Current practices in monitoring patients with pulmonary arterial hypertension (PAH) lack standardization, and health care professionals generally do not comply with standardized methods, according to a study published in Heart & Lung. 

PAH is a severe disease that can lead to early death if extensive evaluations and follow-ups are not conducted. Experts recommend that laboratory, imaging, and hemodynamic variables are examined and re-examined for the patient’s clinical condition to be characterized accurately. 

The American College of Cardiology and the American Heart Association have guidelines regarding how patients with PAH should be assessed and managed. For example, they recommend that stable patients be evaluated every 3 to 6 months, whereas unstable patients should be evaluated every 1 to 3 months. They recommend assessments such as the 6-minute walk test and transthoracic echocardiography. 

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“However, real-world practice regarding frequency and type of follow-up in the PAH population is ill-defined and no studies to date have identified patient surveillance norms,” the authors of the study wrote.

Read more about PAH etiology

The investigators sought to determine how patient assessment practices were carried out in real life. They recruited PAH-treating providers (n=40) from PAH treatment centers throughout the United States. Respondents were experts in the field of PAH treatment and included cardiologists, pulmonologists, and advanced practice providers. These participants were asked to fill in a survey consisting of 11 items that assessed patient surveillance practices. 

The results of the study demonstrated significant heterogeneity in terms of how health care professionals conducted their assessments. There was also a lack of consensus on how often patients with PAH were re-assessed; the overall picture was that patients with severe illness were assessed more frequently than stable patients. The authors of the study also expressed concerns that clinicians may be underassessing patients during the critical early phases of treatment. 

“Data from this survey showcased general trends of care from providers who routinely care for PAH patients,” the authors wrote. “We anticipate the introduction of commonly employed PAH risk assessment tools to influence patient assessment practice.” 


Kingrey JF, Zhou CY, Dalal B, Elwing JM. Expert provider survey of longitudinal assessment in patients with pulmonary arterial hypertensionHeart Lung. 2022;58:34-38. doi:10.1016/j.hrtlng.2022.10.016