PURPOSE: Pulmonary arterial hypertension (PAH) is a clinical syndrome characterized by progressive increases in pulmonary vascular resistance, leading to marked increases in pulmonary artery pressure, exercise intolerance, and ultimately death. The natural history of PAH is heterogeneous, with more rapid clinical deterioration in patients with a greater degree of right ventricular dysfunction (AJRCCM 2006;174:1034–41). Many teams interact with PAH patients, including specialists in pulmonary, cardiology and rheumatology. Hypothesis: We questioned whether formation of a comprehensive PAH Center, with specialists from pulmonary, cardiology and rheumatology, would minimize traditional delays of both scheduling and diagnosing PAH.
METHODS: There were several meetings on formation of the PAH Center conducted between the multiple disciplines. Protocols were developed to ensure appropriate diagnosis of PAH and to rule out other causes of the patients’ symptoms. Current ACCP guidelines were used (Chest 2004;126:14S-34S). Each patient with suspected PAH had the identical screening process conducted. A right heart catheterization protocol with a new catheterization report form was designed to confirm the diagnosis of PAH. Agents used to determine pulmonary artery vasoreactivity during catheterization included inhaled nitric oxide and/or IV adenosine. Ancillary support staff were educated on PAH as were other specialties including Infectious Diseases and Transplant. Days to appointment and days to diagnosis were tabulated by a retrospective chart review before versus after establishing the PAH Center.
RESULTS: The entire process from concept to ”opening“ of the PAH Center required nine months. It was physically located in the Out-patient Cardiology Offices. Patient wait time decreased from greater than 21 days to less than 5 days for first appointment and to less than 10 days for time to diagnosis.
CONCLUSION: Our interdisciplinary out-patient PAH Center successfully decreased time to first appointment and decreased time to diagnosis.
CLINICAL IMPLICATIONS: New pharmacologic treatments of PAH inspired this unique approach to patients. Our interdisciplinary comprehensive PAH Center is expected to maintain efficiency as advances in PAH treatment continue.
DISCLOSURE: Jorge Mercado, Consultant fee, speaker bureau, advisory committee, etc. Gilead Sciences, Inc.: Herbert Patrick: Consultant fees and Speaker bureau.; No Product/Research Disclosure Information