Nationwide trends in inpatient admissions of pulmonary hypertension in the United States from 2000 to 2013

Introduction: Pulmonary Hypertension (PH) is a disorder of the pulmonary vasculature with high mortality and bears a large economic burden on the healthcare system. We conducted a review of the largest inpatient database in the United States and analyzed the trends in hospitalizations due to PH from the turn of the century (2000) to 2013 to evaluate the rate of hospitalizations and determine the cost and mortality associated with PH. Material and methods: We analyzed the National Inpatient Sample Database (NIS) for all patients in which PH (Primary or Secondary) or cor pulmonale was the primary discharge diagnosis (ICD-9: 416.0, 416.8 and 416.9) from 2000 to 2013. The NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, lengths of stays and associated hospital costs over the study period was calculated. Results: In 2000, there were 12,066 hospital admissions with the principal discharge diagnosis of pulmonary hypertension, which increased to 13,605 admissions in 2013 (p < 0.001). The mean length of stay for PH increased from 5.89 days to 6.67 days during this period (p = 0.04). During the same period, the hospital charges increase by 174.5% from US$ 24,973 in 2000 to US$ 68,545 in 2013 (Adjusted for inflation). The aggregate cost of hospital visits of a patient increased by 209.5% from US$ 301,324,218 in 2000 to US$ 932,554,725 in 2013. Conclusion: The number of inpatient discharges related to PH has increased even though the number of inpatient discharges with PAH has been reported to be lower in literature. The mean length of stay has also shown a mild increase. This increase is associated with a significant increase in the mean and aggregate cost. These inpatient costs associated with PH contribute significantly to the total healthcare burden. Further research on cost-effective evaluation and management of PH is required.