Pulmonary Vascular Disease |

Referral Patterns at a Single Centered Institution for Pulmonary Hypertension (PH) FREE TO VIEW

Parinita Dherange, MD; Nimal Singh; Namit Rohant; Vivek Yarlagadda; Ankit Desai
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Banner University Medical Center- South, Tucson, AZ

Chest. 2015;148(4_MeetingAbstracts):956A. doi:10.1378/chest.2271409
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SESSION TITLE: Pulmonary Arterial Hypertension Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Previous reports have established significant differences between referring patterns to dedicated PH centers in terms of diagnosis. We sought to define these changes at a single centered institution and focus on therapy to dissect mechanisms of both novel and established differences.

METHODS: We performed a retrospective chart review of 144 patients referred to University of Arizona Medical Center PH clinic for a period of 2 years ( 2013-2015) for further evaluation of suspected or defined PH. Statistical analysis was performed using STATA/IC13.1.

RESULTS: Of 144 patients referred with a mean age of 63.57 (+/-15) years, 92 (64%) were females and 52 (36%) were males. Of 22 patients who had a pre-referral presumptive diagnosis of PH, 13 (59%) were class 1 and 5 (23%) were class 3. Of 32 patients who had a post-referral definite diagnosis of PH, 21 (65%) were class 1, 4 (13%) were class 2, 5 (16%) were class 3 and 2 (6%) were class 4. 11 out of 22 patients who had a pre-referral diagnosis of PH were misdiagnosed. 45 patients underwent right heart catheterization for the first time. Of 144 patients referred, 73 (51%) were based on Echo findings, 25 (17%) based on RHC and 32 (22%) based on symptoms. Of all patients who got a definitive diagnosis of PH, 17% were referred based on TTE, 16% on RHC and only 3% were based on symptoms. Out of 15 patients who were started on medications before referral, 10 (66%) were taken off the medication after referral. 12 patients were newly started on PH medications that were never treated and 5 patients were added on another class of PH medication to their existing therapy due to inadequate response. An intermediate positive correlation was seen between PASP in pre-referral and post-referral Echo (r=0.56) and a strong positive correlation was seen between PA mean pressures in pre-referral and post-referral RHC (r=0.84). Out of the 45 patients who underwent RHC post referral, 16 (36%) had a PA mean >45mmHg.

CONCLUSIONS: We found that most of the patients referred for diagnosis and treatment in our center received misdiagnoses prior to referral. We also found a significant difference in PH specific medication regimen post referral. We speculate that some of these differences may be due to difference observed in interpretation of PH relevant parameters on echocardiogram in contrast to RHC.

CLINICAL IMPLICATIONS: Referral patterns for both PH diagnosis and treatment is an emergent topic of debate in PH.

DISCLOSURE: The following authors have nothing to disclose: Parinita Dherange, Nimal Singh, Namit Rohant, Vivek Yarlagadda, Ankit Desai

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