Updated Evidence-Based Treatment Algorithm in Pulmonary Arterial Hypertension
Why the study?
Defining risk-benefit profiles for therapeutic options was needed to establish an evidence-based treatment algorithm in pulmonary arterial hypertension.
Population
Patients with pulmonary arterial hypertension
Design
Review and evidence-based treatment algorithm
Authors
Discussion
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Member takes
Implication
Provides a comprehensive, evidence-based treatment algorithm for pulmonary arterial hypertension to guide clinical decision-making based on vasoreactivity and functional class.
Key Points
- To review clinical trial evidence on targeted pharmacological agents and procedural interventions in pulmonary arterial hypertension (PAH) to establish an updated, evidence-based treatment algorithm.
- Synthesized findings from retrospective series and clinical trials regarding supportive interventions (oral anticoagulants, diuretics, oxygen) and procedural therapies (atrial septostomy, lung transplantation).
- A positive acute vasoreactive response occurs in <10% of idiopathic PAH patients, with high-dose calcium channel blockers indicated strictly for this vasoreactive subset.
- Retrospective studies of oral anticoagulation showed 3-year survival improved from 21% to 49% in one series, and 3- and 5-year survival improved from 31% to 47% and 31% to 62%, respectively, in another.
- Patients who are nonresponders to vasoreactivity testing or in WHO functional class III require an oral endothelin-receptor antagonist or phosphodiesterase-5 inhibitor, whereas continuous intravenous epoprostenol remains the treatment of choice in functional class IV.
Structured PICO
P
Population
Review of clinical trials involving approximately 5,000 patients to propose an updated evidence-based treatment algorithm for pulmonary arterial hypertension.
I
Intervention
Evidence-based treatment algorithm including calcium channel blockers, endothelin-receptor antagonists, phosphodiesterase-5 inhibitors, and prostanoids
Provides a comprehensive, evidence-based treatment algorithm for pulmonary arterial hypertension to guide clinical decision-making based on vasoreactivity and functional class.
Limitations
- Extrapolation of these recommendations to other PAH subgroups should be done with caution
Cite This Study
Barst et al. (2009) conducted a review in Pulmonary Arterial Hypertension (n=5,000). Pulmonary arterial hypertension targeted therapies was evaluated. An updated evidence-based treatment algorithm for pulmonary arterial hypertension was proposed, stratifying therapies by acute vasoreactivity and WHO functional class.