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Original Research: Pulmonary Vascular Disease |

Parenteral Prostanoid Use at a Tertiary Referral Center: A Retrospective Cohort Study

Bryan R. Hay, MD; Meredith E. Pugh, MD, MSCI; Ivan M. Robbins, MD; Anna R. Hemnes, MD
Author and Funding Information

FUNDING/SUPPORT: Funding was received by the National Institutes of Health [Grant PO1 HL108800].

CORRESPONDENCE TO: Anna R. Hemnes, MD, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, T1218 Medical Center North, 1161 21st Ave S, Nashville, TN 37232


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(3):660-666. doi:10.1378/chest.15-1051
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Published online

Background  Evidence-based guidelines recommend the use of parenteral prostaglandin (PP) therapy in patients with advanced pulmonary arterial hypertension (PAH). Despite this, many patients with PAH die without PP therapy. We sought to examine the frequency of PP use at a large referral center and characterize patients with PAH who died without receiving PP.

Methods  We conducted a single-center retrospective cohort analysis of consecutive patients with PAH between 2008 and 2012. Clinical data and cause of death were compared between patients with PAH treated with PP (PAH-PP) and those who were not but were not documented as poor PP candidates (PAH-nonPP).

Results  Of the 101 patients who received a diagnosis of PAH and died, 61 received PP therapy. Of the 40 patients not treated with PP, 10 did not have documented evaluations for PP therapy (PAH-nonPP) whereas 30 were not considered candidates or refused PP therapy. Compared with PAH-PP, PAH-nonPP had a longer 6-min walk distance, had a longer duration between time of diagnosis and date of worse functional class visit, were less likely to be diagnosed as functional class IV, and had significantly lower right atrial pressure. None of the PAH-nonPP died of progressive PAH.

Conclusions  We found that most patients who die with PAH are evaluated for PP therapy at a large referral center and the small minority of PAH-nonPP tended to have less severe disease and die of non-PAH-related causes. Our data suggest that at large pulmonary hypertension (PH) centers, the vast majority of patients who are appropriate candidates receive PP therapy.

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