Incidence of Pulmonary Hypertension in the Echocardiography Referral Population.

Rationale: Incidence rates for pulmonary hypertension using diagnostic data in patients with cardiopulmonary disease are not known.

Objectives

To determine incidence rates of, risk factors for, and mortality hazard associated with pulmonary hypertension among patients referred for transthoracic echocardiography.

Methods

A retrospective cohort study was conducted using data from the U.S. Department of Veterans Affairs (VA) (1999-2020) and Vanderbilt University Medical Center (1994-2020). Pulmonary hypertension was defined as pulmonary artery systolic pressure >35 mm Hg, with prevalent cases excluded. Heart failure and chronic obstructive pulmonary disease were the primary exposures of interest. The primary outcome was incident pulmonary hypertension. Secondarily, we examined mortality rate after incident diagnosis.

Results

We identified 245,067 VA patients (94% men, 20% Black) and 117,526 Vanderbilt patients (46% men, 11% Black) without pulmonary hypertension, of whom 38,882 VA patients and 8,061 Vanderbilt patients developed pulmonary hypertension. Only 18-19% of patients with echocardiography-based pulmonary hypertension also had diagnostic codes. The hazard of pulmonary hypertension was fourfold higher in patients with heart failure and chronic obstructive pulmonary disease compared with patients without either. Mortality rates increased from pulmonary artery systolic pressure of 35-45 mm Hg and then plateaued. Independent risk factors for incident pulmonary hypertension included older age, male sex, Black race, and cardiometabolic comorbidities.

Conclusions

Pulmonary hypertension incidence rates estimated by diagnostic data are higher than code-based rates. Heart failure and chronic obstructive pulmonary disease strongly associate with incident pulmonary hypertension. Pulmonary artery systolic pressure >45 mm Hg at diagnosis is associated with high mortality. New pulmonary hypertension on echocardiography is an important prognostic sign.