Managing the Patient with Pulmonary Hypertension

Chakinala, Murali M.; Duncan, Maribeth; Wirth, Joel A.

doi:10.1016/j.ccl.2016.04.008

Cited by 14 publications

(7 citation statements)

References 25 publications

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“…(1-2) Abbreviations: IQR-interquartile range; PH-pulmonary hypertension 1 States with a COVID-19 incidence below the median on April 20, 2020 as reported by the CDC with an average incidence of 0.7 infected individuals per 1,000 inhabitants 2 States with a COVID-19 incidence above the median on April 20, 2020 as reported by the CDC with an average incidence of 3.1 infected individuals per 1,000 inhabitants 3 From the CDC on April 20, 2020; https://www.cdc.gov/coronavirus/2019-ncov/casesupdates/cases-in-us.html#2 19 11 Deaths among patients with recognized COVID- 19 6 Total number of reported PAH/CTEPH patients followed by centers 16,979 Cumulative incidence of recognized COVID-19 among PAH/CTEPH patients (per 1,000 patients) Overall cumulative incidence of recognized COVID-19 2.9 (95% CI: 2.2-3.9) Cumulative incidence in patients from states with a low-COVID incidence 1.4 (95% CI: 0.8-2.4) Cumulative incidence in patients from states with a high-COVID incidence 4.6 (95% CI: 3.4-6.4)…”

Section: Discussionmentioning

confidence: 99%

“…18 (51%) Of these, centers total cessation (n, %) 5 (14%) Centers obtaining fewer VQ scans (n, %) Ref 50 (91%) Of these, centers with <20% reduction (n, %) 6 (12%) Of these, centers with 20-60% reduction (n, %) 9 (18%) Of these, centers with >60% reduction (n, %) 23 (46%) Of these, centers total cessation (n, %) Of these, centers with <20% reduction in new starts (n, %) 3 (18%) Of these, centers with 20-60% reduction in new starts (n, %) 6 (35%) Of these, centers with >60% reduction in new starts (n, %) 5 (29%) Of these, centers total cessation in new starts (n, %) 3 (18%) Centers with fewer transplant referrals (n, %) Ref 15 (27%) Of these, centers with <20% reduction in new referrals (n, %) 2 (13%) Of these, centers with 20-60% reduction in new referrals (n, %) 8 (53%) Of these, centers with >60% reduction in new referrals (n, %) 2 (13%) Of these, centers total cessation in new referrals (n, %) 3 (20%) %) 3 (15%) 0 (0%) Of these, centers with 20-60% reduction (n, %) 5 (25%) 7 (23%) Of these, centers with >61-99% reduction (n, %) 10 (50%) 20 (67%) Of these, centers total cessation (n, %) Of these, centers with 20-60% reduction in new starts (n, %) 1 (17%) 5 (45%) Of these, centers with >60% reduction in new starts (n, %) 1 (17%) 4 (36%) Of these, centers total cessation in new starts (n, %) 2 (33%) 1 (9%) Centers with lower transplant referrals (n, %) Ref 4 (17%) Ref 11 (33%) Of these, centers with <20% reduction in new referrals (n, %) 0 (0%) 2 (18%) Of these, centers with 20-60% reduction in new referrals (n, %) 2 (50%) 6 (55%) Of these, centers with >60% reduction in new referrals (n, %) 1 (25%) 1 (9%) Of these, centers total cessation in new referrals (n, %) 1 (25%) 2 (18%) 1 States with a COVID-19 prevalence below the median on April 20, 2020 as reported by the CDC with an average prevalence of 0.7 infected individuals per 1,000 inhabitants 2 States with a COVID-19 prevalence above the median on April 20, 2020 as reported by the CDC with an average prevalence of 3.1 infected individuals per 1,000 inhabitants 3 From the CDC on April 20, 2020; https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-inus.html#2…”

Section: Table 3 Impact Of the Coronavirus Outbreak On Routine Clinimentioning

confidence: 99%

“…Guidelines for the care of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) recommend regular clinic visits and frequent diagnostic testing at referral centers. 1,2 During the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) has recommended exploring alternatives to face-to-face visits and suggested rescheduling non-urgent visits and testing. 3 Consistent with this recommendation, many institutions are no longer performing non-urgent cardiac catheterizations.…”

