Cardiac catheterisation underused in patients started on PAH therapy
medwireNews: Performing right heart catheterisation to classify pulmonary arterial hypertension (PAH) ahead of initiating medication, in line with consensus guidelines, does not appear to be carried out as often as it should, findings from a US-based population suggest.
The data showed that among 15,772 patients initially diagnosed at an outpatient visit with PAH according to ICD-9 codes, 969 (6.1%) were prescribed PAH-specific medications within a year, most commonly oral medication (94.2%).
But cardiac catheterisation was performed in just 407 (42%) of these patients within 3 months of medication being prescribed and in 583 (60.2%) during the entire study period of 27 months.
By contrast, echocardiography was frequently performed, with 91.4% of patients prescribed medication undergoing an echocardiogram within a year of diagnosis.
The researchers, led by Alexander Duarte (University Boulevard, Galveston, Texas, USA), point out that “[a]lthough echocardiography is a useful modality to determine the presence of pulmonary vascular disease, clinicians should not rely exclusively on echocardiography for diagnosis or monitoring response to therapy.”
They add that “performance of right heart catheterization can provide hemodynamic measurements that allow for greater diagnostic certainty and improved prognostic capability, and can determine the presence of vasodilator reactivity.”
Their review of the Clinformatics Data Mart database indicated that oral agents were the most commonly prescribed therapy among patients (94.2%) and phosphodiesterase-5 was the most frequently prescribed class of medication.
The likelihood of cardiac catheterisation being carried out decreased with advancing age and was less likely among men than women, whereas being concomitantly cared for by a cardiologist or pulmonary specialist increased the odds of receiving cardiac catheterisation.
“The findings of the present study reflect a “real-world” setting and indicate that performance of cardiac catheterization before a prescription of PAH-specific medication is low”, the team report in The Journal of Heart and Lung Transplantation.
They call for measures to be implemented to increase the use of this procedure, pointing out the impact not doing so can have on patient care and understanding the course of the disorder.
“The absence of accurate hemodynamic measurements can lead to a misdiagnosis with overprescribing, or in some cases underprescribing, PAH-specific medications, which may lead the patient to search for alternative therapies lacking demonstrated efficacy and may produce physical harm, emotional distress and economic hardship”, they conclude.
By Lucy Piper
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