Heliyon (Mar 2024)

Exercise capacity-hemodynamics mismatch in elderly patients with pulmonary hypertension: A nationwide multicenter study from Taiwan Society of Cardiology Pulmonary Hypertension Registry (TAIPANS)

  • Chang-Ying Chen,
  • Wang Mei-Tzu,
  • Shih-Hsien Sung,
  • Yih-Jer Wu,
  • Chih-Hsin Hsu,
  • Wan-Jing Ho,
  • Yen-Hung Lin,
  • Wei-Shin Liu,
  • Ju-Chi Liu,
  • Yung-Ta Kao,
  • Wen-Shiann Wu,
  • Chun-Hsien Wu,
  • Meng-Huan Lei,
  • Yu-Wei Chen,
  • Chien Chen-Yu,
  • Yu-Wei Chiu,
  • Zen-Kong Dai,
  • Tsung-Hsien Lin,
  • Lin Lin,
  • Cheng-Chih Chung,
  • Chang-Min Chung,
  • Sung-Hao Huang,
  • Chin-Chang Cheng,
  • Yen-Wen Wu,
  • Ting-Hsing Chao,
  • Juey-Jen Hwang,
  • Charles Jia-Yin Hou,
  • Wei-Chun Huang

Journal volume & issue
Vol. 10, no. 6
p. e27537

Abstract

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Background: Demographics of pulmonary hypertension (PH) has changed a lot over the past forty years. Several recent registries noted an increase in mean age of PH but only a few of them investigated the characteristics of elderly patients. Thus, we aimed to analyze the characteristics of PH in such a population in this study. Methods: This multicenter study enrolled patients diagnosed with PH in group 1, 3, 4, and 5 consecutively from January 1, 2019 to December 31, 2020. A total of 490 patients was included, and patients were divided into three groups by age (≤45 years, 45–65 years, and >65 years). Results: The mean age of PH patients diagnosed with PH was 55.3 ± 16.3 years of age. There was higher proportion of elderly patients classified as group 3 PH (≤45: 1.3, 45–65: 4.5, >65: 8.1 %; p = 0.0206) and group 4 PH (≤45: 8.4, 45–65: 14.5, >65: 31.6 %; p 65, mean difference, 77.8 m [95% confidence interval (CI), 2.1–153.6 m]), lower mean pulmonary arterial pressure (mPAP) (≤45 vs. >65, mean difference, 10.8 mmHg [95% CI, 6.37–15.2 mmHg]), and higher pulmonary arterial wedge pressure (PAWP) (≤45 vs. 45–65, mean difference, −2.1 mmHg [95% CI, −3.9 to −0.3 mmHg]) compared to young patients. Elderly patients had a poorer exercise capacity despite lower mPAP level compared to young population, but they received combination therapy less frequently compared to young patients (triple therapy in group 1 PH, ≤45: 16.7, 45–65: 11.3, >65: 3.8 %; p = 0.0005). Age older than 65 years was an independent predictor of high mortality for PH patients. Conclusions: Elderly PH patients possess unique hemodynamic profiles and epidemiologic patterns. They had higher PAWP, lower mPAP, and received combination therapy less frequently. Moreover, ageing is a predictor of high mortality for PH patients. Exercise capacity-hemodynamics mismatch and inadequate treatment are noteworthy in the approach of elderly population with PH.

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