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confidence: 99%

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A Survey-based Estimate of COVID-19 Incidence and Outcomes among Patients with Pulmonary Arterial Hypertension or Chronic Thromboembolic Pulmonary Hypertension and Impact on the Process of Care

Lee¹,

Burger

Delossantos³

et al. 2020

Annals ATS

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Rationale: Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) typically undergo frequent clinical evaluation. The incidence and outcomes of COVID-19 and its impact on routine management for patients with pulmonary vascular disease is currently unknown. Objectives: For patients with PAH/CTEPH followed at accredited pulmonary hypertension centers, assess the cumulative incidence and outcomes of recognized COVID-19. Evaluate the pandemic's impact on clinic operations at these centers. Methods: A survey was emailed to program directors of centers accredited by the Pulmonary Hypertension Association. Descriptive analyses and linear regression were used to analyze results. Results: Seventy-seven center directors were successfully emailed a survey, 58 responded (75%). The cumulative incidence of COVID-19 recognized in individuals with PAH/CTEPH was 2.1 cases per 1,000 patients, similar to the general United States population. In patients with PAH/CTEPH and recognized COVID-19 30% were hospitalized and 12% died. These outcomes appear worse than the general population. A large impact on clinic operations was observed including fewer clinic visits and substantially increased use of telehealth. A majority of centers curtailed diagnostic testing and a minority limited new starts of medical therapy. Most centers did not use experimental therapies in PAH/CTEPH patients diagnosed with COVID-19. Conclusions: The cumulative incidence of COVID-19 recognized in patients with PAH/CTEPH appears similar to the broader population, although outcomes may be worse. While the total

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Section: Discussionmentioning

confidence: 99%

Section: Table 3 Impact Of the Coronavirus Outbreak On Routine Clinimentioning

confidence: 99%

mentioning

confidence: 99%

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A Survey-based Estimate of COVID-19 Incidence and Outcomes among Patients with Pulmonary Arterial Hypertension or Chronic Thromboembolic Pulmonary Hypertension and Impact on the Process of Care

Lee¹,

Burger

Delossantos³

et al. 2020

Annals ATS

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“…Due to the nonspecific nature of symptoms, PH is most frequently diagnosed when patients are in the advanced stages of the disease [ 47 ]. Currently, there is no cure for PH and treatment is solely aimed at improving symptoms and exercise tolerance, long-term outcomes and QOL, as well as slowing the rate of deterioration [ 48 ]. Pulmonary arterial hypertension (PAH) is a rare (estimated prevalence of 15–50 cases per million) subset group of PH, characterised by progressive pulmonary vascular resistance, leading to right heart failure and death.…”

Section: Palliative Care and Pulmonary Hypertensionmentioning

confidence: 99%

The potential of palliative care for patients with respiratory diseases

Narsavage¹,

Chen²,

Korn³

et al. 2017

Breathe

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Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears. A practical checklist of activities based on the domains of palliative care can assist clinicians to integrate palliative care into their practice. Clinical management of patients receiving palliative care requires consideration of human factors and related organisational characteristics that involve cultural, educational and motivational aspects of the patient/family and clinicians.Educational aimsTo explain the basic domains of palliative care applicable to chronic respiratory diseases.To review palliative care interventions for patients with chronic respiratory diseases.To outline a checklist for clinicians to use in practice, based on the domains of palliative care.To propose recommendations for clinical management of patients receiving palliative care for chronic respiratory diseases.

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“…Considerably less attention has been paid to the organization of PH care outside of expert centers. In the context of rising PH prevalence, 8 understanding PH care organizations outside or alongside expert PH centers is particularly relevant and is a vital first step to standardizing PH care quality across these various care settings 13 . The Veterans Health Administration (VA) is the largest integrated health care system in the United States (U.S.), providing care for over 250,000 patients with PH across 140 medical centers nationally 7 .…”

Section: Introductionmentioning

confidence: 99%