Low-risk status is unattainable for most patients with pulmonary arterial hypertension (PAH), and the first year from diagnosis is important in defining the longitudinal risk status, according to study results published in ESC Heart Failure.

Clinical, hemodynamic, and laboratory data were longitudinally monitored in Swedish patients with PAH. Researchers assessed risk at baseline, after 1 year, and after 3 years. Risk profiles were compared between patients younger than 75 years of age with fewer than 3 comorbidities (group A) and older than 75 years old with more than 3 comorbidities (group B). Risk assessment was conducted according to the risk assessment instrument from the European Society of Cardiology guidelines.

Of the 503 patients with PAH, 340 were assigned to group A, while 163 were in group B. In group A, the baseline risk assessment yielded 23% of patients in the low, 66% of patients in the intermediate, and 11% of patients in the high risk categories. Furthermore, among patients at low, intermediate, or high risk at baseline, 51%, 18%, and 13%, respectively, were at low risk at year 3. In group B, 8% of patients were at low risk, 80% at intermediate risk, and 12% at high risk at baseline. Low-risk status was attained in few patients in group B at 1 or 3 year follow-ups.

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“The first year from diagnosis appears to be critical for the patient with PAH and defines the risk status the patient will reach long term,” the researchers wrote. “A majority of patients [were] treated according to the 2009 PH guidelines, and this less aggressive treatment approach appears to not have succeeded in moving a substantial portion of the patients to a low risk status.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Bouzina H, Rådegran G, Butler O, et al. Longitudinal changes in risk status in pulmonary arterial hypertension ESC Heart Fail. Published online December 10, 2020. doi:10.1002/ehf2.13162