to medical therapy and have a higher age-adjusted mortality. Further characterization of these patients is required. Clinical trials registration: NCT01347216.