Outcomes of COVID-19 in patients vaccinated and unvaccinated against SARS-CoV-2 and suffering from pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

INTRODUCTION Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) lead to progressive right heart failure. The mortality rates in PAH and CTEPH patients due to COVID-19 are high, and vaccination against COVID-19 is recommended in this group.OBJECTIVES We analyzed the incidence and outcomes of COVID-19 in the PAH/CTEPH patients for 2 years of the pandemic, as well as the predictors of worse outcomes of COVID-19 in this group.PATIENTS AND METHODS PAH/CTEPH patient data for this observational, cohort study were obtained from 3 pulmonary hypertension centers between March 11, 2020 and March 11, 2022.RESULTS A total of 364 consecutive patients with PAH/CTEPH (248/122; 232 women [64%]; median [interquartile range] age, 61 years [18-92]) were included in the study. All the patients had advanced pulmonary hypertension at baseline. Eighty-five patients (23%) suffered from COVID-19. Seven of them (8%), all of whom were unvaccinated, died of COVID-19. The unvaccinated patients suffered from COVID-19 more often than the vaccinated ones (46% vs 9%; P <0.001). As many as 31% of the PAH/CTEPH patients with COVID-19 needed hospitalization, in 8% of cases in the intensive care unit. Age equal to or above 65 years and severe pulmonary hypertension defined as a World Health Organization functional class 3 or 4 were associated with severe COVID-19 in the PAH/CTEPH patients.CONCLUSIONS The vaccinated PAH/CTEPH patients suffered from COVID-19 less frequently than the unvaccinated ones. The mortality rate and hospitalization due to COVID-19 were higher in the PAH/CTEPH patients than in the general population. All efforts should be made to convince the PAH/CTEPH patients to vaccinate against COVID-19.