Key result
Objective multiparameter risk assessment tools classified 33% to 79% of functional class II pulmonary arterial hypertension patients as intermediate or high risk, demonstrating only 43% to 54% concordance with physician gestalt.
Why the study?
To better understand risk status determination in functional class II PAH patients by comparing physician-reported risk assessments with objective multiparameter assessment tools.
Does objective multiparameter risk assessment differ from physician gestalt in determining the risk status of patients with functional class II pulmonary arterial hypertension?
Observational (n=153)
Yes
Does objective multiparameter risk assessment differ from physician gestalt in determining the risk status of patients with functional class II pulmonary arterial hypertension?
Physician gestalt frequently underestimates risk in functional class II PAH patients compared to objective multiparameter risk assessment tools, highlighting the importance of incorporating objective algorithms into clinical practice.
Gestalt may underestimate risk versus objective tools in FC II PAH; leaves open whether integration improves outcomes.
BACKGROUND: Accurate and regular risk assessment is important for evaluation and treatment of pulmonary arterial hypertension (PAH) patients, including those with functional class (FC) II symptoms, a population considered at low risk for disease progression. Risk assessment methods include subjective and objective evaluations. Multiparametric assessments include tools based on the European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines (COMPERA and FPHR methods, respectively) and the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL; REVEAL 2.0 tool). To better understand risk status determination in FC II patients, we compared physician-reported risk assessments with objective multiparameter assessment tools. METHODS: This retrospective chart analysis included PAH patients with FC II symptoms receiving monotherapy or dual therapy. Physicians were surveyed (via telephone) to obtain an assessment of patient risk using their typical methodology, which might have been informed by objective risk assessment. Patient risk was then calculated independently using COMPERA, FPHR and REVEAL 2.0 tools. Factors associated with incongruent risk assessment were identified. RESULTS: Of the 153 patients, 41%, 46%, and 13% were classified as low, intermediate, and high risk, respectively, by physicians. Concordance between physician gestalt and objective methods ranged from 43%-54%. Among patients considered as low risk by physician gestalt, 4%-28% were categorized as high risk using objective methods. The most common physician factor associated with incongruent risk assessment was less frequent echocardiography during follow-up (every 7-12 months vs. every 3 months; p = 0.01). CONCLUSIONS: More than half of FC II PAH patients were classified as intermediate/high risk using objective multiparameter assessments. Incorporating objective risk-assessment algorithms into clinical practice may better inform risk assessment and treatment strategies.
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Sahay et al. (2020) conducted an observational in Pulmonary arterial hypertension (WHO functional class II) (n=153). Objective multiparameter risk assessment tools (COMPERA, FPHR, REVEAL 2.0) vs. Physician gestalt was evaluated on Concordance between physician gestalt and objective risk assessment methods. Objective multiparameter risk assessment tools classified 33% to 79% of functional class II pulmonary arterial hypertension patients as intermediate or high risk, demonstrating only 43% to 54% concordance with physician gestalt.
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