Abstract Body: Introduction: Pulmonary Arterial Hypertension (PAH) remains a significant health challenge globally, with its management complexities exacerbated during the COVID-19 pandemic. Despite ongoing research, there exists a notable gap in comprehensive data analyzing the temporal and demographic variations in PAH burden over the last three decades, particularly during the critical early years of the pandemic.

Method: The non-fatal health outcome such as incidence and prevalence were estimated using DISMOD MR 2.1 tool, while fatal health outcome was estimated using cause of death ensemble model (CODEm) due to PAH by age, sex, year and location across the 204 countries and territories from 1990-2021 using global burden of disease tool.

Results: The prevalence of PAH increased from 105,703 (95% UI: 86,381 to 130,334) in 1990 to 191,808 (155,356 to 235,787) in 2021. The largest increase in total percentage of change (TPC) in age-standardized incidence rates (ASIR) occurred in Central Europe at 20% (19%-22%), while Central Asia was the only region with a rise in PAH-related deaths, marking a 4% increase (-13% to 26%). High-middle socio-demographic index countries observed a 6% rise in TPC in ASIR. Nationally, Slovakia saw the highest surge in ASIR at 40%, with Latvia experiencing the most significant rise in mortality rates at 352%, and Mauritius leading in DALYs increase at 165%. The highest incidence rates in 2021 were among the 75-79 age group at 1.66 (1.09-2.39) per 100,000, with infants aged 0-6 days witnessing the highest mortality rates at 13.67 (10.28-18.55) per 100,000.

Conclusion: In 2021, PAH accounted for 0.11% of all cardiovascular deaths, indicating a relatively low but increasing burden despite significant improvements in management strategies. This study highlights the urgent need for enhanced global efforts to address the rising incidence of PAH, particularly given the challenges posed by aging populations and diverse regional health infrastructures. It is essential for healthcare providers to stay informed of these trends and continuously adapt their clinical practices to optimize outcomes for patients with PAH.