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Outcomes of pulmonary vasodilator use in Veterans with pulmonary hypertension associated with left heart disease and lung disease
- Source :
- Pulmonary Circulation, Pulmonary Circulation, Vol 11 (2021)
- Publication Year :
- 2021
- Publisher :
- Wiley, 2021.
-
Abstract
- Randomized trials of pulmonary vasodilators in pulmonary hypertension due to left heart disease (Group 2) and lung disease (Group 3) have demonstrated potential for harm. Yet these therapies are commonly used in practice. Little is known of the effects of treatment outside of clinical trials. We aimed to establish outcomes of vasodilator treatment for Groups 2/3 pulmonary hypertension in real-world practice. We conducted a retrospective cohort study of 132,552 Medicare-eligible Veterans with incident Groups 2/3 pulmonary hypertension between 2006 and 2016, and a secondary nested case–control study. Our primary outcome was a composite of death by any cause or selected acute organ failures. In our cohort analysis, we calculated adjusted risks of time to our outcome using Cox proportional hazards models with facility-specific random effects. In our case–control analysis, we used logistic mixed-effects models to estimate the effect of any past, recent, and cumulative exposure on our outcome. From our cohort study, 3249 (2.5%) Veterans were exposed to pulmonary vasodilators. Exposure to vasodilators was associated with increased risk of our primary outcome, in both Group 3 (HR: 1.58 (95% CI: 1.37–1.82)) and Group 2 (HR: 1.26 (95% CI: 1.12–1.41)) pulmonary hypertension patients. The case–control study determined odds of our outcome increased by 11% per year of exposure (OR: 1.11 (95% CI: 1.07–1.16)). Treating Groups 2/3 pulmonary hypertension with vasodilators in clinical practice is associated with increased risk of harm. This extension of trial findings to a real-world setting offers further evidence to limit use of vasodilators in Groups 2/3 pulmonary hypertension outside of clinical trials.
- Subjects :
- lcsh:RC705-779
Pulmonary and Respiratory Medicine
lcsh:Diseases of the circulatory (Cardiovascular) system
medicine.medical_specialty
Proportional hazards model
business.industry
comparative effectiveness
Cumulative Exposure
Retrospective cohort study
lcsh:Diseases of the respiratory system
Evidence-based medicine
medicine.disease
Pulmonary hypertension
law.invention
Clinical trial
Randomized controlled trial
lcsh:RC666-701
law
Internal medicine
pulmonary hypertension
medicine
Original Research Article
evidence-based medicine
business
Cohort study
Subjects
Details
- ISSN :
- 20458940
- Volume :
- 11
- Database :
- OpenAIRE
- Journal :
- Pulmonary Circulation
- Accession number :
- edsair.doi.dedup.....2d67a2b7d9a4bc2c942b81417c76c139