This activity is sponsored as an educational service by Actelion Pharmaceuticals US, Inc. The information herein is not intended for continuing medical education (CME) purposes.
Ronald J. Oudiz, MD, is professor of medicine at David Geffen School of Medicine at UCLA, director of the Liu Center for Pulmonary Hypertension and clinical director of Wasserman Cardiopulmonary Exercise Laboratory in Torrance, California. Dr. Oudiz is a paid consultant for Actelion Pharmaceuticals, Inc.
Pulmonary arterial hypertension (PAH) is a disease of the lung vasculature defined by a mean pulmonary artery pressure (mPAP) of at least 25 mmHg* with a pulmonary capillary wedge pressure of at most 15 mmHg at rest in the absence of identifiable causes.1 In the majority of patients, disease progression is inevitable, and long-term survival remains poor despite improvements in the management and treatment of PAH.1 World Health Organization (WHO) functional class (FC) is a powerful predictor of outcome in PAH and can also help guide treatment decisions (Table).2,3 Achievement of WHO FC I–II, which is associated with more favorable prognosis than FC III and IV, has been established as an important treatment goal.2,4 Nonetheless, many patients with WHO FC II symptoms still experience disease progression and early death even after initiation of PAH-specific treatment.5 As stated in the 2015 European Society of Cardiology/European Respiratory Society (ESC/ERS) Guidelines, a comprehensive risk assessment that takes into account multiple prognostic variables is required, as no single variable provides sufficient prognostic information alone.4 Risk assessment can be used not only to determine prognosis, but also to identify treatment goals and monitor disease progression, and to evaluate treatment response.6
Despite risk-assessment guidelines for pulmonary hypertension set forth by ESC/ERS,4 physician risk assessment may differ from ESC/ERS risk criteria. Therefore, to better understand real-world treatment strategies as they relate to patient risk, a retrospective analysis was conducted by obtaining patients’ risk level and treatment information from deidentified chart data available from the patient’s last visit or follow-up. This analysis sought to understand both treatment utilization and discrepancies between physician assessment of their patients’ risk and established risk assessment parameters.
*Research was conducted prior to the 6th World Symposium on Pulmonary Hypertension update, which proposed a new hemodynamic definition of PAH from mPAP > 25 mmHg to > 20 mmHg.
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