Elderly patients diagnosed with idiopathic pulmonary arterial hypertension: Results from the COMPERA registry
Elderly patients diagnosed with idiopathic pulmonary arterial hypertension: Results from the COMPERA registry
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DOI：
10.1016/j.ijcard.2012.10.026
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发表时间：
2013-09-30
影响因子：
3.5
通讯作者：
Pittrow, David
中科院分区：
文献类型：
--
作者：
Hoeper, Marius M.;Huscher, Doerte;Pittrow, David
背景：最初报道主要发生在年轻女性，现在越来越多的老年患者被诊断为特发性肺动脉高压。我们的目的是描述这类患者的特征和他们在临床实践条件下的生存情况。方法：在6个欧洲国家的28个中心进行前瞻性登记。比较新诊断的青年(18~65岁)和老年(65岁)IPAH患者的人口学特征、临床特征、血流动力学、治疗方式和转归。结果：共有587例患者进入分析。确诊时的中位年龄(四分位数，[IQR])为71(16)岁。年轻患者(n=209；中位年龄54[16]岁)的性别比为2.3：1，而老年患者(n=378；中位年龄为75[8]岁)的性别比几乎均匀(1.2：1)。PAH药物的组合在这两个人群中都得到了广泛的应用，尽管在老年患者中使用频率较低。老年患者不太可能达到当前的治疗目标(步行6分钟；GT；400米，功能I级或II级)。老年患者诊断为IPAH后1、2和3年的生存率较低，即使调整了年龄和性别匹配的普通人群生存表后也是如此(对数等级分析p=0.006)。结论：在人口老龄化的国家，IPAH多见于老年患者。与年轻患者相比，老年患者具有平衡的性别比例和不同的临床特征，对药物治疗的反应较差，年龄调整后的死亡率较高。需要对这些患者进行进一步的定性。(C)2012爱思唯尔爱尔兰有限公司。保留所有权利。
Background: Originally reported to occur predominantly in younger women, idiopathic pulmonary arterial hypertension (IPAH) is increasingly diagnosed in elderly patients. We aimed to describe the characteristics of such patients and their survival under clinical practice conditions.Methods: Prospective registry in 28 centers in 6 European countries. Demographics, clinical characteristics, hemodynamics, treatment patterns and outcomes of younger (18-65 years) and elderly (>65 years) patients with newly diagnosed IPAH (incident cases only) were compared.Results: A total of 587 patients were eligible for analysis. The median (interquartile, [IQR]) age at diagnosis was 71 (16) years. Younger patients (n=209; median age, 54 [16] years) showed a female-to-male ratio of 2.3:1 whereas the gender ratio in elderly patients (n=378; median age, 75 [8] years) was almost even (1.2:1). Combinations of PAH drugs were widely used in both populations, albeit less frequently in older patients. Elderly patients were less likely to reach current treatment targets (6 min walking distance>400 m, functional class I or II). The survival rates 1, 2, and 3 years after the diagnosis of IPAH were lower in elderly patients, even when adjusted for age- and gender-matched survival tables of the general population (p=0.006 by log-rank analysis).Conclusions: In countries with an aging population, IPAH is now frequently diagnosed in elderly patients. Compared to younger patients, elderly patients present with a balanced gender ratio and different clinical features, respond less well to medical therapy and have a higher age- adjusted mortality. Further characterization of these patients is required. (c) 2012 Elsevier Ireland Ltd. All rights reserved.