Investigators in Greece reported a COVID-19 incidence risk of 3.6% among patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH), along with a hospitalization rate of 44.4%. and a mortality rate of 22.2%, according to their correspondence published online in the Hellenic Journal of Cardiology.

Comparatively, the incidence risk in the general Greek population aged more than 25 years is 4.8%, with a mortality rate of 3%.

Given the increased mortality rate, the authors encouraged medical professionals to strongly advise their patients with PAH or CTEPH “to [get] vaccinated, continue to adhere to preventive infection measures, and [protect themselves] from the disabling and potentially fatal complications of COVID-19 and its variants of concern.”

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The researchers collected data from the Hellenic Pulmonary Hypertension Registry (HOPE) and direct communication with 9 pulmonary hypertension (PH) expert centers in Greece caring for 499 patients, of whom 372 had PAH and 127 had CTEPH. Among these 499 patients, 18 cases of COVID-19 infection (3.6%) occurred between February 2020 and mid-August 2021.

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Of the 18 patients, 77.8% were women and 11.1% were fully vaccinated. The median age of individuals affected was 54.5 years. Twelve patients (66.7%) had PAH, while 6 (33.3%) had CTEPH. Six of the 12 patients with PAH had mixed connective tissue disease.

Eight of the 18 patients with COVID-19 required hospitalization for oxygen therapy and COVID-19 treatments including dexamethasone, remdesivir, antibiotics, and low molecular weight heparin. Four of the 8 hospitalized patients died due to COVID-19 complications—3 while in the hospital and one 3 days following discharge. Three of these deceased patients were 70 years or older and one had significant comorbidities.

The most common acute COVID-19 symptoms, lasting a median of 6 days, included fever, cough, and fatigue. No patients who successfully recovered from COVID-19 reported long-term symptoms or declines in functional status following infection.


Farmakis IT, Karyofyllis P, Frantzeskaki F, et al. Incidence and outcomes of COVID-19 in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: data from the Hellenic pulmOnary hyPertension rEgistry (HOPE). Hellenic J Cardiol. Published online November 26, 2021. doi:10.1016/j.hjc.2021.10.002