Assessing response to therapy in idiopathic pulmonary arterial hypertension: a consensus survey of Canadian pulmonary hypertension physicians

• Published in: Canadian respiratory journal Vol. 18; no. 4; pp. 230 - 234
• Main Authors: Borrie, Adrienne E, Ostrow, David N, Levy, Robert D, Swiston, John R
• Format: Journal Article
• Language: English
• Published: Egypt Pulsus Group Inc 2011; Hindawi Limited
• Subjects: Antihypertensive Agents - therapeutic use; Canada; Consensus; Delphi Technique; Disease Management; Drug Monitoring - methods; Drug Monitoring - standards; Drug Therapy, Combination - methods; Drug Therapy, Combination - standards; Exercise Tolerance; Expert Testimony; Familial Primary Pulmonary Hypertension; Heart Failure - etiology; Heart Failure - physiopathology; Heart Failure - therapy; Hospitalization; Humans; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - physiopathology; Medication Therapy Management - standards; Original; Physical Examination - methods; Physical Examination - standards; Practice Patterns, Physicians' - standards; Severity of Illness Index; Treatment Outcome; Canada
• ISSN: 1198-2241; 1916-7245
• DOI: 10.1155/2011/510874

Many treatment options are now available for patients with idiopathic pulmonary arterial hypertension (IPAH). Data regarding the optimal combination of therapies are lacking, as is consensus on how to assess response to therapy and when to change therapeutic regimens. To gather the opinions of Canadian pulmonary hypertension (PH) experts regarding standard practice in the care of IPAH patients after therapy is initiated. Canadian PH physicians were surveyed using short questionnaires to assess their opinions and practices in the care of IPAH patients. A Delphi forecasting approach was used to gain consensus among Canadian physicians on the most important clinical parameters to consider when assessing patients after the initiation of therapy. Twenty-six of 37 Canadian PH experts who were invited to participate completed the study. All endorsed the use of combination therapy for IPAH patients despite the lack of universal provincial coverage for this approach. By consensus, WHO functional class, 6 min walk distance and hospitalization for right heart failure were the most important clinical parameters. The most highly rated physical examination parameters were jugular venous pressure, peripheral edema, the presence of ascites and body weight. The overall approach to care of IPAH patients is similar across PH centres in Canada. A limited number of clinical and physical examination parameters were considered to be most important to reassess patients after therapy is initiated. These parameters, along with definition of threshold values, will facilitate the development of standard practice guidelines for IPAH patients in Canada.