Deerfield
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Launched in 1994, Deerfield Management Company is an investment firm dedicated to advancing healthcare through information, investment, and philanthropy—all toward the end goal of cures for disease, improved quality of life, and reduced cost of care.

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Self-reported physician practices in pulmonary arterial hypertension: diagnosis, assessment, and referral

Background

Numerous clinical trials have contributed to rapid advancements in thediagnosis and management of pulmonary arterial hypertension (PAH), yet patientsoften do not undergo right heart catheterization (RHC) with vasoreactivitytesting and may receive a delayed or incorrect diagnosis. Efforts to improvestandards of care include the designation of Pulmonary Hypertension Association(PHA)-Accredited PH Care Centers (PHCCs). This study evaluated currentpractices in the diagnosis and assessment of PAH.

Methods

A survey of 167 physicians who had ≥1 claim for PAH in the past 3 months wasconducted.

Results

Of 167 respondents, 15% were affiliated with a PHCC, 40% had referred ≥1patient with diagnosed PAH, and 79% had ≥1 patient referred to them by anotherphysician who they then newly diagnosed with PAH. More than half (52%) reportedhaving ≥1 patient who was previously misdiagnosed with PAH referred to them byanother physician. RHC and vasoreactivity testing, respectively, were performedin 43% and 33% of patients with PAH who respondents referred to anotherphysician, 86% and 67% of patients newly diagnosed by respondents, and 84% and57% of patients who respondents considered accurately diagnosed prior to beingreferred to them. Respondents affiliated with a PHCC were more likely to try torefer to another physician affiliated with a PHCC, and to perform RHC andvasoreactivity testing.

Conclusions

Self-reported clinical practices often deviated from established guidelines.Future research should focus on both clinical efficacy and ways to encourageclinicians to bring their practices in line with well-supported, evidence-basedrecommendations.

Keywords
Pulmonary arterial hypertension; Clinical practice; Right heartcatheterization; Vasoreactivity testing; Pulmonary hypertension

Abbreviations
CCB, calcium channel blocker; FC, functional classification; PAH, pulmonaryarterial hypertension; PCPs, primary care physicians; PH, pulmonaryhypertension; PHA, Pulmonary Hypertension Association; PHCCs, PulmonaryHypertension Care Centers; RHC, right heart catheterization; SHS, SymphonyHealth Solutions