The Use of Risk Assessment Tools and Prognostic Scores in Managing Patients with Pulmonary Arterial Hypertension

Abstract

Purpose of Review Pulmonary arterial hypertension (PAH) is a chronic, progressive, and incurable disease with significant morbidity and mortality. Despite increasingly available treatment options, PAH patients continue to experience disease progression and increased rates of hospitalizations due to right heart failure. Physician’s ability to comprehensively assess PAH patients, determine prognosis, and monitor disease progression and response to treatment remains critical in optimizing outcomes. Recent Findings Risk assessment in PAH should include a range of clinical, hemodynamic, and exercise parameters, performed in a serial fashion over the course of treatment. Approaches to risk assessment in PAH patients include the use of risk variables, scores, and equations that stratify the impact of both modifiable (e.g., 6-min walk distance, functional class, brain natriuretic peptide), and non-modifiable (e.g., age, gender, PAH etiology) risk factors. Such tools allow physicians to better determine prognosis, allocate treatment resources, and enhance the consistency of treatment approaches across providers. Summary Comprehensive and accurate risk prediction is essential to make individualized treatment decisions and optimizing outcomes in PAH.

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“…The existing stratification approaches reliably identify low and high-risk PAH strata, yet these tools less accurately discriminate intermediate-risk patients. 23 Moreover, a recent study revealed that only one-half of intermediate-risk patients (stratified by REVEAL 2.0 and COMPERA scores) achieved the target low-risk profile after guideline-recommended treatment with upfront oral combination therapy. 46 A more granular assignment of risk along the continuum, such as that offered by PHORA, could potentially better inform therapy interventions (particularly in the intermediate-risk range).…”