Patients With PAH Fared Well During the COVID-19 Pandemic

The COVID-19 pandemic had little effect on patients with pulmonary arterial hypertension (PAH) enrolled in the Pulmonary Hypertension Association Registry (PHAR), according to new research published in Pulmonary Circulation.

Data show that these patients visited the emergency department less, spent fewer nights in the hospital, and demonstrated improvement in objective health outcomes during the global health emergency compared with the time prior.

However, “irrespective of the COVID-19 pandemic, patients who were on publicly sponsored insurance seemed to do worse, consistent with a previous study demonstrating the impact of social determinants of health,” researchers wrote.

They hypothesized established care relationships in pulmonary hypertension comprehensive care centers may have mitigated COVID-19’s impact on patients.

Their retrospective cohort study included information of health insurance status, health care access, disease severity, and patient-reported outcomes. Data were collected from the time of PHAR’s inception in 2015 until March 2022. PHAR “is a multicenter, prospective registry that has enrolled over 2000 patients from over 60 centers across the [United States] to date,” the authors wrote.

The social issues that came alongside the COVID-19 pandemic resulted in changes in employment and insurance status for many individuals, they added.These factors may have limited patients’ access to care.

A total of 1679 patients with 6137 visits were included in the final analysis. Of these, 3255 were considered “prepandemic visits” as they occurred before March 13, 2020. Most patients were female and White, while mean (SD) age at the time of first visit was 55.2 (16.0) years.

In addition, “the majority had either idiopathic PAH or connected tissue disease–associated PAH and were classified under the [World Health Organization] Functional Classification (FC) as either FC III (49%) or FC II (36%),” the authors said.

Analyses revealed:

• Patients with PAH were more likely to be on publicly sponsored insurance during the COVID-19 pandemic compared with before the pandemic
• Throughout the pandemic, these patients did not experience statistically significant delays in access to medications, increased emergency department visits or nights in the hospital, or worsening of mental health metrics
• Patients on publicly sponsored insurance had higher health care utilization and worse objective measures of disease severity vs privately insured individuals, irrespective of the COVID-19 pandemic
• The relatively small impact of the COVID-19 pandemic on pulmonary hypertension­–related outcomes was unexpected but may be due to pre-established access to high quality care at pulmonary hypertension comprehensive care centers

The researchers note the finding that individuals on publicly sponsored insurance tended to do worse overall was consistent with prior studies.

“Unexpectedly, we found that some objective measures of pulmonary hypertension disease severity actually improved during the COVID-19 pandemic,” they added.

Factors that improved included longer 6-minute walk distances, lower NT-proBNP values and improved mental health scores. Although the researchers do not know the exact mechanisms behind these improvements, one possible explanation could be that the pandemic allowed patients more time to focus on their health.

Patients with PAH also reported feeling more calm and peaceful, having more energy and fewer feelings of downheartedness and depression, the results showed.

Referral bias may have been present in PHAR enrollment, marking a limitation to the study. Data are also subject to recall bias.

After controlling for demographics, the researchers did not find evidence that subjective evaluations of health worsened during the pandemic, although this may have been due to the consequences of patient death and dropout during the crisis.

“Likewise, for those patients who died, we were not able to correlate any objective data from visits and therefore cannot make inferences about disease severity and death,” they wrote.

Reference

Mayer M, Badesch DB, Nielsen KH, et al. Impact of the COVID-19 pandemic on chronic disease management and patient reported outcomes in patients with pulmonary hypertension: the Pulmonary Hypertension Association Registry. Pulm Circ. Published online April 18, 2023. doi:10.1002/pul2.12233