Pulmonary arterial hypertension screening of systemic sclerosis patients in clinical practice: an independent chart review

Abstract

78% and 47%, respectively. Those with underlying pulmonary fibrosis have even worse survival rates (3). Screening for PAH in SSc leads to earlier diagnosis, implementation of appropriate therapy, and improvement of clinical outcomes (5). To improve early detection of PAH, several organizations have published guidelines recommending annual screening for dyspnea and either pulmonary function testing (PFT), transthoracic echocardiogram (TTE), or both, starting at the time of SSc diagnosis (6-8). A combination of PFT and TTE screening yields the highest sensitivity (9), and guidelines published by the American College of Rheumatology in 2013 recommend both annual PFT and TTE (7). Recent research indicates that PAH screening among Canadian rheumatologists for annual PFT and TTE may be suboptimal, with <50% reporting completion of these tests annually (10). However, in this same study, results from a retrospective chart review completed by rheumatologists on their own practices revealed higher rates of TTE and PFT screening over the preceding year. Among non-experts in SSc care, TTE and PFT screening rates were 80% and 74%, respectively, with no significant difference compared to experts. A survey conducted among rheumatologists in New Zealand suggested similar practice, with 80% ordering annual PFT and 64% ordering annual TTE (11). An independent chart review of SSc patients in the UK produced more disparaging results; over the

Pulmonary arterial hypertension screening practices in scleroderma patients among Canadian rheumatologists

“…The response rate of 16.8% is similar to previous studies on this topic. 11 This study shows that while screening rates continue to be sub-optimal (81% for TTE and 78% for PFT), rates were similar to those in Hamilton, Ontario 8 and slightly higher than Canadian SSc specialists in 2012. 9 Interestingly, screenings rates reported here are also higher than those seen in Australia which ranged from 40 to 60% depending on the type of SSc (limited vs. diffuse) and duration of disease.…”

“…• • Initial screening of all patients with pulmonary function testing (PFT) including diffusing capacity for carbon monoxide (DLCO), transthoracic echocardiogram (TTE) and N-terminal pro b-type natriuretic peptide (NT-Pro BNP); Annual PFT and TTE, even in asymptomatic patients Previous research has examined local rheumatologists' screening practices within Hamilton, Ontario 8 and among SSc specialists across Canada. 9 Kelly et al 8 found that Hamilton rheumatologists who self-identified as SSc experts were more likely to order annual screening TTEs and PFTs than non-experts. In contrast, a Canada-wide study found no significant difference in screening rates between experts and a select group of seven non-experts.…”

“…We hypothesized that a lack of familiarity with the recommendations would be the primary reason based on the higher adherence rates to screening guidelines among SSc experts seen at our centre. 8 Other potential reasons include disagreement with recommendations, lack of timely access to screening tests or patient-centred factors. Although several of these factors have been studied in other nations, notably by Morrisroe et al, 10 disagreement with recommendations is a novel factor and could provide new insights into this area of research.…”