Association between pre-existing Pulmonary Hypertension and COVID-19 related outcomes in inpatient and ambulatory care settings

Shilpa Vijayakumar, David W. Louis, Emily Corneau, Sebhat Erqou, Stephen W. Waldo, Mary E. Plomondon, Madhura Gokhale, Wasiq Sheikh, Phinnara Has, Saad Marwan, J. Dawn Abbott, Matthew Jankowich, Herbert D. Aronow, Wen-Chih Wu, Gaurav Choudhary.

Abstract

Afflicting up to 1% of population, pulmonary hypertension (PH) is commonly associated with cardiopulmonary and metabolic diseases, but the effect of COVID-19 in patients with pre-existing PH remains unclear.

Introduction

Pulmonary hypertension (PH) is defined as a mean pulmonary artery pressure (mPAP) > 20 mmHg during right heart catheterization (RHC) [1,2]. PH results from multifactorial causes, encompassing both pre-capillary and post-capillary, ultimately leading to right ventricular (RV) overload and dysfunction [2].

Methods

A retrospective analysis of a nationwide cohort of Veterans was performed using the Clinical Assessment, Reporting and Tracking (CART) Program data from the Department of Veterans Affairs [12,13].

Results 

Baseline demographic and clinical characteristics for the inpatient cohort, stratified by mPAP, are shown in Table 1. A total of 1204 Veterans were included, with mean age (SD) 72.1 (9.6), 96.9% male, 65.5% White and 28.8% Black. 

Discussion

In a large, national cohort, our study demonstrates the influence of pre-existing PH on both acute outcomes following hospitalization for COVID-19 and longer-term outcomes for those who tested positive for COVID-19 in an outpatient setting.

Conclusion

Patients with pre-admission PH admitted with COVID-19 had higher rates of in-hospital mortality than those without pre-admission PH, both in a national VA cohort and validated in a local hospital network. 

Citation: Vijayakumar S, Louis DW, Corneau E, Erqou S, Waldo SW, Plomondon ME, et al. (2025) Association between pre-existing Pulmonary Hypertension and COVID-19 related outcomes in inpatient and ambulatory care settings. PLoS ONE 20(4): e0321964. https://doi.org/10.1371/journal.pone.0321964

Editor: Fateen Ata, Hamad Medical Corporation, QATAR

Received: August 20, 2024; Accepted: March 13, 2025; Published: April 24, 2025

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: NO authors have competing interests