Chronic thromboembolic pulmonary hypertension global cross-sectional scientific survey (CLARITY) – interim results on the adoption and perception of guidelines

Abstract

Background The chronic thromboembolic pulmonary hypertension (CTEPH) global cross-sectional scientific survey (CLARITY) was established to provide insights into current clinical practices and unmet needs in the diagnosis and treatment of CTEPH. The European Society of Cardiology (ESC) plays a leading role in establishing guidelines (GLs) for clinical decision-making in acute pulmonary embolism (PE) and CTEPH. It is of interest to better understand how these GLs affect real-world practice. Purpose To assess the adoption and perception of clinical practice GLs among medical specialists working in the fields of cardiology. Methods The online survey was developed by an independent committee of 11 international CTEPH experts using the Delphi method and designed to elicit responses regarding disease awareness and management, including follow-up after acute PE and diagnosis of suspected CTEPH. Logic functions were implemented to ensure respondents only viewed questions relevant to their clinical practice. To date, professional members of 17 Scientific Societies and other medical organizations were invited to respond to the survey. For this interim analysis response data were collected from 10.09.2021 to 10.02.2022. Results Out of 242 respondents, 107 specialized in cardiology (44%) and 7 specialized in angiology (3%) were included in this interim analysis. Respondents were from Europe (75%, n=85), Asia Pacific (20%, n=23) and the Americas (5%, n=6) and generally had 15–29 (40%, n=45) or 5–14 (37%, n=42) years of working experience. Of the 67 respondents (59%) that did not work in a pulmonary hypertension (PH)/CTEPH expert centre, only 24 (36%) were affiliated with such a centre. Of respondents involved in acute PE management (n=101) and CTEPH diagnosis (n=87), 87 (86%) and 71 (82%) reported following the 2019 PE ESC/European Respiratory Society (ERS) and 2015 PH ESC/ERS GLs, respectively. Regardless of country, a higher proportion of respondents from Asia Pacific also reported using national GLs for PE (44%, n=10) and CTEPH (52%, n=12) compared to respondents from Europe (15%, n=11; 25%, n=15) and the Americas (25%, n=1; 40%, n=2). Overall, GLs were perceived to facilitate clinical practice (Fig. 1). Lack of GLs to screen for CTEPH following acute PE was more often reported as a barrier by respondents from Asia Pacific and those working in an expert centre. Low adherence to GLs was reported as a barrier to CTEPH diagnosis by approximately 1/3 of respondents, irrespective of care setting, and in higher proportion among those with more working experience. Conclusion Despite the availability of GLs, reported barriers indicate an opportunity for educational activities to improve adoption and adherence to GLs. Observed differences and potential gaps between clinical practice and the GLs warrant further exploration through additional global insights collected by the survey throughout April 2022. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): This survey is sponsored by Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson

Pulmonary Embolism (PE) to Chronic Thromboembolic Pulmonary Disease (CTEPD): Findings from a Survey of UK Physicians

“…The CLARITY survey found that the most frequent barriers affecting the detection of CTEPH after PE reported by respondents (353 physicians from Europe, Asia–Pacific and the Americas) were low disease awareness among nonexperts (77%), lack of structured follow-up after acute PE (56%), nonspecific presentation of disease (43%), incomplete understanding of the natural history of disease (39%) and lack of clinical guidelines to screen for possible CTEPH (73, 23%) [ 25 ]. Moreover, low adherence to guidelines was reported as a barrier to CTEPH diagnosis by approximately one-third of respondents [ 26 ]. The variability in the physicians’ practices, as shown in this survey, could support this finding that more comprehensive guidelines on PE follow-up are needed.…”