Format

Send to

Choose Destination
See comment in PubMed Commons below
J Heart Lung Transplant. 2015 Mar;34(3):356-61. doi: 10.1016/j.healun.2014.09.016. Epub 2014 Sep 28.

Prognostic implications of serial risk score assessments in patients with pulmonary arterial hypertension: a Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) analysis.

Author information

1
Allegheny General Hospital, Division of Cardiovascular Diseases, Pittsburgh, Pennsylvania. Electronic address: rbenza@wpahs.org.
2
ICON Clinical Research, San Francisco, California.
3
Baylor College of Medicine, Division of Cardiovascular Diseases, Houston, Texas.
4
University of Colorado Denver, Division of Pulmonary Sciences and Critical Medicine, Aurora, Colorado.
5
Actelion Pharmaceuticals US, Inc, South San Francisco, California.
6
Mayo Clinic, Division of Cardiovascular Diseases, Rochester, Minnesota.

Abstract

BACKGROUND:

Data from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) were used previously to develop a risk score calculator to predict 1-year survival. We evaluated prognostic implications of changes in the risk score and individual risk-score parameters over 12 months.

METHODS:

Patients were grouped by decreased, unchanged, or increased risk score from enrollment to 12 months. Kaplan-Meier estimates of subsequent 1-year survival were made based on change in the risk score during the initial 12 months of follow-up. Cox regression was used for multivariable analysis.

RESULTS:

Of 2,529 patients in the analysis cohort, the risk score was decreased in 800, unchanged in 959, and increased in 770 at 12 months post-enrollment. Six parameters (functional class, systolic blood pressure, heart rate, 6-minute walk distance, brain natriuretic peptide levels, and pericardial effusion) each changed sufficiently over time to improve or worsen risk scores in ≥5% of patients. One-year survival estimates in the subsequent year were 93.7%, 90.3%, and 84.6% in patients with a decreased, unchanged, and increased risk score at 12 months, respectively. Change in risk score significantly predicted future survival, adjusting for risk at enrollment. Considering follow-up risk concurrently with risk at enrollment, follow-up risk was a much stronger predictor, although risk at enrollment maintained a significant effect on future survival.

CONCLUSIONS:

Changes in REVEAL risk scores occur in most patients with pulmonary arterial hypertension over a 12-month period and are predictive of survival. Thus, serial risk score assessments can identify changes in disease trajectory that may warrant treatment modifications.

KEYWORDS:

1-year survival; REVEAL; predictors of survival; prognosis; pulmonary arterial hypertension; risk score calculator

PMID:
25447572
DOI:
10.1016/j.healun.2014.09.016
[Indexed for MEDLINE]
Free full text
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center