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Yet these therapies are commonly used in practice. Little is known of the effects of treatment outside of clinical trials. We aimed to establish outcomes of vasodilator treatment for Groups 2\/3 pulmonary hypertension in real\u2010world practice. We conducted a retrospective cohort study of 132,552\u00a0Medicare\u2010eligible Veterans with incident Groups 2\/3 pulmonary hypertension between 2006 and 2016, and a secondary nested case\u2013control study. Our primary outcome was a composite of death by any cause or selected acute organ failures. In our cohort analysis, we calculated adjusted risks of time to our outcome using Cox proportional hazards models with facility\u2010specific random effects. In our case\u2013control analysis, we used logistic mixed\u2010effects models to estimate the effect of any past, recent, and cumulative exposure on our outcome. From our cohort study, 3249 (2.5%) Veterans were exposed to pulmonary vasodilators. Exposure to vasodilators was associated with increased risk of our primary outcome, in both Group 3 (HR: 1.58 (95% CI: 1.37\u20131.82)) and Group 2 (HR: 1.26 (95% CI: 1.12\u20131.41)) pulmonary hypertension patients. The case\u2013control study determined odds of our outcome increased by 11% per year of exposure (OR: 1.11 (95% CI: 1.07\u20131.16)). Treating Groups 2\/3 pulmonary hypertension with vasodilators in clinical practice is associated with increased risk of harm. This extension of trial findings to a real\u2010world setting offers further evidence to limit use of vasodilators in Groups 2\/3 pulmonary hypertension outside of clinical trials.<\/jats:p>","DOI":"10.1177\/20458940211001714","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T15:54:36Z","timestamp":1614268476000},"page":"1-12","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Outcomes of pulmonary vasodilator use in Veterans with pulmonary hypertension associated with left heart disease and lung disease"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5333-259X","authenticated-orcid":false,"given":"Kari R.","family":"Gillmeyer","sequence":"first","affiliation":[{"name":"Center for Healthcare Organization &amp; Implementation Research Edith Nourse Rogers Veterans Hospital Bedford MA USA"},{"name":"The Pulmonary Center Boston University School of Medicine Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald R.","family":"Miller","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization &amp; Implementation Research Edith Nourse Rogers Veterans Hospital Bedford MA USA"},{"name":"Center for Population Health University of Massachusetts Lowell MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark E.","family":"Glickman","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization &amp; Implementation Research Edith Nourse Rogers Veterans Hospital Bedford MA USA"},{"name":"Department of Statistics Harvard University Cambridge MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirley X.","family":"Qian","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization &amp; Implementation Research Edith Nourse Rogers Veterans Hospital Bedford MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth S.","family":"Klings","sequence":"additional","affiliation":[{"name":"The Pulmonary Center Boston University School of Medicine Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley A.","family":"Maron","sequence":"additional","affiliation":[{"name":"Department of Cardiology Veterans Affairs Boston Healthcare System Boston MA USA"},{"name":"Division of Cardiovascular Medicine Brigham and Women\u2019s Hospital Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph T.","family":"Hanlon","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion Veterans Affairs Pittsburgh Healthcare System Pittsburgh PA USA"},{"name":"Geriatric Research Education and Clinical Center Veterans Affairs Pittsburgh Healthcare System Pittsburgh PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seppo T.","family":"Rinne","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization &amp; Implementation Research Edith Nourse Rogers Veterans Hospital Bedford MA USA"},{"name":"The Pulmonary Center Boston University School of Medicine Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renda S.","family":"Wiener","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization &amp; Implementation Research Edith Nourse Rogers Veterans Hospital Bedford MA USA"},{"name":"Center for Healthcare Organization &amp; Implementation Research Veterans Affairs Boston Healthcare System Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,3]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.127.5.1531"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.110.958801"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00002713"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1233315"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1067\/mje.2002.118526"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.107.5.1193"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu193"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(00)01102-5"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs104"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201710-2093PP"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2016.03.031"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2016.08.002"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.14.1718"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv336"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201403-0446OC"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00176312"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(14)70013-X"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001458"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1159\/000107791"},{"key":"e_1_2_13_21_1","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01886-2017","article-title":"Macitentan in pulmonary hypertension due to left ventricular dysfunction","volume":"51","author":"Vachi\u00e9ry JL","year":"2018","journal-title":"Eur Respir J"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx700"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(19)30250-4"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01537-2014"},{"key":"e_1_2_13_25_1","article-title":"Pulmonary hypertension in chronic lung disease and hypoxia","author":"Nathan SD","year":"2019","journal-title":"Eur Respir J. 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