Top End Pulmonary Hypertension Study: Understanding Epidemiology, Therapeutic Gaps and Prognosis in Remote Australian Setting

Pyi Naing; David Playford; Geoff Strange; Asanga Abeyaratne; Thomas Berhane; Sanjay Joseph; Ellie Costelloe; Maddison Hall; Gregory M Scalia; Douglas L Forrester; Henrik Falhammar; Nadarajah Kangaharan

doi:10.1016/j.hlc.2020.08.008

Top End Pulmonary Hypertension Study: Understanding Epidemiology, Therapeutic Gaps and Prognosis in Remote Australian Setting

Heart Lung Circ. 2021 Apr;30(4):507-515. doi: 10.1016/j.hlc.2020.08.008. Epub 2020 Sep 19.

Authors

Affiliations

¹ Royal Darwin Hospital, Darwin, NT, Australia; University of Notre Dame, Fremantale, WA, Australia; Flinders University, Adelaide, SA, Australia; The Prince Charles Hospital, Brisbane, Qld, Australia. Electronic address: kopyinaing@gmail.com.
² University of Notre Dame, Fremantale, WA, Australia.
³ Royal Darwin Hospital, Darwin, NT, Australia; Menzies School of Health Research, Darwin, NT, Australia.
⁴ Royal Darwin Hospital, Darwin, NT, Australia.
⁵ University of Queensland, Brisbane, Qld, Australia; The Prince Charles Hospital, Brisbane, Qld, Australia.
⁶ Royal Darwin Hospital, Darwin, NT, Australia; University of Queensland, Brisbane, Qld, Australia; The Prince Charles Hospital, Brisbane, Qld, Australia.
⁷ Royal Darwin Hospital, Darwin, NT, Australia; Menzies School of Health Research, Darwin, NT, Australia; Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
⁸ Royal Darwin Hospital, Darwin, NT, Australia; Flinders University, Adelaide, SA, Australia; Northern Territory Cardiac, Darwin, NT, Australia; Menzies School of Health Research, Darwin, NT, Australia.

PMID: 32962944
DOI: 10.1016/j.hlc.2020.08.008

Abstract

Introduction: The Top End of Australia has a high proportion of Indigenous people with a high burden of chronic cardiac and pulmonary diseases likely to contribute to pulmonary hypertension (PH). The epidemiology of PH has not been previously studied in this region.

Methods: Patients with PH were identified from the Northern Territory echocardiography database from January 2010 to December 2015 and followed to the end of 2019 or death. Pulmonary hypertension was defined as a tricuspid regurgitation velocity ≥2.75 m/s measured by Doppler echocardiography. The aetiology of PH, as categorised by published guidelines, was determined by reviewing electronic health records.

Results: 1,764 patients were identified comprising 49% males and 45% Indigenous people. The prevalence of PH was 955 per 100,000 population (with corresponding prevalence of 1,587 for Indigenous people). Hypertension, atrial fibrillation, diabetes and respiratory disease were present in 85%, 45%, 41% and 39%, respectively. Left heart disease was the leading cause for PH (58%), the majority suffering from valvular disease (predominantly rheumatic). Pulmonary arterial hypertension (PAH), respiratory disease related PH, chronic thromboembolic PH (CTEPH) and unclear multifactorial PH represented 4%, 16%, 2% and 3%, respectively. Underlying causes were not identifiable in 17% of the patients. Only 31% of potentially eligible patients were on PAH-specific therapy. At census, there was 40% mortality, with major predictors being age, estimated pulmonary artery systolic pressure (ePASP) and Indigenous ethnicity.

Conclusion: Pulmonary hypertension is prevalent in Northern Australia, with a high frequency of modifiable risk factors and other treatable conditions. Whether earlier diagnosis, interpretation and intervention improve outcomes merits further assessment.

Keywords: Indigenous; Pulmonary hypertension; Remote Australia.

MeSH terms

Familial Primary Pulmonary Hypertension
Female
Humans
Hypertension, Pulmonary* / diagnosis
Hypertension, Pulmonary* / epidemiology
Hypertension, Pulmonary* / etiology
Male
Northern Territory / epidemiology
Prognosis
Pulmonary Arterial Hypertension*