The diagnosis and management of pulmonary hypertension (PH) varies amongst physicians. The objective of this survey was to determine the patterns of PH practice in programs across Canada, specifically targeting program structure, access, referral patterns, diagnostic workup and treatment approach.
The 66 question survey was developed by a Canadian working group of PH experts and distributed to the 12 established Canadian PH centers in September 2003.
Ten of the 12 PH centers completed the survey. The annual number of referrals to Canadian PH programs increased substantially from an average of 24 (range 0-120) cases in 2000 to 72 (6-240) cases per year in 2003. Of patients referred, 25% had primary (idiopathic) PH and 34% had PH related to connective tissue diseases. At the time of referral, 51 ± 18(SD) % of patients were in WHO functional class 3. The investigation of choice for diagnosis and assessment of PH severity was echocardiogram with assessment of right ventricular systolic pressure and function. In 70% of centers, acute vasodilator responsiveness was determined either as an absolute reduction of pulmonary vascular resistance (PVR) to close to normal or a reduction of 20% of systolic pulmonary artery pressure and PVR. For vasodilator responders, calcium channel blockers were the initial treatment of choice in 70% of the centers. For WHO class 3 vasodilator non-responders, endothelin receptor antagonists (bosentan) were the first choice in 80% of programs. All centers considered the initiation of epoprostenol, or WHO class 3/4 symptoms despite optimal medical therapy, as indications for transplant referral in suitable patients. Transplant programs were easily accessible to 80% of the PH centers.
This survey provides practical information describing the patterns of PH practice in Canada. There are many areas of both agreement and divergence in terms of diagnostic and therapeutic management approach.
The survey provides an environmental scan useful for the development of Canadian PH practice guidelines related to program structure, access, referral patterns, diagnostic workup and treatment approach.
T. Shaipanich, None.