Utilization of risk assessment tools in management of PAH: A PAH provider survey

Abstract

Pulmonary arterial hypertension (PAH) is a chronically progressive fatal disease. A goal-oriented approach to achieve low risk status has been associated with improved survival. A variety of risk stratification tools are available, but use is low. We conducted a survey to assess potential reasons for under-utilization. We conducted a survey-based study of global PAH disease specialists with a goal of assessing risk assessment utilization and identifying modifiable barriers to use. The survey was designed by the American College of Chest Physicians' Pulmonary Vascular Diseases (PVD) NetWork.

Pulmonary Hypertension Association's 2022 International Conference Scientific Sessions Overview

“…In February 2020 to April 2020 primary care telemedicine visits moved from <1% to nearly 43%, and now between 60% and 90% of physicians are using telemedicine services to some extent. The ACCP PVD Network steering committee found that 93% of patient care was affected and telemedicine use increased from 15% prepandemic to 84% during the early pandemic 46 …”

Risk assessment in pulmonary arterial hypertension: A step towards clinical implementation based on the 2022 ESC/ERS pulmonary hypertension guidelines

“…Risk assessment should be used more regularly as 59-63% utilization among clinicians is far from sufficient. [1][2][3]10 However, risk assessment should not replace clinical gestalt, as the former only fulfils an objective complement to clinical assessment. Given these findings, it is all the more important to implement the 2022 ESC/ERS PH guidelines through integrating risk assessment, irrespective of preferred validated calculation model, into clinical practice to guide treatment in PAH.…”

“…A study by Wilson et al 1 found that nonphysicians compared with physicians had two major issues accounting for the underutilization of risk assessment tools, including lack of education and training (20% vs. 4%), and lack of clarity on the best tool to use (30% vs. 18%). 1 A study by Sahay et al 3 found that risk assessment was used among 63% of clinicians and the most commonly identified barriers of underutilization were time constraints and lack of integration into electronic medical records. Additionally, a study by Simons et al 10 found a 55% discordance between clinical gestalt and calculated risk score, as well as that 80% of patients clinically judged as low-risk were assigned to higher risk categories based on their calculated risk.…”

“…We read with great interest the studies by Wilson et al 1 "Current clinical utilization of risk assessment tools in pulmonary arterial hypertension: a descriptive survey of facilitation strategies, patterns, and barriers to use in the United States," and "Clinical application of risk assessment in PAH: Expert center APRN recommendations," 2 as well as the recent publication by Sahay et al 3 "Utilization of risk assessment tools in management of PAH: A PAH provider survey"; all published in previous issues of Pulmonary Circulation. We acknowledge the authors for their contributions on assessing the clinical utilization of risk assessment in pulmonary arterial hypertension (PAH), 1,3 identifying potential major barriers impacting clinical underutilization and presenting recommendations to overcome these barriers. 2,3 From a brief historical perspective, the 2004 European Society of Cardiology (ESC) PAH guidelines and the succeeding 2009 ESC/European Respiratory Society (ERS) pulmonary hypertension (PH) guidelines, advocated multiparametric assessments in patients with PAH, to acquire better prognostication.…”

End-of-Life and Palliative Care Issues for Patients Living with Pulmonary Arterial Hypertension: Barriers and Opportunities

“…While one survey found that the majority of physicians made palliative care referral at least once in the past 12 months found a much higher rate of utilization (91%), 16 fewer physicians (7%) prompted goals of care and palliative care discussion with their patients. 17 A recently published study by Anand et al provided an in-depth, longitudinal view of specialist palliative care service utilization in patients with PAH. 11 The authors utilized the National Inpatient Sample-a nationwide database of all inpatient admissions for 20% stratified sample of all hospitalizations-from 2001 to 2017 to determine the rate of utilization of palliative care services overall, temporal trends, predictors of use, length of stays, cost, in-hospital mortality, disposition, and use of do-not-resuscitate (DNR) status.…”