PAH Practice Pearls: Risk Assessment, Right Heart Focus, and Optimism

To close, "PAH Practice Pearls: Risk Assessment, Right Heart Focus, and Optimism" asks each panelist for one change that clinicians can make tomorrow.

Dr. McLaughlin asks each panelist for one shift in treatment that clinicians, whether at a specialty center or in the community, could start tomorrow. Dr. Kim chooses risk assessment, which he compares to a vital sign. He says clinicians should pick any validated tool, since they overlap, and apply it at every visit, because follow-up assessment may be even more powerful than the initial one.

A colleague adds that this is easy because the data are already collected in clinic, including functional class, walk distance, vital signs, labs, NT-proBNP, and kidney function. One program uses an electronic record flowsheet that calculates serial scores at the bottom of the clinic note.

Dr. Vaidya emphasizes that when in doubt, clinicians should look at the right side of the heart, which helps guide direction for each patient. She adds that PAH has grown complicated on both the diagnostic and therapeutic sides and is a disease of commitment and partnership. She urges clinicians not to merely dabble, welcomes growing awareness, and describes very little ego in the field, with experts partnering with community clinicians so patients everywhere have access to care. Dr. McLaughlin joins her point with Dr. Kim's, noting that risk assessment is critical but is one part of the puzzle, complemented by echo and hemodynamics.

Dr. Channick offers a different message, a positive attitude. Patients often arrive having been told that the disease will eventually kill them. He disagrees and tells patients his goal is that they will not die of pulmonary hypertension but with it, and he describes the relief visible on their faces. He does not know how the disease will be treated in five years and tells patients to expect five more therapies by then, so they should not dwell on prognosis. Dr. McLaughlin thanks the panelists and viewers.

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