05 August 2022

This week in PVD

How much do physicians know about SDOH in their patients with PAH?

Clinicians interviewed in a recent study reported various social determinants of health (SDOH) affecting health outcomes for patients with pulmonary arterial hypertension (PAH), indicating the need to address SDOH in PAH care.

Adding a social worker to clinical staff in specialized pulmonary hypertension centers and integrating screening for social determinants of health (SDOH) to support patient care and improve outcomes was viewed positively by pulmonologists and cardiologists, according to results of a recent survey.

Writing in Pulmonary Circulation, researchers aimed to investigate their perspectives on how (SDOH) impacts patients with pulmonary arterial hypertension (PAH). SDOH are the conditions of a patient’s environment that affect their health risks and outcomes.

Participants in the study reported that various SDoH impacted patient health and expressed support for the implementation of SDoH screening and social workers to optimize care for patients with PAH.

Study gauges long-term survival for PAH patients on opsumit

More than half of people with pulmonary arterial hypertension (PAH) who start daily treatment with oral Opsumit (macitentan) are expected to still be alive after nine years on the therapy, according to a new analysis of data from the SERAPHIN clinical trial and its open-label extension.

“These analyses provide important clinical insights into the long-term safety and tolerability for PAH patients receiving [Opsumit] 10 mg, with a follow-up period of up to 9 years,” its researchers wrote.

The team noted that this analysis “provides the longest follow-up for safety and survival published to date for any PAH therapy.”

The study, “Long-Term Safety, Tolerability and Survival in Patients with Pulmonary Arterial Hypertension Treated with Macitentan: Results from the SERAPHIN Open-Label Extension,” was published in the journal Advances in Therapy. The work was funded by Opsumit’s developer, Actelion Pharmaceuticals, a Janssen Pharmaceutical Company of Johnson & Johnson.

Tailored metered-dose inhaler education improves technique for patients with asthma, COPD

Tailored metered-dose inhaler education was more effective compared with brief intervention for improving asthma patients’ inhaler techniques, but those with low health literacy may benefit less, researchers reported in Respiratory Medicine.

“Currently, the United States is experiencing growth in its geriatric population, which includes a growing population at-risk for COPD and/or asthma. Unfortunately, inferior asthma outcomes are evident amongst older patients as they experience more asthma-related urgent care than middle-aged or younger adults,” Kristin C. Trela, MD, anesthesiologist in the department of anesthesiology and critical care at the University of Chicago Medicine, and colleagues wrote. “Additionally, inhaler misuse is among one of the most significant self-management issues for both asthma and COPD disease control among older patients.”

Prenatal echocardiograms may help predict PH in newborns

When done during pregnancy, an echocardiogram — a noninvasive measurement of heart function that uses sound waves — may help doctors predict pulmonary hypertension in newborns, a study in China suggests.

An echocardiogram can show how well the heart’s right ventricle, one of its bottom pumping chambers, will push blood through to the lungs without becoming too stressed. According to researchers, prenatal echocardiogram results strongly predicted the likelihood of a baby being diagnosed with persistent pulmonary hypertension of the newborn (PPHN) after birth.

The study, “Perinatal changes of right ventricle-pulmonary artery coupling and its value in predicting persistent pulmonary hypertension of the newborn,” was published in the journal Clinical Physiology and Functional Imaging.

Risk assessment in SLE-associated PAH holds significant prognostic value

Researchers discovered that risk assessment in patients with pulmonary arterial hypertension (PAH) associated with systemic lupus erythematosus (SLE) has significant prognostic value, according to a study published in SAGE Journals. 

PAH is a potentially deadly complication of SLE, being 1 of the top 3 causes of death in patients with SLE. SLE has surpassed Sjorgen’s syndrome and systemic sclerosis as the main connective tissue disease (CTD) associated with PAH. However, risk assessment has not been thoroughly characterized in SLE-associated PAH. 

Studies have demonstrated that a multidimensional risk stratification system for PAH holds prognostic value. In SLE, inflammation is a major driver of PAH; the authors of the study hence proposed that any risk assessment of SLE-associated PAH should include serositis as an inflammation indicator.

