Jeff Min1, Rui Feng2, David Badesch3, Erika Berman-Rosenzweig4, Charles Burger5, Murali Chakinala6, Teresa De Marco7, Jeremy Feldman8, Anna Hemnes9, Evelyn M Horn10, Matthew R Lammi11, Stephen Mathai12, John W McConnell13, Kenneth Presberg14, Jeffrey Robinson15, Jeffrey Sager16, Oksana A Shlobin17, Marc Simon18, Thenappan Thenappan19, Corey Ventetuolo20, Nadine Al-Naamani21. 1. University of Pennsylvania, 6572, Pulmonary and Critical Care Medicine, Philadelphia, Pennsylvania, United States. 2. University of Pennsylvania Perelman School of Medicine, 14640, Philadelphia, Pennsylvania, United States. 3. University of Colorado, Medicine, Aurora, Colorado, United States. 4. Columbia University Medical Center, 21611, New York, New York, United States. 5. Mayo Clinic, Pulmonary and Critical Care, Jacksonville, Florida, United States. 6. Washington University, Internal Medicine, Saint Louis, Missouri, United States. 7. University of California San Francisco, Medicine, San Francisco, California, United States. 8. Arizona Pulmonary Specialists, Phoenix, Arizona, United States. 9. Vanderbilt University School of Medicine, Nashville, Tennessee, United States. 10. Weill-Cornell Medical School, New York, New York, United States. 11. Louisiana State University Health Sciences Center, Pulmonary/Critical Care and Allergy/Immunology, New Orleans, Louisiana, United States. 12. Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Medicine, Baltimore, United States. 13. Kentuckiana Pulmonary Associates, Louisville, Kentucky, United States. 14. Froedtert and the Medical College of Wisconsin Froedtert Hospital, 20721, Milwaukee, Wisconsin, United States. 15. The Oregon Clinic, 6678, Portland, Oregon, United States. 16. Santa Barbara Pulmonary Associates, Santa Barbara, California, United States. 17. Inova Fairfax Hospital, Advanced Lung Disease and Transplant, Falls Church, Virginia, United States. 18. UPMC and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States. 19. University of Minnesota, Medicine, Minneapolis, Minnesota, United States. 20. Brown University, Medicine , Providence, Rhode Island, United States. 21. University of Pennsylvania, 6572, Philadelphia, Pennsylvania, United States; nadine.al-naamani@pennmedicine.upenn.edu.
Abstract
RATIONALE: Obesity is associated with pulmonary arterial hypertension (PAH), but its impact on outcomes such as health-related quality of life (HRQoL), hospitalizations and survival is not well understood. OBJECTIVES: To assess the effect of obesity on health-related quality of life (HRQoL), hospitalizations and survival in patients with PAH. METHODS: We performed a cohort study of adults with PAH from the Pulmonary Hypertension Association Registry, a prospective multicenter registry. Multivariate linear mixed effects regression was used to examine the relationship between weight categories and HRQoL using the Short Form-12 (SF-12) and emPHasis-10 (e10). We used multivariable negative binomial regression to estimate hospitalization incidence rate ratios (IRRs) and Cox regression to estimate hazard ratios (HRs) for transplant-free survival by weight status. RESULTS: 767 subjects were included: mean age of 57 years, 74% female, 33% overweight and 40% obese, with median follow-up duration of 527 days. Overweight and obese patients had higher baseline e10 scores (worse HRQoL), which persisted over time (p<0.001). The overweight and obese have a trend towards increased incidence of hospitalizations compared to normal weight (IRR 1.34, 95% confidence interval (95%CI) 0.94-1.92 and 1.33, 95%CI 0.93-1.89, respectively). Overweight and obese patients had lower risk of transplant or death as compared to normal weight patients (HR 0.45, 95%CI 0.25-0.80 and 0.39, 95%CI 0.22-0.70, respectively). CONCLUSIONS: In a large multicenter, prospective cohort of PAH, overweight and obese patients had worse disease-specific HRQoL despite better transplant-free survival compared to normal weight patients. Future interventions should address the specific needs of these patients.
RATIONALE: Obesity is associated with pulmonary arterial hypertension (PAH), but its impact on outcomes such as health-related quality of life (HRQoL), hospitalizations and survival is not well understood. OBJECTIVES: To assess the effect of obesity on health-related quality of life (HRQoL), hospitalizations and survival in patients with PAH. METHODS: We performed a cohort study of adults with PAH from the Pulmonary Hypertension Association Registry, a prospective multicenter registry. Multivariate linear mixed effects regression was used to examine the relationship between weight categories and HRQoL using the Short Form-12 (SF-12) and emPHasis-10 (e10). We used multivariable negative binomial regression to estimate hospitalization incidence rate ratios (IRRs) and Cox regression to estimate hazard ratios (HRs) for transplant-free survival by weight status. RESULTS: 767 subjects were included: mean age of 57 years, 74% female, 33% overweight and 40% obese, with median follow-up duration of 527 days. Overweight and obese patients had higher baseline e10 scores (worse HRQoL), which persisted over time (p<0.001). The overweight and obese have a trend towards increased incidence of hospitalizations compared to normal weight (IRR 1.34, 95% confidence interval (95%CI) 0.94-1.92 and 1.33, 95%CI 0.93-1.89, respectively). Overweight and obese patients had lower risk of transplant or death as compared to normal weight patients (HR 0.45, 95%CI 0.25-0.80 and 0.39, 95%CI 0.22-0.70, respectively). CONCLUSIONS: In a large multicenter, prospective cohort of PAH, overweight and obese patients had worse disease-specific HRQoL despite better transplant-free survival compared to normal weight patients. Future interventions should address the specific needs of these patients.
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Authors: Kevin Y Chang; Sue Duval; David B Badesch; Todd M Bull; Murali M Chakinala; Teresa De Marco; Robert P Frantz; Anna Hemnes; Stephen C Mathai; Erika Berman Rosenzweig; John J Ryan; Thenappan Thenappan Journal: J Am Heart Assoc Date: 2022-04-27 Impact factor: 6.106