P730Characteristics of patients with pulmonary hypertension from a developing country setting; data from the PROKERALA registry in Kerala, India

Abstract

Background: Epidemiological data on pulmonary Hypertension (PH) are scarce from developing countries including India. Methods: We established a multi-center hospital based registry of PH, the PROKERALA registry, in India. In total, fifty hospitals across Kerala enrolled consecutive eligible adult (>18 years) patients into the registry for a period of one year. Echocardiographic criteria (right ventricular systolic pressure - RVSP >50 mm Hg) was the main principal inclusion criteria for registration. Relevant baseline data were collected by trained nurses using a structured questionnaire and after reviewing the patient charts. Results: In total, 2003 patients (52% Women, mean age 56±16.1 years) were enrolled. Nearly one of five study participants (18.5%), reported evidence of right heart failure. More than one third (36.5%) of the study population reported symptoms equivalent to NYHA class 3 or more. The mean right ventricular systolic pressure in the whole population was 68.2 (SD=17.9) mmHg. Majority of the study participants (59%) belonged to group 2 of the updated WHO Danapoint classification (PH secondary to left heart disease). While one of five patients (21.2%) belonged to group 1, 13.3%, 3.8% and 2.4% of the study population belonged to group 3, group 4 and group 5 respectively. The mean age was highest among patients in group 3 and lowest in those in group 1. There was a male predominance in Group 2 and 3, while females predominated in other groups. One of four study participants (27%) reported PH due to left heart disease with valvular disease etiology, while 23.1% were due to coronary artery disease (CAD). The other common etiological factors were - Chronic obstructive pulmonary disease (COPD) - 10.6%, congenital heart disease (CHD) 14.6%, idiopathic pulmonary hypertension (IPAH) - 5.8%, and chronic thromboembolic pulmonary hypertension (3.8%). Very few patients underwent hemodynamic testing prior to be being initiated on PH specific therapy. Only 4.3% participants were on calcium channel blocker therapy. The details of PH specific therapy is as follows; phosphodiesterase V inhibitors - 17.1%, endothelin receptor antagonists (ERAs)- 2.3%, combination therapy usage was negligible. More than half (55%) of patients in group 1 category were using some form of PH specific therapy, while only 4.4% of patients in Group 2 were taking such therapies. The usage of PH specific therapies were 25.2%, 39.3% and 11.8%, respectively among patients with group 3, group 4 and group 5 PH categories. Conclusion: PROKERALA is the first PH registry from South Asia and this is the second largest registry of PH globally. Our data show unique features pertaining to the developing world.