Low-risk profile in pulmonary arterial hypertension patients predicts better survival

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

Literature - Kylhammar D, Kjellström B, Hjalmarsson C, et al. - Eur Heart J 2017, In press

Main results

At baseline, low-risk, intermediate-risk and high-risk corresponded to 23%, 67% and 10% of patients respectively. Age was on average lower in the low-risk group compared to intermediate (P<0.001) and high-risk (P=0.004) groups.
At follow-up, intermediate-risk and high-risk corresponded to 29%, 60% and 11% of patients respectively. Also now, age was on average lower in the low-risk group compared to intermediate (P<0.001) and high-risk groups (P<0.001).
Survival after 1, 3 and 5 years based on baseline risk groups were 99, 95 and 85% respectively for the low-risk group, 83, 67 and 52% respectively for the intermediate-risk group and 74, 51 and 35% for the high-risk group (P<0.001 for difference between risk groups).
Survival after 1, 3 and 5 years based on follow-up risk groups were 99, 97 and 92% respectively for the low-risk group, 91, 73 and 56% respectively for the intermediate-risk group and 27, 25 and 6% for the high-risk group (P<0.001 for difference between risk groups).
Survival for patients that remained in the low-risk group after 1, 3 and 5 years was 100, 98 and 89% respectively. This was 98, 96 and 96% for those who improved to low-risk. Accordingly, for those who remained in the intermediate-risk of high-risk groups survival was 90, 68 and 50% after 1, 3 and 5 years respectively and 81, 60 and 43% for those who worsened to intermediate or high-risk.
After multivariable correction (age, sex and PAH subsets), mortality risk was reduced for patients in the low-risk group at follow-up (HR 0.2, 95% CI 0.1-0.4, P<0.001).
Survival was also better for patients with a higher proportion of variables that were categorized as low-risk.

Conclusion

These results support the use of comprehensive risk assessments and goal-oriented treatment approach towards a low-risk profile, as proposed by the ESC/ERS guidelines 2015. Moreover, the fact that only 29% of patients were in the low-risk group at follow-up, urges for better treatments and treatment strategies in general. Furthermore, the risk assessment successfully discriminates patients with better or worse outcome both at baseline and at follow-up, in which determination at follow-up better predicts long-term outcome.

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