Acute decompensated pulmonary hypertension outcomes in pulmonary arterial hypertension patients: systematic review and meta-analysis of proportions

Marcos Vinicius Fernandes Garcia; Abdelrahman Nanah; Pedro Caruso

doi:10.1016/j.hrtlng.2024.11.009

Acute decompensated pulmonary hypertension outcomes in pulmonary arterial hypertension patients: systematic review and meta-analysis of proportions

Heart Lung. 2024 Nov 22:70:57-64. doi: 10.1016/j.hrtlng.2024.11.009. Online ahead of print.

Authors

Marcos Vinicius Fernandes Garcia¹, Abdelrahman Nanah², Pedro Caruso³

Affiliations

¹ Cleveland Clinic Foundation, Fairview Hospital, Cleveland, Ohio, USA. Electronic address: garciam26@ccf.org.
² Cleveland Clinic Foundation, Fairview Hospital, Cleveland, Ohio, USA.
³ Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil; Pulmonary Department, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

PMID: 39579648
DOI: 10.1016/j.hrtlng.2024.11.009

Abstract

Background: Acute decompensated pulmonary arterial hypertension (ADPH) is characterized by right heart failure due to elevated afterload and inadequate cardiac output, and it presents a significant mortality risk. Understanding mortality proportions and the impact of life-sustaining therapies is crucial for informing clinical practice and patient prognosis.

Objectives: To assess mortality proportions in ADPH across different clinical settings and to assess how they vary depending on the type of life-sustaining interventions used.

Methods: A systematic review and meta-analysis of proportions were conducted, examining mortality in ADPH focusing on three primary outcomes: ICU mortality, hospital mortality, and hospital mortality in patients requiring extracorporeal membrane oxygenation (ECMO). Common and random-effects meta-analyses were performed to calculate pooled mortality proportions with 95% confidence intervals (CI95%). Temporal trends were analyzed using meta-regression.

Results: Twenty-five observational studies conducted between 2003 and 2023, involving 1,249 ADPH patients, were included. The random-effect analysis revealed an ICU pooled mortality proportion of 29% (CI95% 25-34, I²=40%, p=0.12) and a pooled hospital mortality proportion of 38% (CI95% 31-47, I²=70%, p<0.01). Pooled mortality proportion for patients on ECMO was 45% (CI95% 38-52, I²=0%, p=0.96). Patients receiving inotropes or vasopressors had pooled mortality proportion of 56% (CI95% 44-68, I²=42%, p=0.18) and 57% (CI95% 48-65, I²=57%, p=0.02), respectively. Meta-regression analysis revealed no significant trend in hospital mortality over the span of twenty years.

Conclusions: Variation in ADPH mortality across hospital settings and life-sustaining therapies underscores the complexity of managing ADPH. These findings inform clinical practice and support prognostic discussions with patients and families.

Keywords: Extracorporeal membrane oxygenation; Intensive care unit; Mortality; Pulmonary hypertension; Right heart failure.