title: Characterization of first-time hospitalizations in patients with newly diagnosed pulmonary arterial hypertension in the REVEAL registry.
abstract: BACKGROUND
  Hospitalization is an important outcome in pulmonary arterial hypertension (PAH), shown previously to correlate with survival. Using the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry), we sought to characterize first-time hospitalizations and their effect on subsequent hospitalization and survival in patients with newly diagnosed disease.
  
  
  METHODS
  Patients with newly diagnosed PAH (n = 862, World Health Organization group 1) were evaluated for first-time hospitalization. The hospitalizations were categorized as PAH related or PAH unrelated based on the case report form. Categories for PAH-related and PAH-unrelated hospitalization were defined before independent review. Patient demographics and disease characteristics are described as well as freedom from hospitalization and survival.
  
  
  RESULTS
  Of 862 patients, 490 (56.8%) had one or more hospitalizations postenrollment: 257 (52.4%) PAH related, 214 (43.7%) PAH unrelated, and 19 (3.9%) of undetermined causes. The most common causes of PAH-related hospitalization were congestive heart failure and placement/removal of a central venous catheter. Patients with PAH-related hospitalizations were more likely to receive parenteral therapy, be in functional class III/IV, and have higher risk scores before hospitalization at enrollment. Following discharge, 25.4% ± 3.2% and 31.0% ± 4.0% of patients with PAH-related and PAH-unrelated first hospitalization, respectively, remained hospitalization-free for 3 years (P = .11). Survival estimates at 3 years postdischarge were 56.8% ± 3.5% and 67.8% ± 3.6% (P = .037) for patients with PAH-related and PAH-unrelated hospitalization, respectively.
  
  
  CONCLUSIONS
  In the REVEAL Registry, PAH-related hospitalization was associated with relatively more rehospitalizations and worse survival at 3 years.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov.
authors.affiliation: From the Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL. Electronic address: burger.charles@mayo.edu.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Burger
authors.affiliation: Department of Clinical Research, Mayo Clinic, Jacksonville, FL.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Long
authors.affiliation: ICON Clinical Research, San Francisco, CA.
authors.forename: Monarch R
authors.initials: MR
authors.lastname: Shah
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Michael D
authors.initials: MD
authors.lastname: McGoon
authors.affiliation: ICON Clinical Research, San Francisco, CA.
authors.forename: Dave P
authors.initials: DP
authors.lastname: Miller
authors.affiliation: Actelion Pharmaceuticals US, Inc, South San Francisco, CA.
authors.forename: Alain J
authors.initials: AJ
authors.lastname: Romero
authors.affiliation: Actelion Pharmaceuticals US, Inc, South San Francisco, CA.
authors.forename: Wade W
authors.initials: WW
authors.lastname: Benton
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Safford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D019468:Disease Management; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015994:Incidence; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology