Causes and circumstances of death in pulmonary arterial hypertension

Adriano R Tonelli, Vineesha Arelli, Omar A Minai, Jennie Newman, Nancy Bair, Gustavo A Heresi, Raed A Dweik
American Journal of Respiratory and Critical Care Medicine 2013 August 1, 188 (3): 365-9

RATIONALE: The causes and circumstances surrounding death are understudied in patients with pulmonary arterial hypertension (PAH).

OBJECTIVES: We sought to determine the specific reasons and characteristics surrounding the death of patients with PAH.

METHODS: All deaths of patients with pulmonary hypertension (PH) followed in the Cleveland Clinic Pulmonary Vascular Program were prospectively reviewed by the PH team. A total of 84 patients with PAH (age 58 ± 14 yr; 73% females) who died between June 2008 and May 2012 were included.

MEASUREMENTS AND MAIN RESULTS: PH was determined to be the direct cause of death (right heart failure or sudden death) in 37 (44%) patients; PH contributed to but did not directly cause death in 37 (44%) patients; and the death was not related to PH in the remaining cases (n = 7; 8.3%). In three (3.6%) patients the final cause of death could not be adequately assessed. Most patients died in a healthcare environment and most received PH-specific therapies. In our cohort, 50% of all patients with PAH and 75.7% of those who died of right heart failure received parenteral prostanoid therapy. Less than half of patients had advanced healthcare directives.

CONCLUSIONS: Most patients with PAH in our cohort died of their disease; however, right ventricular failure or sudden death was the sole cause of death in less than half of patients.

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