Diagnostic delay in pulmonary arterial hypertension: Insights from the Australian and New Zealand pulmonary hypertension registry

Khou, Victor; Anderson, James; Strange, Geoff; Corrigan, Carolyn; Collins, Nicholas; Celermajer, David S.; Dwyer, Nathan; Feenstra, John; Horrigan, Mark; Keating, D.; Kotlyar, Eugene; Lavender, Melanie; McWilliams, Tanya; Steele, Peter; Weintraub, Robert G.; Whitford, Helen; Whyte, K.; Williams, Trevor; Wrobel, Jérémy; Keogh, Anne; Lau, Edmund

doi:10.1111/resp.13768

Cited by 53 publications

(72 citation statements)

References 29 publications

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“…In the beginning of March, a lockdown was proposed, restricting the daily life as well as the routine care in hospitals. 4 In pulmonary hypertension (PH), an early diagnosis is a demanding but crucial target 5 – 7 and the importance of regular visits to constantly monitor treatment in expert centres is highlighted in the current guidelines as well as the proceedings of the 6th World Symposium on PH. 7 , 8 In general, patients are either scheduled for out-patient visits according to their urgency (next day, within one week, within one month) or for immediate hospital admission.…”

mentioning

confidence: 99%

“…PH patients are already facing a substantial delay from onset of symptom to definite diagnosis and treatment initiation in PH centres. 5,6 As diagnostic delays might influence the overall outcome in PH, 5 reducing this gap has been defined as a major goal during the last PH world symposium. 8 Therefore, the SARS-CoV-2 pandemic and its related impact on social behaviour worsened the hitherto described diagnostic delay and increased the referral gap in PH.…”

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confidence: 99%

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Impact of SARS‐CoV‐2 pandemic on pulmonary hypertension out‐patient clinics in Germany: a multi‐centre study

et al. 2020

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confidence: 99%

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confidence: 99%

Impact of SARS‐CoV‐2 pandemic on pulmonary hypertension out‐patient clinics in Germany: a multi‐centre study

et al. 2020

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“…COVID-19 has brought unprecedented challenges to healthcare, especially in the management of chronic diseases like PAH, which is often associated with delayed diagnosis 8 . and, once diagnosed, warrants close monitoring.…”

Section: Impact Of Covid-19 On Pah Carementioning

confidence: 99%

Risk assessment in patients with pulmonary arterial hypertension in the era of COVID 19 pandemic and the telehealth revolution: State of the art review

Milks

Sahay

Benza

et al. 2021

The Journal of Heart and Lung Transplantation

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Patients affected by pulmonary arterial hypertension (PAH) benefit from intensive, continuous clinical monitoring to guide escalation of treatments that carry the potential to improve survival and quality of life. During the COVID-19 pandemic, the need for physical distancing has fueled the expeditious expansion of various telehealth modalities, which may apply in a unique manner to individuals with PAH. Performance of objective risk assessments in patients with PAH remotely via telemedical visits and other telehealth mechanisms is unprecedented and not yet rigorously validated. The uniquely high risk for rapid deterioration in PAH patients demands a high degree of sensitivity to detect changes in functional assessments. In this review, several telehealth modalities for potential utilization in risk assessment and treatment titration in patients with PAH are explored, yet additional study is needed for their validation with the pre-pandemic care paradigm.

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“…Advanced PH therapy is recommended for the treatment of PAH, however it requires specialist centre prescription, careful monitoring and is expensive [14]. Moreover, there are significant delays in definitive diagnosis of PH leading to delayed commencement of appropriate therapy [15,16]. Better understanding of PH epidemiology will allow better planning and management of scarce health resources and thence hopefully improve the outcomes.…”

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confidence: 99%

The challenge of an expanded therapeutic window in pulmonary hypertension

2020

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Introduction: The Top End of Australia has a high proportion of Indigenous people with a high burden of chronic cardiac and pulmonary diseases likely to contribute to pulmonary hypertension (PH). The epidemiology of PH has not been previously studied in this region. Methods: Patients with PH were identified from the Northern Territory echocardiography database from January 2010 to December 2015 and followed to the end of 2019 or death. PH was defined as a tricuspid regurgitation velocity ≥2.75 m/s measured by Doppler echocardiography. The etiology of PH, as categorized by published guidelines, was determined by reviewing electronic health records. Results: 1764 patients were identified comprising 49% males and 45% Indigenous people. The prevalence of PH was 955 per 100,000 population (with corresponding prevalence of 1587 for Indigenous people). Hypertension, atrial fibrillation, diabetes and respiratory disease were present in 85%, 45%, 41% and 39%, respectively. Left heart disease was the leading cause for PH (58%), the majority suffering from valvular disease (predominantly rheumatic). Pulmonary arterial hypertension (PAH), respiratory disease related PH, chronic thromboembolic PH (CTEPH) and unclear multifactorial PH represented 4%, 16%, 2% and 3%, respectively. Underlying causes were not identifiable in 17% of the patients. Only 31% of potentially eligible patients were on PAH-specific therapy. At census, there was 40% mortality, with major predictors being age, ePASP and Indigenous ethnicity. Conclusion: PH is prevalent in Northern Australia, with a high frequency of modifiable risk factors and other treatable conditions. Whether earlier diagnosis, interpretation and intervention improves outcomes merits further assessment.

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Diagnostic delay in pulmonary arterial hypertension: Insights from the Australian and New Zealand pulmonary hypertension registry

Abstract: This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 53 publications

References 29 publications

Impact of SARS‐CoV‐2 pandemic on pulmonary hypertension out‐patient clinics in Germany: a multi‐centre study

Impact of SARS‐CoV‐2 pandemic on pulmonary hypertension out‐patient clinics in Germany: a multi‐centre study

Risk assessment in patients with pulmonary arterial hypertension in the era of COVID 19 pandemic and the telehealth revolution: State of the art review

The challenge of an expanded therapeutic window in pulmonary hypertension

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