Abstract
Objectives Pulmonary endarterectomy (PEA) is recommended for eligible patients with chronic thromboembolic pulmonary hypertension (CTEPH) and is potentially curative. However, persistent/recurrent CTEPH post-PEA can occur. Here we describe symptom and diagnostic assessment rates for residual disease post-PEA and longitudinal diagnostic patterns before and after riociguat approval for persistent/recurrent CTEPH after PEA.
Methods This US retrospective cohort study analysed MarketScan data (1 January 2002–30 September 2018) from patients who underwent PEA following a CTEPH/pulmonary hypertension (PH) claim with at least 730 days of continuous enrolment post-PEA. Data on pre-specified PH symptoms and the types and timings of diagnostic assessments were collected.
Results Of 103 patients (pre-riociguat approval, n=55; post-riociguat approval, n=48), residual PH symptoms more than 3 months after PEA were reported in 89% of patients. Overall, 89% of patients underwent 1 or more diagnostic tests (mean 4.6 tests/patient), most commonly echocardiography (84%), with only 5% of patients undergoing right heart catheterisation (RHC). In the post- versus pre-riociguat approval subgroup, assessments were more specific for CTEPH with an approximate 2-fold increase in 6-minute walking distance and N-terminal prohormone of brain natriuretic protein measurements and ventilation/perfusion scans, and a 4-fold increase in RHCs.
Conclusions Low RHC rates suggest that many patients with PH symptoms post-PEA are not being referred for full diagnostic work-up. Changes to longitudinal diagnostic patterns may indicate increased recognition of persistent/recurrent CTEPH post-PEA; however, there remains a need for greater awareness around the importance of continued follow-up for patients with residual PH symptoms post-PEA.
Footnotes
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Conflict of Interest: Oisin Butler is a current employee of Bayer AG.
Conflict of Interest: Shinyoung Ju is a current employee of Bayer AG. Contracts have been received from GlaxoSmithKline, outside the submitted work.
Conflict of Interest: Soeren Hoering is a current employee of Bayer AG.
Conflict of Interest: Kai Vogtlander is a current employee of Bayer AG.
Conflict of Interest: Sameer Bansilal is a current employee of Bayer HealthCare Pharmaceuticals.
Conflict of Interest: Gustavo A. Heresi reports receiving advisory board fees from Bayer HealthCare and Janssen Pharmaceuticals, outside the submitted work.
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- Received October 1, 2021.
- Accepted March 29, 2022.
- Copyright ©The authors 2022
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