title: Predictors of hospitalisations for heart failure and mortality in patients with pulmonary hypertension associated with left heart disease: a systematic review.
abstract: OBJECTIVE
  Left heart disease (LHD) is the main cause of pulmonary hypertension (PH), but little is known regarding the predictors of adverse outcome of PH associated with LHD (PH-LHD). We conducted a systematic review to investigate the predictors of hospitalisations for heart failure and mortality in patients with PH-LHD.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  PubMed MEDLINE and SCOPUS from inception to August 2013 were searched, and citations identified via the ISI Web of Science.
  
  
  METHODS
  Studies that reported on hospitalisation and/or mortality in patients with PH-LHD were included if the age of participants was greater than 18 years and PH was diagnosed using Doppler echocardiography and/or right heart catheterisation. Two reviewers independently selected studies, assessed their quality and extracted relevant data.
  
  
  RESULTS
  In all, 45 studies (38 from Europe and USA) were included among which 71.1% were of high quality. 39 studies were published between 2003 and 2013. The number of participants across studies ranged from 46 to 2385; the proportion of men from 21% to 91%; mean/median age from 63 to 82 years; and prevalence of PH from 7% to 83.3%. PH was consistently associated with increased mortality risk in all forms of LHD, except for aortic valve disease where findings were inconsistent. Six of the nine studies with data available on hospitalisations reported a significant adverse effect of PH on hospitalisation risk. Other predictors of adverse outcome were very broad and heterogeneous including right ventricular dysfunction, functional class, left ventricular function and presence of kidney disease.
  
  
  CONCLUSIONS
  PH is almost invariably associated with increased mortality risk in patients with LHD. However, effects on hospitalisation risk are yet to be fully characterised; while available evidence on the adverse effects of PH have been derived essentially from Caucasians.
authors.affiliation: Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Anastase
authors.initials: A
authors.lastname: Dzudie
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
authors.forename: Andre Pascal
authors.initials: AP
authors.lastname: Kengne
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Faculty of Health Sciences, Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Thienemann
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa Cape Heart Group, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
mesh_terms: D019468:Disease Management; D005060:Europe / Q000453:epidemiology; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015996:Survival Rate / Q000639:trends; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality / Q000628:therapy
keywords: Pulmonary hypertension; hospitalization; left heart disease; mortality; outcome; predictors