Incidence and Outcomes of Covid-19 in Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension: Data from the Hellenic Pulmonary Hypertension Registry (Hope)

ABSTRACT

Few reports on coronavirus disease 2019 (COVID-19) infection in patients with group 1 or group 4 pulmonary hypertension (PH) have been published, with a discrepancy in the incidence of the disease in this rare and heterogeneous population and also differences in the reported outcomes, such as hospitalization and mortality rates. The aim was to describe the case incidence of COVID-19 among Greek PH expert centers. A total of nine PH expert centers participated in this report, cumulatively caring for 499 PH patients [372 patients with pulmonary arterial hypertension (PAH) and 127 patients with chronic thromboembolic pulmonary hypertension (CTEPH)] according to recent data retrieved from the prospective HOPE Registry and personal communication with the expert centers, to record RTPCR- confirmed COVID-19 cases. Eighteen cases of COVID-19 (12 PAH and six CTEPH) were reported from the end of February 2020 to 14 August 2021, contributing to an estimated incidence of 36.1 (95% confidence interval 21.5-56.4) COVID-19 cases in 1,000 patients with group 1 and 4 PH. The median age of affected patients was 54.5 years (range 25-86 years), and 77.8% were women. All patients reported a symptomatic course of COVID-19 [median duration 6 days (range 2-30 days)]. No case of incident venous thromboembolism was described. All patients resumed PAH-targeted therapies during the course of the infection. Eight (44.4%) patients were hospitalized, and four (22.2%) died. Three of them were >=70 years of age, and the other had significant comorbidities. The remaining four were discharged after a median of 11 days (range 8-30 days). Recovered patients do not report deterioration of their functional status after COVID-19 infection, nor persistent symptoms. There is increased severity of COVID-19 among PAH and CTEPH patients, mainly owing to the increased age and comorbidities of the patients. Strong medical advice should be offered to all PH group 1 and 4 patients to be vaccinated and continue to adhere to preventive infection measures.