PAH Risk Assessment: Why Reaching Low Risk Matters for Patients

Welcome back to another HCPLive Peer Exchange series. In "PAH Risk Assessment: Why Reaching Low Risk Matters for Patients," moderator Vallerie McLaughlin, MD is joined by Richard Channick, MD, Anjali Vaidya, MD, FACC, FASE, FACP, and Nick H. Kim, MD to open the series on pulmonary arterial hypertension.

Dr. McLaughlin outlines a program that spans guideline-based risk stratification, combination therapy, route of administration, escalation and switching, and newer therapies, then asks Dr. Kim what the treatment burden looks like for patients who have not reached low-risk status. Dr. Kim notes that many patients are diagnosed late and remain symptomatic even on treatment.

He explains that risk assessment combines clinical and laboratory data to gauge the health of the right ventricle, so an intermediate or high-risk label means the right ventricle is still struggling. In his view that status is not acceptable, and the goal is to bring every patient to low risk. He compares risk assessment to a new vital sign, closest to a hemoglobin A1c in this disease, and cites registry data showing hospitalization and mortality above 20% per year in high-risk patients.

Dr. Vaidya adds that patients rarely ask about their risk category and instead say they want to feel better, spend time with family, attend events, and stay out of the hospital. She argues that quality of life and functional capacity matter as much as formal calculations, although validated questionnaires are hard to complete at every visit.

Dr. Channick cautions that risk calculators work best at the population level, because each patient has different variables and needs an individualized assessment. His central message is that patients must be reassessed by whatever method the clinician prefers, and he calls patients who never get reassessed the bigger problem. As treatment options expand, frequent and regular follow-up becomes even more important.

Our next episode, "PAH Care Teams, Unmet Needs, and the Four Treatment Pathways," turns to the multidisciplinary team and Dr. Vaidya's overview of the four treatment pathways.