Background and Importance The 2015 and 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary arterial hypertension [PAH] recommend treatment decisions based on an estimation of the patient’s 1-year mortality risk. Furthermore, the 2022 guideline provides a simplified four-strata risk-assessment tool for this estimation
Aim and Objectives To assess whether patients’ mortality risk is estimated and registered in clinical charts to guide treatment decisions in a cohort of PAH patients.
To assess whether it is possible to measure patients’ risk with the simplified tool using medical chart data.
Material and Methods A cross-sectional, retrospective, descriptive (March 2022) study was carried out in 2 tertiary hospitals, including alive adult PAH patients who initiated a PAH-specific therapy after 2016.
We collected variables from medical charts: demographic data, PAH subsets, PH-specific drug initiated, year of the initiation, and physician’s explicit assertions of the patient risk.
We calculated the simplified four-strata risk-assessment tool with the following variables: World Health Organization functional class [WHO-FC], 6-minute walking distance [6MWD], and N-terminal pro-brain natriuretic peptide [NT-proBNP]. Data are presented as percentages and medians (range).
Results Overall, 102 patients complied with inclusion criteria, 64.7% women aged 56 (18–99). Patients‘ HAP subsets were 35%, 29%, 9%, 3%, and 2% associated with adult congenital heart disease, connective tissue disease, portal hypertension, human immunodeficiency virus infection, drugs and toxins, respectively. 22% were classified as idiopathic HAP.
Overall, 145 changes in pulmonary-specific therapy were observed. Physicians registered the patient‘s risk in clinical charts in only 13.8% (20/145) of treatment initiations.
Using the simplified tool, we were able to estimate the patient‘s risk in 35.9% (52/145) treatment initiations: 17 low, 20 intermediate-low, 14 intermediate-high, and one high risk. We were unable to calculate the risk due to missing: 6MWD, NT-proBNP, and WHO-FC in 46% (67/145), 39% (56/145), and 27% (39/145) of cases.
Conclusion and Relevance In this multicentre study, it was rare for physicians to explicitly claim patients‘ mortality risk.
Even when trying to assess patients‘ risk with the simplified tool, it was impossible to estimate it for most patients. Therefore, this process is missing critical clinical variables, even if the mortality risk is being assessed but not registered in clinical charts.
Conflict of Interest No conflict of interest
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