Top End Pulmonary Hypertension Study: Understanding Epidemiology, Therapeutic Gaps and Prognosis in Remote Australian Setting.

Autor: Naing P; Royal Darwin Hospital, Darwin, NT, Australia; University of Notre Dame, Fremantale, WA, Australia; Flinders University, Adelaide, SA, Australia; The Prince Charles Hospital, Brisbane, Qld, Australia. Electronic address: kopyinaing@gmail.com., Playford D; University of Notre Dame, Fremantale, WA, Australia., Strange G; University of Notre Dame, Fremantale, WA, Australia., Abeyaratne A; Royal Darwin Hospital, Darwin, NT, Australia; Menzies School of Health Research, Darwin, NT, Australia., Berhane T; Royal Darwin Hospital, Darwin, NT, Australia., Joseph S; Royal Darwin Hospital, Darwin, NT, Australia., Costelloe E; Royal Darwin Hospital, Darwin, NT, Australia., Hall M; Royal Darwin Hospital, Darwin, NT, Australia., Scalia GM; University of Queensland, Brisbane, Qld, Australia; The Prince Charles Hospital, Brisbane, Qld, Australia., Forrester DL; Royal Darwin Hospital, Darwin, NT, Australia; University of Queensland, Brisbane, Qld, Australia; The Prince Charles Hospital, Brisbane, Qld, Australia., Falhammar H; Royal Darwin Hospital, Darwin, NT, Australia; Menzies School of Health Research, Darwin, NT, Australia; Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden., Kangaharan N; Royal Darwin Hospital, Darwin, NT, Australia; Flinders University, Adelaide, SA, Australia; Northern Territory Cardiac, Darwin, NT, Australia; Menzies School of Health Research, Darwin, NT, Australia.
Jazyk: angličtina
Zdroj: Heart, lung & circulation [Heart Lung Circ] 2021 Apr; Vol. 30 (4), pp. 507-515. Date of Electronic Publication: 2020 Sep 19.
DOI: 10.1016/j.hlc.2020.08.008
Abstrakt: Introduction: The Top End of Australia has a high proportion of Indigenous people with a high burden of chronic cardiac and pulmonary diseases likely to contribute to pulmonary hypertension (PH). The epidemiology of PH has not been previously studied in this region.
Methods: Patients with PH were identified from the Northern Territory echocardiography database from January 2010 to December 2015 and followed to the end of 2019 or death. Pulmonary hypertension was defined as a tricuspid regurgitation velocity ≥2.75 m/s measured by Doppler echocardiography. The aetiology of PH, as categorised by published guidelines, was determined by reviewing electronic health records.
Results: 1,764 patients were identified comprising 49% males and 45% Indigenous people. The prevalence of PH was 955 per 100,000 population (with corresponding prevalence of 1,587 for Indigenous people). Hypertension, atrial fibrillation, diabetes and respiratory disease were present in 85%, 45%, 41% and 39%, respectively. Left heart disease was the leading cause for PH (58%), the majority suffering from valvular disease (predominantly rheumatic). Pulmonary arterial hypertension (PAH), respiratory disease related PH, chronic thromboembolic PH (CTEPH) and unclear multifactorial PH represented 4%, 16%, 2% and 3%, respectively. Underlying causes were not identifiable in 17% of the patients. Only 31% of potentially eligible patients were on PAH-specific therapy. At census, there was 40% mortality, with major predictors being age, estimated pulmonary artery systolic pressure (ePASP) and Indigenous ethnicity.
Conclusion: Pulmonary hypertension is prevalent in Northern Australia, with a high frequency of modifiable risk factors and other treatable conditions. Whether earlier diagnosis, interpretation and intervention improve outcomes merits further assessment.
(Copyright © 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.)
Databáze: MEDLINE
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