Low Utilization of Prostacyclin Therapy Prior to Death Among Medicare Patients With Pulmonary Arterial Hypertension

Mathai, Stephen C.; Morland, Kellie; Classi, Peter; Chen, Herman; Forys, Amanda; Nelsen, Andrew C.

doi:10.1016/j.chest.2020.08.1861

Chest

2020

DOI: 10.1016/j.chest.2020.08.1861

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Low Utilization of Prostacyclin Therapy Prior to Death Among Medicare Patients With Pulmonary Arterial Hypertension

Stephen C. Mathai¹,

Kellie Morland²,

Peter Classi³

et al.

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2021

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“…A number of studies indicate that less than half of PAH patients receive pPCY therapy before death or clinical deterioration. [8][9][10][11] In the Registry to Evaluate Early and Longterm PAH Disease Management (REVEAL Registry), only 43% of patients who died during the study period were receiving IV prostacyclin as monotherapy or combination therapy prior to death due to any cause. The authors also found that only 51% of patients were receiving pPCY therapy when they deteriorated to World Health Organization Functional Class IV.…”

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Reasons for refusing parenteral therapy: a qualitative study of patients with pulmonary arterial hypertension

et al. 2021

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While parenteral prostacyclin (pPCY) therapy, delivered either subcutaneously or intravenously (IV)is recommended for pulmonary arterial hypertension (PAH) patients with severe or rapidly developing disease, some patients refuse this treatment. This study aimed to understand, directly from patients with PAH, why pPCY was refused and, in some cases, later accepted. Interviews were conducted with 25 PAH patients who previously refused pPCY therapy (Group A: Refused/Never Initiated [n=9] and Group B: Refused/Initiated [n=16]). Patients in both groups believed that pPCY could improve their symptoms, slow disease progression, and provide them a greater ability to perform activities. Reasons for refusal included concern over side effects and the perceived limitations of pPCY on daily activities. Group A perceived their decision as a balance between quality of life and prolonging life and most acknowledged they would reconsider pPCY if other treatment options were exhausted. Group B cited they initiated therapy due to a worsening of symptoms, disease progression, to improve quality of life, to be there for their family, or a desire to live. Following initiation, Group B indicated their experience met expectations with reduced symptoms, slowed disease progression, and perception of improved survival; concerns related to pPCY were described as manageable. Given the efficacy of pPCY therapy, clinicians should apply knowledge of these findings in clinical practice. Patients noted improvements to parenteral pump technologies to include smaller size, water resistance, and implantability may increase their acceptance of this modality. Development efforts should focus on technologies that increase the acceptance of pPCY when indicated.

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Reasons for refusing parenteral therapy: a qualitative study of patients with pulmonary arterial hypertension

et al. 2021

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Low Utilization of Prostacyclin Therapy Prior to Death Among Medicare Patients With Pulmonary Arterial Hypertension

Cited by 1 publication

References 4 publications

Reasons for refusing parenteral therapy: a qualitative study of patients with pulmonary arterial hypertension

Reasons for refusing parenteral therapy: a qualitative study of patients with pulmonary arterial hypertension

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