Smaller airway structures may increase risk for COPD in women

Smaller airway structures among women were associated with increased risk for chronic lung diseases including COPD, according to secondary analyses of the COPDGene cohort published in Radiology.

“The prevalence of COPD in women is fast approaching that seen in men, and airway disease may underlie some of the high COPD numbers in women that we are seeing,” Surya P. Bhatt, MD, MSPH, associate professor of medicine in the division of pulmonary, allergy and critical care medicine at the University of Alabama Lung Imaging Lab and Lung Health Center in Birmingham, said in a related press release. “When airways narrow due to cigarette smoking, the impact on symptoms and survival is greater in women than in men.”

Could L-carnitine supplementation become a treatment approach for PAH?

L-carnitine supplementation improves right ventricular contractility by increasing fatty acid oxidation and reducing lipid accumulation, according to a new study published in the journal Pulmonary Circulation.

Based on this finding, the authors concluded that correcting carnitine deficiency by L-carnitine supplementation could reverse right ventricular failure in pulmonary arterial hypertension (PAH).

Right ventricular failure, the main cause of death in patients with PAH, is, in part, the result of reduced fatty acid oxidation and lipid accumulation that is toxic to cells. The authors of the present study hypothesized that this could be driven, at least in part, by a relative carnitine deficiency.

Symptomatic undiagnosed COPD and asthma: Disease burden and quality of life

Canadian adults experiencing breathing problems often have undiagnosed chronic obstructive pulmonary disease (COPD) or asthma, which manifested as an increased burden of respiratory symptoms and worse health-related quality of life. These were among study findings published in Respiratory Medicine.

The effects of living with undiagnosed asthma or COPD — with respect to quality of life and mortality — is unknown. Investigators sought to examine the symptom burden, quality of life, and utilization of health care among individuals with self-reported respiratory issues that were subsequently identified as undiagnosed airflow obstruction. The researchers also compared these individuals with others who had self-reported respiratory symptoms but who were not deemed to have undiagnosed airflow obstruction.

Social determinants of health correlate with composite PAH patient outcomes

Social determinants of health (SDOH) data compiled from the Pulmonary Hypertension Association Registry (PHAR) were used to create a model that correlated with composite outcomes in patients with pulmonary arterial hypertension (PAH). The model, called the PHAR Evaluation, was discussed in an article published in Pulmonary Circulation.

The model was able to yield a c-statistic of 0.608 (95% CI, 0.583-0.632), which was significant compared to a random-chance model (P <.001), to predict an event during the next 6-month interval for patients. 

“The derivation of a model utilizing SDOH and their interactions to predict an important patient outcome is novel and important,” the authors said. “The ability to predict PAH outcomes based on SDOH is essential to identifying and helping those at greater risk.”

PAH patients prefer yutrepia over tyvaso in INSPIRE study

Yutrepia, an inhaled formulation of treprostinil, was generally well tolerated and improved the quality of life for people with pulmonary arterial hypertension (PAH) in the Phase 3 INSPIRE clinical trial.

The therapy was preferred by nearly all trial participants who switched to it from Tyvaso, an older inhaled treprostinil formulation marketed by United Therapeutics.

Full trial results were detailed in the study, “INSPIRE: Safety and Tolerability of Inhaled LIQ861 (Treprostinil) in Pulmonary Arterial Hypertension (PAH),” published in Pulmonary Circulation. The work was funded by Yutrepia developer Liquidia.

“The INSPIRE study confirms the long-term safety profile, dosing convenience, and tolerability of Yutrepia in PAH patients,” Rajeev Saggar, chief medical officer at Liquidia, said in a press release.

Nearly a third of COVID-19 patients show PH signs in study

Nearly a third (29.7%) of COVID-19 patients showed signs of pulmonary hypertension (PH) on an echocardiogram — a scan of heart movement — according to a study in the Netherlands.

While mortality rates were significantly higher among those with suspected PH than those without it, follow-up tests suggested that signs of PH were reversible in surviving patients.

The findings suggest estimated PH may be a prognostic risk factor in COVID-19 patients, the researchers said, adding that “vigilant attention” should be paid for signs of PH in this population.

The study, “Echo cardiographic estimation of pulmonary hypertension in COVID-19 patients,” was published in the Netherlands Heart Journal. 

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