The Standard Child

Pulmonary Vascular Disease SESSION TITLE: Pulmonary Vascular Disease I SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM A Single-Center Experience With Outpatient Initiation of IV Prostacyclin Therapy for PAH MaryEllen Antkowiak MD* University of Vermont College of Medicine, Burlington, VT PULMONARY VASCULAR DISEASE PURPOSE: Intravenous (IV) prostacyclins remain standard therapy for advanced pulmonary arterial hypertension (PAH) but typically require hospitalization for initiation. At our small, academic referral center, bed availability became a frequent barrier to admissions, prompting development of a plan for outpatient initiation. In this retrospective analysis, we assessed patient outcomes following outpatient initiation of IV prostacyclin. METHODS: Our analysis included 31 patients, with 14 inpatient and 17 outpatient initiations. There were no significant differences between groups in dose (15.37.8 vs.11.96.8, P¼0.21) dose increase between 1st and 2nd shipment (5.87.4 vs.9.06.2, P¼0.20), maximum dose (53.5 (30-100) vs. 77 (40-155) P¼0.72), patients remaining on therapy at 3 months (71% vs.82% OR1.9, P¼0.67), or 6 months (64% vs.82% OR 2.6, P¼0.41), readmission for complications of PAH or therapy (21% vs.24%, OR 1.13, P¼0.89) or any cause (29% vs.29%, OR 1.04, P¼0.99). No patients required catheter replacement within 3 months. Hemodynamic measures were similar between groups. Dichotomous outcomes were compared by Fisher’s exact test. Continuous outcomes were compare by t-test or Wilcoxon rank sum. Associations were not significantly altered following adjustment for age, sex or baseline hemodynamic values. RESULTS: Our analysis included 31 patients, with 14 inpatient and 17 outpatient initiations. There were no significant differences between groups in dose (15.37.8 vs.11.96.8, P¼0.21) dose increase between 1st and 2nd shipment (5.87.4 vs.9.06.2, P¼0.20), maximum dose (53.5 (30-100) vs. 77 (40-155) P¼0.72), patients remaining on therapy at 3 months (71% vs.82% OR1.9, P¼0.67), or 6 months (64% vs.82% OR 2.6, P¼0.41), readmission for complications of PAH/therapy (21% vs.24%, OR 1.13, P¼0.89) or any cause (29% vs.29%, OR 1.04, P¼0.99). No patients required catheter replacement within 3 months. Hemodynamic measures were similar between groups. Associations were not significantly altered following adjustment for age, sex or baseline hemodynamic values. CONCLUSIONS: We did not demonstrate a difference in patient outcomes between sites of therapy initiation. While this study was not powered for statistical significance, our intent was largely to describe our unique experience with outpatient initiation of IV therapy. Readmission rates were similar in both groups and outpatients tended towards higher rates of therapy continuation. Adjustment for hemodynamic measures did not affect results, suggesting that patients initiated on therapy as inpatients were not sicker than those initiated as outpatients. CLINICAL IMPLICATIONS: This study did not demonstrate that outpatient initiation of IV therapy worsened patient outcomes. While this could improve patient satisfaction and decrease healthcare costs, larger studies are needed to demonstrate non-inferiority. DISCLOSURE: The following authors have nothing to disclose: MaryEllen Antkowiak No Product/Research Disclosure Information DOI: http://dx.doi.org/10.1016/j.chest.2016.08.1281 Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. 1172A [ 150#4S CHEST OCTOBER 2016 ]