Pulmonary Hypertension in Rural Minnesota: Prevalence and Clinical Classification

Purpose Pulmonary arterial hypertension (PAH) is a progressive disease characterized by pulmonary vascular remodeling and right ventricular (RV) dysfunction. Pulmonary hypertension (PH) classification and prevalence at major urban centers is well described. PH in rural areas is under-defined. Methods All consecutive patients at Minneapolis Heart Institute Baxter/Crosby/Aitkin outreach with estimated RVSP (right ventricular systolic pressure) ≥ 50 mmHg on echo or suspected PH by referring clinician based on symptoms and right ventricular enlargement and/or right ventricular systolic dysfunction. All patients had echo and right heart catheterization. PAH and PH prevalence were calculated for Crow Wing and Aitkin County, MN using 2017 census data and zip codes. Results Of 109 patients, 10 patients did not have PH, 26 patients had group 1 PH, and 73 patients had group 2, 3, or Group 5 PH. Patients with PAH were older compared to non-group 1 PH (69±13 vs. 75±9 years; p=0.01) and tended to have lower 6 minute walk distance (246±138 vs. 289±108 meters; p=0.05). Table 1 and 2 illustrate hemodynamic data. Group 1 PH prevalence in Crow Wing and Aitkin Counties was 124 cases and 196 cases/million respectively. PH prevalence in Crow Wing and Aitkin counties was 631 cases and 638 cases/million respectively. Conclusion Group 1 PH prevalence in rural Minnesota appears 2.5-13 times higher than the estimated 15-50 cases/million compared to national/international PAH registry data suggesting PH registries may underestimate prevalence in rural communities. Review of echocardiogram outreach databases may provide an opportunity for timely diagnosis.