Pulmonary Vascular Disease: Pulmonary Vascular Disease I |

Non-Physician Factors Affecting Use of Prostacyclins in PAH Patients With Advanced Functional Class FREE TO VIEW

Sheila Krishnan, MD; Kimberly Robinson, APRN-BC; J. Wesley McConnell, MD
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Kentuckiana Pulmonary Associates, Louisville, KY

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

Chest. 2016;150(4_S):1170A. doi:10.1016/j.chest.2016.08.1279
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SESSION TITLE: Pulmonary Vascular Disease I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Current guidelines for treatment of pulmonary arterial hypertension (PAH) recommend intravenous prostacyclin as first-line therapy in patients with World Health Organization (WHO) functional class (FC) IV, or combination therapy for patients with FC III or any FC who do not respond to monotherapy. Recent research identified patients enrolled in the REVEAL (Registry to Evaluate Early and Long-Term PAH Disease Management) Registry who deteriorated to FC IV or died, reporting that intravenous prostacyclin and combination therapy were not consistently used in this cohort. We sought to investigate the reason for this, suspecting that the etiology was not due to poor compliance with guidelines, but rather due to other patient factors not in control of the prescribing provider.

METHODS: A total of 20 patients enrolled in the REVEAL Registry who died from pulmonary hypertension were identified in a PHA (Pulmonary Hypertension Association) accredited pulmonary hypertension center. Chart review was performed to collect the following data: FC on last clinic visit, type of therapy, and cause of death (PH-related, PH-unrelated, or unknown). For those patients with advanced FC who were not on intravenous prostacyclin or combination therapy, the justification was also collected though chart review.

RESULTS: Of the 20 patients who died, 75% (n = 15 of 20) had a PH-related death. Of those 15 patients, 4 (27%) were on intravenous (IV) prostacyclin therapy and 5 (33%) were on non-IV prostacyclin therapy. 73% (n = 11 of 15) were on combination therapy. 33% (n = 5 of 15) had FC IV and of those patients, 2 were on parenteral prostacyclin therapy while 3 were on inhaled prostacyclin therapy. In those three patients who were on inhaled prostacylin, one was unable to demonstrate competency with using parenteral therapy, one refused to start intravenous therapy, and one was under hospice care doing well on an inhaled prostacyclin.

CONCLUSIONS: In PH patients who have advanced functional class, parenteral prostacyclin and combination therapy are recommended to patients consistently, however, patient factors unrelated to the prescriber’s compliance with PAH therapy guidelines prevented use in the appropriate patients.

CLINICAL IMPLICATIONS: Upfront education at time of PAH diagnosis may help patients accept intravenous therapy later in their clinical course.

DISCLOSURE: J. Wesley McConnell: Consultant fee, speaker bureau, advisory committee, etc.: Actelion Pharmaceuticals, Consultant fee, speaker bureau, advisory committee, etc.: United Therapeutics, Consultant fee, speaker bureau, advisory committee, etc.: Bayer, Consultant fee, speaker bureau, advisory committee, etc.: Reata, Consultant fee, speaker bureau, advisory committee, etc.: Lung Rx, Consultant fee, speaker bureau, advisory committee, etc.: Gilead The following authors have nothing to disclose: Sheila Krishnan, Kimberly Robinson

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