1. Clinical Differences and Outcomes between Methamphetamine-associated and Idiopathic Pulmonary Arterial Hypertension in the Pulmonary Hypertension Association Registry.
- Author
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Kolaitis, Nicholas A, Zamanian, Roham T, de Jesus Perez, Vinicio A, Badesch, David B, Benza, Raymond L, Burger, Charles D, Chakinala, Murali M, Elwing, Jean M, Feldman, Jeremy, Lammi, Matthew R, Mathai, Stephen C, McConnell, John W, Presberg, Kenneth W, Robinson, Jeffrey C, Sager, Jeffrey, Shlobin, Oksana A, Simon, Marc A, Kawut, Steven M, Glidden, David V, Singer, Jonathan P, and De Marco, Teresa
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Lung ,Clinical Research ,Methamphetamine ,Health Services ,Cardiovascular ,Good Health and Well Being ,Familial Primary Pulmonary Hypertension ,Humans ,Hypertension ,Pulmonary ,Prospective Studies ,Quality of Life ,Registries ,United States ,Pulmonary Hypertension Association Registry ,methamphetamine-associated pulmonary arterial hypertension ,idiopathic pulmonary arterial hypertension ,health-related quality of life ,drug- and toxin-induced pulmonary arterial hypertension ,Pulmonary Hypertension Association Registry Investigators ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
Rationale: Single-center studies demonstrated that methamphetamine use is associated with pulmonary arterial hypertension (Meth-APAH). We used the Pulmonary Hypertension Association Registry to evaluate the national distribution of Meth-APAH and to compare its impact on patient-reported and clinical outcomes relative to idiopathic PAH.Objectives: To determine if patients with Meth-APAH differ from those with idiopathic PAH in demographics, regional distribution in the United States, hemodynamics, health-related quality of life, PAH-specific treatment, and health care use.Methods: The Pulmonary Hypertension Association Registry is a U.S.-based prospective cohort of patients new to care at a Pulmonary Hypertension Care Center. The registry collects baseline demographics, clinical parameters, and repeated measures of health-related quality of life, World Health Organization functional class, 6-minute walk distance, therapy, and health care use. Repeated measures of functional class, health-related quality of life, type of therapy, emergency department visits, and hospitalizations were compared using generalized estimating equations.Results: Of 541 participants included, 118 had Meth-APAH; 83% of Meth-APAH arose in the western United States. The Meth-APAH group was younger and had a poorer socioeconomic status and lower cardiac index than the idiopathic PAH group, despite no difference in mean pulmonary artery pressure or pulmonary vascular resistance. The Meth-APAH group had a more advanced functional class in longitudinal models (0.22 points greater; 95% confidence interval [CI], 0.07 to 0.37) and worse PAH-specific (emPHasis-10) health-related quality of life (-5.4; 95% CI, -8.1 to -2.8). There was no difference in dual combination therapy; however, participants with Meth-APAH were less likely to be initiated on triple therapy (odds ratio [OR], 0.43; 95% CI, 0.24 to 0.77) or parenteral therapy (OR, 0.10; 95% CI, 0.04 to 0.24). Participants with Meth-APAH were more likely to seek care in the emergency department (incidence rate ratio, 2.30; 95% CI, 1.71 to 3.11) and more likely to be hospitalized (incidence rate ratio, 1.42; 95% CI, 1.10 to 1.83).Conclusions: Meth-APAH represents a unique clinical phenotype of PAH, most common in the western United States. It accounts for a notable proportion of PAH in expert centers. Assessment for methamphetamine use is necessary in patients with PAH.
- Published
- 2021