Pulmonary endarterectomy (PEA) is the treatment of choice for patients with proximal chronic thromboembolic pulmonary hypertension (CTEPH). The UK has a single centre performing this operation and the program became nationally funded since 2000. Patients are referred from seven specialist pulmonary hypertension centres.Method
All 625 patients treated with PEA from 2000 to 2010 were mapped according to their home postcode at the time of PEA surgery. Primary care trusts (PCT's) were assigned from these home postcodes. The incidence rate of each PCT and overall incidence were analysed. Mapinfo software was used to generate the referral maps.Results
The new patient incidence ranges from no referrals in 123 PCT's in 2000–2002 to 90 in 2008–2010. The most recent period shows highest referral rates for PEA. From our PEA data mapping analysis we have calculated that the incidence of operated patients was 0.4 million population in 2000 (n=22) and 2 per million population in 2010 (n=122).Conclusion
There has been a fivefold increase in PEA activity in the UK over the last decade. The analysis of our data are limited to surgical cases. The current incidence of PEA in the UK is already higher than historical estimation of the incidence of all CTEPH (0.1–0.5/million, Fedullo, N Engl J Med 2001). Since 30% of patients with CTEPH have distal disease distribution and some patients with proximal CTEPH do not proceed to surgery due to choice or comorbidities, the overall incidence of CTEPH is likely to be significantly higher than 2 per million/year and higher than previously suspected.