TY - JOUR
T1 - Impact of the COVID-19 pandemic on chronic disease management and patient reported outcomes in patients with pulmonary hypertension
T2 - The Pulmonary Hypertension Association Registry
AU - Mayer, Megan
AU - Badesch, David B.
AU - Nielsen, Kelly H.
AU - Kawut, Steven
AU - Bull, Todd
AU - Ryan, John J.
AU - Sager, Jeffrey
AU - Mazimba, Sula
AU - Hemnes, Anna
AU - Klinger, James
AU - Runo, James
AU - McConnell, John W.
AU - De Marco, Teresa
AU - Chakinala, Murali M.
AU - Yung, Delphine
AU - Elwing, Jean
AU - Kaplan, Adolfo
AU - Argula, Rahul
AU - Pomponio, Raymond
AU - Peterson, Ryan
AU - Hountras, Peter
N1 - Publisher Copyright:
© 2023 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.
PY - 2023/4
Y1 - 2023/4
N2 - To better understand the impact of the COVID-19 pandemic on the care of patients with pulmonary hypertension, we conducted a retrospective cohort study evaluating health insurance status, healthcare access, disease severity, and patient reported outcomes in this population. Using the Pulmonary Hypertension Association Registry (PHAR), we defined and extracted a longitudinal cohort of pulmonary arterial hypertension (PAH) patients from the PHAR's inception in 2015 until March 2022. We used generalized estimating equations to model the impact of the COVID-19 pandemic on patient outcomes, adjusting for demographic confounders. We assessed whether insurance status modified these effects via covariate interactions. PAH patients were more likely to be on publicly-sponsored insurance during the COVID-19 pandemic compared with prior, and did not experience statistically significant delays in access to medications, increased emergency room visits or nights in the hospital, or worsening of mental health metrics. Patients on publicly-sponsored insurance had higher healthcare utilization and worse objective measures of disease severity compared with privately insured individuals irrespective of the COVID-19 pandemic. The relatively small impact of the COVID-19 pandemic on pulmonary hypertension-related outcomes was unexpected but may be due to pre-established access to high quality care at pulmonary hypertension comprehensive care centers. Irrespective of the COVID-19 pandemic, patients who were on publicly-sponsored insurance seemed to do worse, consistent with prior studies highlighting outcomes in this population. We speculate that previously established care relationships may lessen the impact of an acute event, such as a pandemic, on patients with chronic illness.
AB - To better understand the impact of the COVID-19 pandemic on the care of patients with pulmonary hypertension, we conducted a retrospective cohort study evaluating health insurance status, healthcare access, disease severity, and patient reported outcomes in this population. Using the Pulmonary Hypertension Association Registry (PHAR), we defined and extracted a longitudinal cohort of pulmonary arterial hypertension (PAH) patients from the PHAR's inception in 2015 until March 2022. We used generalized estimating equations to model the impact of the COVID-19 pandemic on patient outcomes, adjusting for demographic confounders. We assessed whether insurance status modified these effects via covariate interactions. PAH patients were more likely to be on publicly-sponsored insurance during the COVID-19 pandemic compared with prior, and did not experience statistically significant delays in access to medications, increased emergency room visits or nights in the hospital, or worsening of mental health metrics. Patients on publicly-sponsored insurance had higher healthcare utilization and worse objective measures of disease severity compared with privately insured individuals irrespective of the COVID-19 pandemic. The relatively small impact of the COVID-19 pandemic on pulmonary hypertension-related outcomes was unexpected but may be due to pre-established access to high quality care at pulmonary hypertension comprehensive care centers. Irrespective of the COVID-19 pandemic, patients who were on publicly-sponsored insurance seemed to do worse, consistent with prior studies highlighting outcomes in this population. We speculate that previously established care relationships may lessen the impact of an acute event, such as a pandemic, on patients with chronic illness.
KW - COVID-19
KW - PHAR
KW - insurance
KW - pulmonary hypertension
UR - http://www.scopus.com/inward/record.url?scp=85162178980&partnerID=8YFLogxK
U2 - 10.1002/pul2.12233
DO - 10.1002/pul2.12233
M3 - Article
C2 - 37159803
AN - SCOPUS:85162178980
SN - 2045-8932
VL - 13
JO - Pulmonary Circulation
JF - Pulmonary Circulation
IS - 2
M1 - e12233
ER -