Collaborative Cardiology and Pulmonary Management of Pulmonary Hypertension

Fernandes, Caio; Steigner, Michael L.; Piazza, Gregory; Goldhaber, Samuel Z.

doi:10.1016/j.chest.2019.04.099

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…Median wait-time until first cardiologist or pulmonologist visit was 1.2 months for PAH patients in the claims database but considerably longer when considering only pulmonologist visits (7.1 months) versus cardiologist visits (1.8 months). It is not PULMONARY CIRCULATION mandatory for patients with suspected or confirmed PH to be referred to a pulmonologist, but respiratory medicine specialists often lead expert PH referral centers in the United States 34,35 and collaborative management of PH by cardiologists and pulmonologists is thought to be ideal. 34,36 The slight differences in findings from the claims database compared with the EHR database (e.g., shorter time-to-first pulmonologist visit) likely reflects differences between the EHR and claims patient populations.…”

Section: Discussionmentioning

confidence: 99%

“…It is not PULMONARY CIRCULATION mandatory for patients with suspected or confirmed PH to be referred to a pulmonologist, but respiratory medicine specialists often lead expert PH referral centers in the United States 34,35 and collaborative management of PH by cardiologists and pulmonologists is thought to be ideal. 34,36 The slight differences in findings from the claims database compared with the EHR database (e.g., shorter time-to-first pulmonologist visit) likely reflects differences between the EHR and claims patient populations. The EHR database includes uninsured patients and patients with Medicaid support (i.e., not insured through their employer or Medicare) and there may be gaps in the patients' diagnostic journey.…”

Section: Discussionmentioning

confidence: 99%

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Time to diagnosis of pulmonary hypertension and diagnostic burden: A retrospective analysis of nationwide US healthcare data

et al. 2023

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The main aim of this analysis was to investigate time from symptom onset (chronic unexplained dyspnoea [CUD]) to diagnosis of Group 1 pulmonary hypertension (PH)—pulmonary arterial hypertension (PAH)—and to characterize healthcare resource utilization leading up to diagnosis using a nationwide US claims and an electronic health record (EHR) database from Optum © . Eligible patients were ≥18 years old at first CUD diagnosis (index event) and had a PAH diagnosis on or after index date. Based on administrative codes, PAH was defined as right heart catheterization (RHC), ≥ 2 PAH diagnoses (1 within a year of RHC), and ≥1 post‐RHC prescription for PAH treatment. All values are median (1st quartile–3rd quartile) unless otherwise stated. Of 854,722 patients with CUD in the claims database, 582 (0.1%) had PAH. Time from CUD to PAH diagnosis was 2.26 (0.73–4.22) years. PAH patients experienced 3 (2–4) transthoracic echocardiograms (TTEs), 6 (3–12) specialist visits, and 2 (1–4) hospitalizations during the diagnostic interval. Almost one‐third of patients (29%) waited 10 months or more to have a TTE. Findings from the EHR database were broadly similar. Resource utilization during the diagnostic interval was also analyzed in an overall PH cohort: findings were generally similar to the PAH cohort (2 [1–3] TTEs, 4 [2–9] specialist visits and 2 [1–4] hospitalizations). These data indicate a delay in the diagnostic pathway for PAH, and illustrate the burden associated with PAH diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Time to diagnosis of pulmonary hypertension and diagnostic burden: A retrospective analysis of nationwide US healthcare data

et al. 2023

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“…Finally, RAP is an important treatment target in pulmonary arterial hypertension, where elevated values are a proxy of a failing right ventricle heralding adverse prognosis [ 57 , 58 ]. A lot of prognostic markers have been studied in such patients; however, due to a prevalence of pneumologists as clinical managers of such a disease, echocardiographic parameters have been evaluated only in a few studies compared to other clinical variables [ 59 , 60 , 61 ]. Our new system could broaden the adoption of serial RAP assessment as a prognostic marker and treatment target among patients with advanced HF and pulmonary arterial hypertension [ 46 ], enhancing current RAP grading with its continuous nature.…”

Section: Rap In Advanced Heart Failure and Pulmonary Hypertensionmentioning

confidence: 99%

Inferior Vena Cava Edge Tracking Echocardiography: A Promising Tool with Applications in Multiple Clinical Settings

et al. 2022

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Ultrasound (US)-based measurements of the inferior vena cava (IVC) diameter are widely used to estimate right atrial pressure (RAP) in a variety of clinical settings. However, the correlation with invasively measured RAP along with the reproducibility of US-based IVC measurements is modest at best. In the present manuscript, we discuss the limitations of the current technique to estimate RAP through IVC US assessment and present a new promising tool developed by our research group, the automated IVC edge-to-edge tracking system, which has the potential to improve RAP assessment by transforming the current categorical classification (low, normal, high RAP) in a continuous and precise RAP estimation technique. Finally, we critically evaluate all the clinical settings in which this new tool could improve current practice.

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“…O manejo terapêutico dessa compressão é feito analogamente ao que se faz em lesão de TCE por aterosclerose: a revascularização miocárdica deve ser considerada, sendo a abordagem percutânea a modalidade mais atrativa e segura para esses pacientes. 119 Dados italianos demonstraram um bom resultado com essa abordagem. Entre 53 pacientes submetidos a angioplastia e com tempo médio de seguimento de 4,5 anos, 19 faleceram (37,3%) sem nenhum caso de infarto ou trombose de stent, sendo que 5 pacientes necessitaram nova angioplastia.…”

Section: Fernandes Et Al Atualização No Tratamento De Hipertensão Arterial Pulmonarunclassified

Atualização no Tratamento da Hipertensão Arterial Pulmonar

Fernandes

Calderaro²,

Assad

et al. 2021

Arquivos Brasileiros De Cardiologia

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Muitos avanços ocorreram nas últimas décadas na terapêutica da hipertensão arterial pulmonar (HAP), uma doença grave, progressiva, incurável e potencialmente fatal. Para seu tratamento adequado, são fundamentais o diagnóstico hemodinâmico e a classificação de sua etiologia, em que várias delas (colagenoses, hipertensão portal, cardiopatia congênitas, esquistossomose) requerem medidas específicas, além do tratamento farmacológico característico para HAP.O tratamento com fármacos-alvo para HAP baseia-se em produtos farmacêuticos que interferem em três vias fisiopatológicas moleculares: da prostaciclina, da endotelina e do óxido nítrico. Tais fármacos apresentam múltiplas apresentações (oral, endovenosa, subcutânea e inalatória) e mudaram a história da HAP. Essas medicações e suas estratégias de uso, assim como particularidades das diferentes formas de HAP, são o foco desta revisão.

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Collaborative Cardiology and Pulmonary Management of Pulmonary Hypertension

Cited by 3 publications

References 12 publications

Time to diagnosis of pulmonary hypertension and diagnostic burden: A retrospective analysis of nationwide US healthcare data

Time to diagnosis of pulmonary hypertension and diagnostic burden: A retrospective analysis of nationwide US healthcare data

Inferior Vena Cava Edge Tracking Echocardiography: A Promising Tool with Applications in Multiple Clinical Settings

Atualização no Tratamento da Hipertensão Arterial Pulmonar

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