A19-08 Assessment of Pulmonary Arterial Hypertension Management at the Time of Death: A Comparative Study Between France and the UK

Introduction ESC/ERS Guidelines recommend the use of parenteral prostacyclin analogues (PCA) in combination therapy in patients with pulmonary arterial hypertension (PAH) at high risk of death. The aim of the study was to describe the management of patients with PAH at the last follow-up before death to verify compliance with the ESC/ERS guidelines. Methods We examined the treatment received at the time of death in PAH patients from the French PH Registry and Imperial College London between 2009 and 2022. Results After a median follow-up of 2 years [IQR 0.4-4.7], 1924/4629 patients had died in the French cohort while 558/1080 patients died in the English cohort after 4.3 years [IQR 1.5-8.4]. Among the patients from the French PH registry who died, 9% (n = 160) were receiving triple combination therapy including IV/SC PCA at the time of death. This proportion was similar in the English cohort: 50/558 patients (9%). In both cohorts, 43% and 44% of patients received oral dual therapy, respectively. In the most recent period (2020-2022), 67% of patients received combination therapy, vs 48% before 2015, p < 0.001. In the French cohort, at the last follow-up visit (5 months before death), 7% were at low-risk, 23% at intermediate-low risk, 35% at intermediate-high risk and 35% at high-risk of death. Only 20% of patients at high-risk and 15% of patients at intermediate-high risk received triple combination therapy. Similar results were observed in the subset of patients with idiopathic / heritable or drug induced PAH. Conclusion Despite the different healthcare systems in France and the UK, only a minority of PAH patients were receiving the maximum medical treatment recommended in the guidelines at the time of their death.