Patients With PAH Have Similar Incidence of COVID-19, but Potentially Worse Outcomes

Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension had similar incidence of COVID-19, but the impact on clinical operations at the centers that treat these patients was substantial.

Although the incidence of COVID-19 in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) is similar to the general population, their outcomes may be worse, according to the results of a survey published in Annals of the American Thoracic Society. In addition, the centers that treat these patients reported substantial impacts on clinical operations that may have impacted patients more than the pandemic itself.

Patients with PAH and CTEPH typically have frequent clinic visits and outpatient testing and procedures; however, the onset of the COVID-19 pandemic resulted in many institutions halting nonurgent visits and testing. As a result, “patients with PAH or CTEPH are likely to be particularly affected by the current pandemic,” the authors explained.

They conducted a cross-sectional survey of program directors at accredited pulmonary hypertension referral centers. The online survey was delivered on April 17, 2020; designed to take 5 to 10 minutes; and only active for 1 week. A follow-up survey on the outcomes of patients with COVID-19 from the first survey was conducted from April 27 to May 1, 2020.

The survey garnered 58 responses from 30 states. The cumulative incidence of COVID-19 in patients with PAH or CTEPH was approximately 2.9 cases per 1000 patients, which was similar to the CDC population estimate of 2.4 cases per 1000 for the entire United States. The researchers found that in states with a high population burden of COVID-19, the cumulative incidence of recognized COVID-19 in patients with PAH or CTEPH was higher than in states with a low burden.

However, the authors noted that the finding of incidence may be “cautiously reassuring” and that the similarity should not be overinterpreted. The survey results focused on “recognized” COVID-19, and they explained that a lack of widespread testing and incomplete awareness by center directors may have underestimated the overall burden among patients with PAH and CTEPH.

The outcomes for patients with PAH or CTEPH appear to have been worse than the broader population. Nearly three-fourths of hospitalized patients in the survey required intensive care compared with 14% of hospitalized patients in New York.

Despite the relatively small percentage of patients with COVID-19, the authors found a substantial impact on clinical operations at the centers. Within the 2 months of the start of the pandemic, 45% of the centers had reduced overall staffing, 85% reduced in-person staffing during clinic, and more than 80% reported they were obtaining fewer echocardiograms, right heart catheterizations, and ventilation-perfusion scans. More than 80% said they had a decline in visits as a result of a hospital or health system mandate, but more than 60% also said that declining visits was the result of fears that the patient would acquire COVID-19.

“Whether these impacts will ultimately affect outcomes is unknown, but at this time, these indirect impacts of the pandemic affect a significantly higher proportion of patients with PAH or CTEPH than the infection itself,” the authors concluded.

Reference

Lee JD, Burger CD, Delossantos GB, et al. A survey-based estimate of COVID-19 incidence and outcomes among patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension and impact on the process of care. Ann Am Thorac Soc. 2020;17(12):1576-1582. doi:10.1513/AnnalsATS.202005-521OC