Abstract 11192: Diagnosis and Management of PAH: An Initiative to Close the Care Gap
Purpose: This knowledge translation program was intended to support clinicians in managing patients with pulmonary arterial hypertension (PAH) according to a guideline based approach.
Methods: Between October 2005 and June 2007, 62 US specialists enrolled and recorded patient work up, management, and outcome data. Queries were generated automatically if the guideline recommended tests were not performed and required physician response.
Results: Of 787 enrolled patients with PAH, 77.5% were women, 55 years old (45, 66), and 8.6% were in class I, 38.8% in II, 47.5% in III, and 5.1% in IV .Of the ACCP recommended work up at baseline, CBC was performed in 90.7%, LFT in 90.6%, CTD screen in 50.2%, HIV screen in 29.0%, CXR in 88.3%, ECG in 81.6%, PFT in 2.8%, V/Q scan in 57.4%, 2-D Echo in 96.8%, 6MW in 76.0%, and RHC in 90.3% of patients. All typical cardiology recommended tests (CXR, ECG and Echo) were performed in 73.7%. The quality enhancement component of this program generated 1494 reminders on 636 patients (80.8%) with validated baseline data. A majority of patients had one reminder (median of 2 reminders (1, 3). The impact of reminders is shown in the table and reveals that physician feedback resulted in more guidelines based use of dignostic tests. With respect to management, 77.8% of patients were on disease specific therapy. Calcium blockers were used in 21.6% and approximately half were on this therapy specifically for PAH. While RHC was performed in the majority of these patients, the vasoreactivity was assessed in only 36.5% and was positive in only 8.2%.
Conclusions: The database from this knowledge translation initiative allows a real world look at the diagnosis, management and outcome in PAH patients. The results suggest that PAH work-up and management may be suboptimal for some patients and can be improved through further interventional programs. CLINICAL IMPLICATIONS: Greater adherence to guidelines may improve outcome in these high-risk patients.
- © 2010 by American Heart Association, Inc.