Outpatient Evaluation and Follow-Up of Veterans with Group 3 Pulmonary Hypertension Treated with Phosphodiesterase-5-Inhibitors
Year: 2021
Type: conference-abstract
Abstract: Rationale: Pulmonary hypertension guidelines provide clear recommendations for baseline diagnostic testing and follow up after treatment initiation in patients with Group 1 pulmonary arterial hypertension (PAH), but no such guidance exists for PH due to hypoxemic lung disease (Group 3 PH).While PAH-approved treatments are not recommended for Group 3 patients, increasing off-label utilization emphasizes the need for guidance regarding follow up assessments for efficacy and harm.Among a cohort of Group 3 patients treated off-label with PAH therapy, we hypothesized that baseline diagnostic testing and outpatient follow-up to evaluate safety and efficacy would be limited.Methods: We performed a retrospective cohort study of Medicare-eligible Veterans diagnosed with Group 3 PH and treated with phosphodiesterase-5-inhibitors (PDE5i) between 2006 and 2017.Those who died in the first year after medication initiation were excluded.Primary outcome was time to PH-linked outpatient follow-up after treatment initiation.Secondary outcomes included use of right heart catheterization (RHC) prior to therapy initiation and time to follow-up RHC.Results: Of 249 Medicare-eligible Veterans with Group 3 PH treated with PDE5i during the study period, only 168 (67.5%) had PH-linked follow-up visits within the year following medication initiation.Among those patients, median time to follow up was 54 days (IQR 108) and ranged from one day to almost one year (350 days).On average, patients had significantly more PH-linked visits in the year after starting PDE5i therapy (1.6 vs. 3.8; p<0.0001).In our cohort, only 45 patients (18.1%) underwent RHC prior to starting therapy; 6 of these patients (13.3%) were evaluated with repeat RHC within the first year.Of those who did not undergo RHC prior to starting therapy, 17 (8.3%)were evaluated with RHC after prescription initiation with total median time to follow-up RHC in both groups of 157 days (IQR 231).Conclusions: This retrospective cohort study highlights wide variability in evaluation and management of patients with Group 3 PH receiving PAH therapy.While frequency of outpatient visits increased in the year following treatment initiation, only two thirds of patients were actually seen in follow-up for PH with a wide range in time to first visit.Additionally, many patients received PAH therapy without a diagnostic RHC and even fewer had a repeat hemodynamic assessment.These data suggest the need for recommendations to more clearly guide clinical practice and potentially limit adverse outcomes in patients with Group 3 PH treated with PAH therapy.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4246078872