Pulmonary Vascular Disease |

Referral Pattern and Baseline Assessment for Pulmonary Hypertension (PH) Prior to Evaluation in a Community-Based Tertiary Referral Center FREE TO VIEW

Zhou Zhang, MD; Kenneth Wei, MD
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Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA

Chest. 2014;146(4_MeetingAbstracts):849A. doi:10.1378/chest.1958981
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters IV

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To analyze the community evaluation and referral pattern for pulmonary hypertension (PH) seen at a regional tertiary PH center of major southern California HMO.

METHODS: Retrospective chart review performed on new referrals to Kaiser Permanente Los Angeles Medical Center PH program from February 2012 to July 2013. Information on sources of referral, patient baseline demographics and diagnostic workup conducted prior to referral were collected.

RESULTS: There were 79 referrals made during the study period, majority of which were from outlying medical facilities (71%). Average patient age was 58.6 years, and 58.2% being female. Dyspnea was the most common initial complaint (80%). While most had been initially evaluated by either pulmonologist or cardiologist 66 (83.5%), large portions of referrals were generated by general practitioners (IM/FP 23.9%) or other subspecialists (rheumatology 7.6%, hepatology 11.4%. Nearly all patients received echocardiogram (92.4%) which triggered subsequent evaluation for PH. PFT and chest CT were commonly performed (73.4% and 65.8%, respectively), although V/Q scan was less frequently utilized (34%). Half of all referred patients (38/79) had received a diagnostic right heart catheterization prior to their tertiary evaluation, many without vasoreactivity testing (52%). PH was diagnosed or confirmed in 72/79 (91%) of the cases, where WHO group 1 diagnoses comprised 42 (58.3%), group 2 12 (16.7%), group 3 13 (18%), group 4 3 (4.2%) and group 5 2 (2.7%). Among those with group 1 PAH, the initial NYHA functional class were I 21.4%, II 35.7%, III 40.5% and IV 2.4%.

CONCLUSIONS: PH seen in a community tertiary referral center is common, many are recognized by physicians across various subspecialties. Echocardiogram is the most commonly utilized initial diagnostic modality. Large number of patients had diagnostic RHC already performed and were referred primarily for confirmation of diagnosis or treatment decisions. Many but not all patients have WHO group 1 PAH. Diagnosis of advanced disease seems rare, suggesting heightened awareness of PH leading to early diagnosis of the condition.

CLINICAL IMPLICATIONS: Regional PH centers drawing referrals from outlying medical facilities are being relied on for both diagnosis confirmation and treatment decision-making. Continued focus on greater disease awareness in the community through education can likely help in achieving earlier diagnosis, avoiding delay in therapy initiation.

DISCLOSURE: The following authors have nothing to disclose: Zhou Zhang, Kenneth Wei

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