D22-20 Pulmonary Arterial Hypertension Management in the US: A National Physician Survey

Abstract Rationale Physician knowledge of management of pulmonary arterial hypertension (PAH) and use of guidelines in the U.S. have not been quantified. This study describes real-world physician perspectives regarding PAH management. Methods From December 2024 through February 2025, physician specialists managing PAH patients recruited from a U.S. national panel were surveyed about: information sources on PAH, views on diagnostics, treatment, risk assessment, and barriers to care in clinical practice. Results A total of 351 physicians responded (201 cardiologists, 150 pulmonologists). Most respondents (67%) had 5-19 years of experience treating PAH. Approximately half from community practice (53%), and half from specialized practices: PHA-accredited Comprehensive Care Center (27%), PHA-accredited Regional Clinical Program (4%), and academic institutions (16%). Community practice respondents reported more years of experience than those from specialized practices. Respondents treated a median of 50 adult patients with PAH in the past year (IQR: 25-100). Most respondents (84%) consulted multiple sources for information on diagnosis and treatment of PAH. Most frequently referenced were: 2019 CHEST guidelines (73%) and 2022 ESC/ERS guidelines (46%). More recent sources were cited less frequently: U.S. consensus paper (Sahay et al.) (15%) and 2024 World Symposium proceedings (18%). These patterns were similar in both community practices and specialized practice settings. Respondents demonstrated limited knowledge of the latest clinical practice guidance from Sahay et al. While almost all (92%) selected right heart catheterization (RHC) to confirm a PAH diagnosis, fewer use an objective risk assessment tool (e.g., REVEAL 2.0, REVEAL 2.0 Lite, COMPERA 2.0 4-Risk Strata) to assess stable patients (33%) for treatment change or clinical worsening (38%). Likewise, only 37% reported their first treatment regimen would be ERA + PDE5i for non-vasoreactive, low/ intermediate risk patient with PAH at time of diagnosis (Ambition protocol). First treatment regimen as ERA + PDE5i + IV/SC for high risk at time of PAH diagnosis was only selected by 9%. Respondents cited barriers to timely diagnosis as insurance complexities (67%) and RHC availability (29%) / wait times (28%). Insurance was also the primary barrier to delayed treatment initiation (82%) and intensification (82%). Conclusions Cardiologists and pulmonologists treating PAH in the U.S. demonstrated limited awareness of the latest guidance for diagnosis and treatment. Insurance complexities and wait times pose barriers to timely diagnosis and treatment intensification. Addressing insurance complexity barriers and improving awareness and adoption of updated guidelines within U.S. cardiology and pulmonology specialties, could improve diagnosis and management of PAH. This abstract is funded by: Merck & Co., Inc., Rahway, NJ, USA