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Survival trends in patients with chronic thromboembolic pulmonary hypertension: an observational study
Takatoyo Kiko1, Ryotaro Asano1,2, Yusuke Yoshikawa3
1Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Insights
Outcomes for chronic thromboembolic pulmonary hypertension (CTEPH) patients have significantly improved. Advances in treatment, including multimodal therapy, have led to better survival rates across different eras.
Area of Science:
- Cardiology
- Pulmonology
- Medical Outcomes Research
Background:
- Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious condition with evolving treatment landscapes.
- While treatment options have expanded, the impact on patient outcomes over time remained unclear.
Purpose of the Study:
- To evaluate temporal trends in treatment and outcomes for patients with CTEPH.
- To assess changes in all-cause mortality among CTEPH patients across different historical eras.
Main Methods:
- Retrospective analysis of 834 CTEPH patients from April 1980 to December 2023.
- Patients categorized into early, middle, and current treatment eras.
- All-cause mortality analyzed using multivariable Cox proportional hazards models.
Main Results:
- Significant increase in CTEPH therapy adoption, from 35% in the early era to 97% in the current era.
- Multimodal treatment increased from 0% to 58% over time.
- Overall survival significantly improved (log-rank p<0.001), with 5-year survival rising from 68% to 93%.
Conclusions:
- The long-term prognosis for patients with CTEPH has markedly improved in recent decades.
- Increased adoption of therapies and multimodal treatment strategies correlate with improved survival.
Background:
Treatment options for patients with chronic thromboembolic hypertension (CTEPH) have increased over the past decade. However, it is unknown whether the outcomes of patients with CTEPH have changed as well.
Methods:
This retrospective study analysed the data of 834 patients with CTEPH, categorised into early (April 1980-December 1999), middle (January 2000-September 2010) and current (October 2010-December 2023) eras. The primary end-point was all-cause mortality. Multivariable Cox proportional hazards models were used to assess changes in all-cause mortality after adjusting for confounding variables.
Results:
95, 210 and 529 patients were from the early, middle and current eras, respectively. The proportion of patients who did not receive CTEPH therapy decreased from 65% in the early era to 36% and 3% in the middle and current eras, respectively. Meanwhile, the adoption of multimodal treatment increased from 0% to 58% over time. The Kaplan-Meier analysis revealed significant improvements in overall survival (log-rank p<0.001). The 5-year survival rates improved from 68% in the early era to 85% and 93% in the middle and current eras, respectively. The adjusted hazard ratios for mortality were 0.291 (95% CI 0.154-0.550; p<0.001) for the early versus middle era, 0.447 (95% CI 0.249-0.804; p=0.007) for the middle versus current era and 0.130 (95% CI 0.067-0.254; p<0.001) for the early versus current era.
Conclusion:
The long-term prognosis of patients with CTEPH has significantly improved in recent decades.
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