Highlights
- •40 PH providers answered focused questions of longitudinal patient assessment.
- •Patients with advanced disease are generally followed more frequently in clinic.
- •Providers trend toward more frequent objective testing in sicker patients.
- •Heterogenous longitudinal assessment patterns prevail among PH providers.
Abstract
Background
Patients suffering from pulmonary arterial hypertension (PAH) demand frequent assessment
to keep pace with a dynamic and sometimes rapidly progressive disease course. To improve
our understanding of patient monitoring, we conducted a survey of pulmonary hypertension
(PH) providers to establish real-world practice patterns.
Objective
To evaluate the type and frequency of patient assessment methods employed by expert
PH providers following PAH diagnosis
Methods
A descriptive cross-sectional survey of PH providers across the United States was
utilized to assess provider practices. Between September 14, 2017 to October 17, 2017,
a survey was distributed electronically to PH experts assessing follow-up frequency
and testing evaluation of patients with PAH.
Results
40 (11.4%) providers completed the survey, representing cardiologists, pulmonologists,
and advanced practice providers at centers who cared for an average of 95 patients
per year with PAH. Follow-up testing and clinic evaluation was influenced by severity
of patient illness. Frequency of re-assessment of clinic follow-up, six-minute walk
test, echocardiogram, brain natriuretic peptide, and right heart catheterization in
various clinical scenarios all reflected disparate practice.
Conclusions
Current clinical practice patterns in the monitoring of patients with PAH are variable
and do not necessarily reflect guideline-based practices, suggesting the need for
further research and improved guidelines on the frequency of follow up and repeat
testing.
Keywords
Abbreviations:
PAH (Pulmonary Arterial Hypertension), PH (Pulmonary Hypertension), SQ (Subcutaneous), IV (Intravenous), TTE (Transthoracic Echocardiogram), RHC (Right Heart Catheterization), CPET (cardiopulmonary exercise test)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute CareAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Survival in incident and prevalent cohorts of patients with pulmonary arterial hypertension.Eur Respir J. 2010; 36: 549-555https://doi.org/10.1183/09031936.00057010
- Predicting survival in pulmonary arterial hypertension: Insights from the registry to evaluate early and long-term pulmonary arterial hypertension disease management (REVEAL).Circulation. 2010; 122: 164-172https://doi.org/10.1161/CIRCULATIONAHA.109.898122
- 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.Eur Respir J. 2015; 46: 903-975https://doi.org/10.1183/13993003.01032-2015
- Prognostic implications of serial risk score assessments in patients with pulmonary arterial hypertension: A Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) analysis.J Hear Lung Transplant. 2015; 34: 356-361https://doi.org/10.1016/j.healun.2014.09.016
- ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association.Circulation. 2009; 119: 2250-2294https://doi.org/10.1161/CIRCULATIONAHA.109.192230
- The prognostic impact of follow-up assessments in patients with idiopathic pulmonary arterial hypertension.Eur Respir J. 2012; 39: 589-596https://doi.org/10.1183/09031936.00092311
- Evaluation of the predictive value of a clinical worsening definition using 2-year outcomes in patients with pulmonary arterial hypertension: A REVEAL registry analysis.Chest. 2013; 144: 1521-1529https://doi.org/10.1378/chest.12-3023
- Prognostic value of echocardiographic changes in patients with pulmonary arterial hypertension receiving parenteral prostacyclin therapy.J Am Soc Echocardiogr. 2014; 27 (e2.): 733-741https://doi.org/10.1016/j.echo.2014.03.012
- Risk assessment in patients with functional class II pulmonary arterial hypertension: Comparison of physician gestalt with ESC/ERS and the REVEAL 2.0 risk score.PLoS One. 2020; 15: 1-12https://doi.org/10.1371/journal.pone.0241504
- Mortality in pulmonary arterial hypertension: Prediction by the 2015 European pulmonary hypertension guidelines risk stratification model.Eur Respir J. 2017; 50: 1-10https://doi.org/10.1183/13993003.00740-2017
- Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension.Eur Respir J. 2017; 50: 1-10https://doi.org/10.1183/13993003.00889-2017
- Predicting Survival in Patients With Pulmonary Arterial Hypertension: The REVEAL Risk Score Calculator 2.0 and Comparison With ESC/ERS-Based Risk Assessment Strategies.Chest. 2019; 156: 323-337https://doi.org/10.1016/j.chest.2019.02.004
- Risk stratification and medical therapy of pulmonary arterial hypertension.Eur Respir J. 2019; 53https://doi.org/10.1183/13993003.01889-2018
- A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension.Eur Heart J. 2018; 39: 4175-4181https://doi.org/10.1093/eurheartj/ehx257
- Right heart catheterisation is still a fundamental part of the follow-up assessment of pulmonary arterial hypertension.Eur Respir J. 2018; 52: 6-8https://doi.org/10.1183/13993003.00738-2018
- Is right heart catheterisation still a fundamental part of the follow-up assessment of pulmonary arterial hypertension? The argument against.Eur Respir J. 2018; 52: 6-8https://doi.org/10.1183/13993003.00996-2018
- Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension [CE: This is duplicate referene with reference 11.].Eur Respir J. 2017; 50: 1-10https://doi.org/10.1183/13993003.00889-2017
- Development and Validation of an Abridged Version of the REVEAL 2.0 Risk Score Calculator, REVEAL Lite 2, for Use in Patients With Pulmonary Arterial Hypertension.Chest. 2021; 159: 337-346https://doi.org/10.1016/j.chest.2020.08.2069
- Role of Cardiac Magnetic Resonance Imaging in the Management of Patients With Pulmonary Arterial Hypertension.J Am Coll Cardiol. 2008; 52: 1683-1692https://doi.org/10.1016/j.jacc.2008.08.033
- A computed method for noninvasive MRI assessment of pulmonary arterial hypertension.J Appl Physiol. 2004; 96: 463-468https://doi.org/10.1152/japplphysiol.00225.2004
- Outcomes of Pulmonary Arterial Hypertension Are Improved in a Specialty Care Center.Chest. 2020; 158: 330-340https://doi.org/10.1016/j.chest.2020.01.046
Article info
Publication history
Published online: November 10, 2022
Accepted:
October 21,
2022
Received in revised form:
October 20,
2022
Received:
July 18,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
