Europe PMC

This website requires cookies, and the limited processing of your personal data in order to function. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy.

A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension.

Author information

Affiliations

  • 1. Department of Clinical Sciences Lund, Cardiology, Lund University, and The Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden.
      Authors
    • Kylhammar D 1
    • Rådegran G 1
    (2 authors)
  • 2. Cardiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
      Authors
    • Kjellström B 2
    (1 author)
  • 3. Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden.
      Authors
    • Hjalmarsson C 3
    (1 author)
  • 4. Departments of Cardiology and Clinical Physiology, Institution of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
      Authors
    • Jansson K 4
    (1 author)
  • 5. Department of Medicine Solna, Karolinska Institute, and The Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
      Authors
    • Nisell M 5
    (1 author)
    • Show all (7)

ORCIDs linked to this article

European Heart Journal, 01 Dec 2018, 39(47):4175-4181
https://doi.org/10.1093/eurheartj/ehx257 PMID: 28575277 

A comment on this article appears in "Validation of a risk assessment instrument for pulmonary arterial hypertension." Eur Heart J. 2018 Dec 14;39(47):4182-4185. A comment on this article appears in "Assessing risk in pulmonary arterial hypertension: what we know, what we don't." Eur Respir J. 2017 Aug 3;50(2):.

Abstract 

Aims

Guidelines recommend a goal-oriented treatment approach in pulmonary arterial hypertension (PAH). The aim is to reach a low-risk profile, as determined by a risk assessment instrument. This strategy is incompletely validated. We aimed to investigate the bearing of such risk assessment and the benefit of reaching a low-risk profile.

Methods and results

Five hundred and thirty PAH patients were included. Follow-up assessments performed after a median of 4 (interquartile range 3-5) months were available for 383 subjects. Patients were classified as 'Low', 'Intermediate', or 'High risk' and the benefit of reaching the 'Low risk' group was estimated. Survival differed (P < 0.001) between the risk groups at baseline and at follow-up. Survival was similar for patients who remained in or improved to the 'Low risk' group. Survival was similar for patients who remained in or worsened to the 'Intermediate risk' or 'High risk' groups. Irrespective of follow-up risk group, survival was better (P < 0.001) for patients with a higher proportion of variables at low risk. Results were unchanged after excluding patients with idiopathic PAH >65 years at diagnosis, and when patients with idiopathic or connective tissue disease-associated PAH were analysed separately. Patients in the 'Low risk' group at follow-up exhibited a reduced mortality risk (hazard ratio 0.2, 95% confidence interval 0.1-0.4 in multivariable analysis adjusted for age, sex and PAH subset), as compared to patients in the 'Intermediate risk' or 'High risk' groups.

Conclusion

These findings suggest that comprehensive risk assessments and the aim of reaching a low-risk profile are valid in PAH.

Full text links 

Read article at publisher's site: https://doi.org/10.1093/eurheartj/ehx257

References 

Articles referenced by this article (21)

Show 10 more references (10 of 21)

Citations & impact 

Impact metrics

227
Citations
Jump to Citations

Citations of article over time

Alternative metrics

Altmetric item for https://www.altmetric.com/details/21100902
Altmetric
Discover the attention surrounding your research
https://www.altmetric.com/details/21100902

Smart citations by scite.ai
Smart citations by scite.ai include citation statements extracted from the full text of the citing article. The number of the statements may be higher than the number of citations provided by EuropePMC if one paper cites another multiple times or lower if scite has not yet processed some of the citing articles.
Explore citation contexts and check if this article has been supported or disputed.
https://scite.ai/reports/10.1093/eurheartj/ehx257

Supporting
Mentioning
Contrasting
34
483
6

Article citations

Go to all (227) article citations

Similar Articles 

To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.

Funding 

Funders who supported this work.

Bayer Health Care

    Swedish Association of Local Authorities and Regions