Results From the United States Chronic Thromboembolic Pulmonary Hypertension Registry: Enrollment Characteristics and 1-Year Follow-up.

BACKGROUND: The United States Chronic Thromboembolic Pulmonary Hypertension Registry (US-CTEPH-R) was designed to characterize the demographic characteristics, evaluation, clinical course, and outcomes of surgical and nonsurgical therapies for patients with chronic thromboembolic pulmonary hypertension. RESEARCH QUESTION: What are the differences in baseline characteristics and 1-year outcomes between operated and nonoperated subjects? STUDY DESIGN AND METHODS: This study describes a multicenter, prospective, longitudinal, observational registry of patients newly diagnosed (< 6 months) with CTEPH. Inclusion criteria required a mean pulmonary artery pressure ≥ 25 mm Hg documented by right heart catheterization and radiologic confirmation of CTEPH. Between 2015 and 2018, a total of 750 patients were enrolled and followed up biannually until 2019. RESULTS: Most patients with CTEPH (87.9%) reported a history of acute pulmonary embolism. CTEPH diagnosis delays were frequent (median, 10 months), and most patients reported World Health Organization functional class 3 status at enrollment with a median mean pulmonary artery pressure of 44 mm Hg. The registry cohort was subdivided into Operable patients undergoing pulmonary thromboendarterectomy (PTE) surgery (n = 566), Operable patients who did not undergo surgery (n = 88), and those who were Inoperable (n = 96). Inoperable patients were older than Operated patients; less likely to be obese; have a DVT history, non-type O blood group, or thrombophilia; and more likely to have COPD or a history of cancer. PTE resulted in a median pulmonary vascular resistance decline from 6.9 to 2.6 Wood units (P < .001) with a 3.9% in-hospital mortality. At 1-year follow-up, Operated patients were less likely treated with oxygen, diuretics, or pulmonary hypertension-targeted therapy compared with Inoperable patients. A larger percentage of Operated patients were World Health Organization functional class 1 or 2 at 1 year (82.9%) compared with the Inoperable (48.2%) and Operable/No Surgery (56%) groups (P < .001). INTERPRETATION: Differences exist in the clinical characteristics between patients who exhibited operable CTEPH and those who were inoperable, with the most favorable 1-year outcomes in those who underwent PTE surgery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT02429284; URL: www.clinicaltrials.gov.

Statewide Real-Time Tracking of Beds and Ventilators During Coronavirus Disease 2019 and Beyond.

This brief report describes the rapid deployment of a real-time electronic tracking board for all hospitals in the state of Oregon. In preparation for the coronavirus disease 2019 surge on hospital resources, and in collaboration across health systems, with health authorities and an industry partner, we combined existing infrastructures to create the first automated tracking board for our entire state, including bed types by health system and geographic area, and with granularity to the individual unit level for each participating hospital. At the time of submission, we have a live snapshot of 87% of beds in the state, including real-time ventilator data across eight health systems. The tracking board allows for rapid assessment of available bed and ventilator resources and pulls electronic health record data that is created through normal care processes rather than relying upon manual entry. It is updated every 5 minutes and is drillable from state to unit level. Together these factors make the data actionable, which is essential in a crisis. The new tracking system integrates seamlessly with our preexisting statewide, manually updated tracking board via bidirectional data sharing to ensure existing processes across the state can continue. This new tool allows any health system in our state to visualize occupancy by type and location in real time. Amid pandemic uncertainty, having a reliable tool for tracking critical hospital resources will enhance our statewide ability to maintain healthcare functionality in a world with coronavirus disease 2019.