PURPOSE: The Pulmonary Arterial Hypertension Quality Enhancement Research Initiative (PAH-QuERI) was set up to support clinicians and facilitate a guideline based approach to PAH.
METHODS: Between October 2005 and June 2007, 62 US specialist practices participated. Physicians recorded patient work up, management, and outcome data into an electronic data management system. Queries were generated automatically at each of the prescheduled follow-up visits if the guideline recommended tests were not performed at least once.
RESULTS: Of 787 patients 77.5% were women, 55 years old (45, 66), 8.6% were in class I, 38.8% in II, 47.5% in III, and 5.1% in IV .Of the ACCP recommended work up variables at baseline, CBC was performed in 90.7%, LFT in 90.6%, CTD screen in 50.2%, HIV screen in 29.0%, CXR in 88.3%, ECG in 81.6%, PFT in 2.8%, V/Q scan in 57.4%, 2-D Echo in 96.8%, 6MW in 76.0%, and RHC in 90.3% of patients. The quality enhancement component of this program generated 1494 reminders on 636 patients (80.8%) with validated baseline data. A majority of patients had one reminder (median of 2 reminders (1, 3)) resulting in proportion of patients in whom a recommended ACCP test was not done at baseline but was done at 6 or 12-month follow up visit. All recommended tests (CXR, ECG and Echo) were performed in 73.7%. With respect to management, 77.8% of patients were on disease specific therapy. Calcium blockers were used in 21.6% and approximately half were on this therapy specifically for PAH. While RHC was performed in the majority of these patients, the vasoreactivity was assessed in only 36.5% and was positive in only 8.2%.
CONCLUSION: The PAH-QuERI database allows a real world look at the diagnosis, management and outcome in PAH patients. The results suggest that PAH work-up and management may be suboptimal for some patients but can be improved through educational initiatives.
CLINICAL IMPLICATIONS: Greater adherence to guidelines may improve outcome in these high-risk patients.
DISCLOSURE: Anatoly Langer, Grant monies (from industry related sources) Actelion has provided reserach grant for this work.; No Product/Research Disclosure Information