S Harikrishnan1, G Sanjay2, M Ashishkumar3, Jaideep Menon4, Gopalan Nair Rajesh5, Raman Krishna Kumar4, A George Koshy6, Thankachan V Attacheril7, Raju George8, Eapen Punnoose9, S M Ashraf10, S R Arun11, Mohammed Cholakkal12, Panniyammakal Jeemon2. 1. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India. Electronic address: drhari@sctimst.ac.in. 2. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India. 3. Malabar Institute of Medical Sciences, Calicut, India. 4. Amrita Institute of Medical Sciences, Kochi, India. 5. Medical College, Calicut, India. 6. Medical College, Trivandrum, India. 7. Lourde Hospital, Ernakulam, India. 8. Medical College, Kottayam, India. 9. MOSC Medical College, Kolencherry, India. 10. Academy of Medical Sciences, Pariyaram, India. 11. Medical College, Trivandrum, India; General Hospital, Trivandrum, India. 12. IQRAA Hospital, Calicut, India.
Abstract
BACKGROUND: Epidemiological data on pulmonary hypertension (PH) are scarce from developing countries including India. METHODS: We established a multi-center registry of PH, the PRO-KERALA registry, in Kerala, India. Fifty hospitals enrolled consecutive adult (>18 years) patients for one year. Echocardiographic criteria (right ventricular systolic pressure - RVSP > 50 mmHg) or invasively obtained mean pulmonary artery pressure > 25 mmHg was the criteria for entry. RESULTS: There were 2003 patients (52% Women, mean age 56 ± 16.1 years) enrolled. The mean RVSP was 68.2 (SD = 17.9) mmHg. Majority of the study participants (59%) belonged to group 2 of the WHO Nice Classification 2013 (PH secondary to left heart disease). One-fifth (21.2%) belonged to group 1, while 13.3%, 3.8% and 2.4% of the study population belonged to groups 3, 4 and 5 respectively. More than a quarter (27%) reported PH due to left heart disease with valvular disease etiology; while 20.7% had coronary artery disease. The other common etiological factors were chronic obstructive pulmonary disease (10.6%), congenital heart disease (14.6%), idiopathic pulmonary hypertension (5.8%), and chronic thromboembolic pulmonary hypertension (3.8%). Only one of two patients with pulmonary artery hypertension was receiving PH specific therapies. The use of combination therapy was negligible and PH-specific therapies were prescribed off-label to a small proportion of patients too. CONCLUSION: PRO-KERALA is the first PH registry from South Asia and the second largest globally. Left heart diseases attribute to three fifths of patients with PH. Utilization rates of PH specific drug therapies are remarkably lower than the Western population.
BACKGROUND: Epidemiological data on pulmonary hypertension (PH) are scarce from developing countries including India. METHODS: We established a multi-center registry of PH, the PRO-KERALA registry, in Kerala, India. Fifty hospitals enrolled consecutive adult (>18 years) patients for one year. Echocardiographic criteria (right ventricular systolic pressure - RVSP > 50 mmHg) or invasively obtained mean pulmonary artery pressure > 25 mmHg was the criteria for entry. RESULTS: There were 2003 patients (52% Women, mean age 56 ± 16.1 years) enrolled. The mean RVSP was 68.2 (SD = 17.9) mmHg. Majority of the study participants (59%) belonged to group 2 of the WHO Nice Classification 2013 (PH secondary to left heart disease). One-fifth (21.2%) belonged to group 1, while 13.3%, 3.8% and 2.4% of the study population belonged to groups 3, 4 and 5 respectively. More than a quarter (27%) reported PH due to left heart disease with valvular disease etiology; while 20.7% had coronary artery disease. The other common etiological factors were chronic obstructive pulmonary disease (10.6%), congenital heart disease (14.6%), idiopathic pulmonary hypertension (5.8%), and chronic thromboembolic pulmonary hypertension (3.8%). Only one of two patients with pulmonary artery hypertension was receiving PH specific therapies. The use of combination therapy was negligible and PH-specific therapies were prescribed off-label to a small proportion of patients too. CONCLUSION: PRO-KERALA is the first PH registry from South Asia and the second largest globally. Left heart diseases attribute to three fifths of patients with PH. Utilization rates of PH specific drug therapies are remarkably lower than the Western population.
Authors: Anand Reddy Maligireddy; Supriya Shore; A Sreenivas Kumar; S Harikrishnan; S Ajit Mullasari; B K Sastry; Sameer Gupta; Nikhil Choudhary; Auras R Atreya; Sonali Arora; Victor M Moles; Vallerie V Mclaughlin; Vikas Aggarwal Journal: Pulm Circ Date: 2022-04-01 Impact factor: 2.886