Most pulmonary arterial hypertension (PAH) patients did not receive any modification to their therapy after hospitalization, according to a recent retrospective study published in Pulmonary Therapy.

The study found that 72.8% of PAH patients with all-cause hospitalizations received no change to their therapy while 20.0% actually had a de-escalation of their therapy (15% went from monotherapy to no therapy).

These results are in contrast to recent research and clinical guidelines that suggest an early intensification of treatment with combination therapies may be beneficial for patients.

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Clinical guidelines from the European Society of Cardiology, European Respiratory Society, and the CHEST Guideline and Expert Panel Report recommend earlier and more aggressive use of combination therapies to target different signaling pathways, according to the article.

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While the majority of cases did not result in treatment intensification, 6.1% did receive an escalation in treatment after their hospitalization, with 2.2% moving from no therapy to monotherapy and 3.2% moving from monotherapy to double or triple therapy.

A total of 3116 PAH patients were identified and included in the study analysis. The patients were identified between January 1, 2014, and June 30, 2019, using a clinical database and inclusion criteria of having continuous enrollment in a health plan 6 months prior to hospitalization and 90 days after.

The mean age of patients identified was 68.1 years and the study population was predominantly female (68.1%) and from the Southern US region (45.8%). Patients had a mean Charlson Comorbidity Index score of 5.1, with hypertension (81.5%) and chronic obstructive pulmonary disease (46.9%) being the most prevalent comorbidities.

“These results warrant future research to understand the reasons behind the limited treatment intensification observed and the impact of post-hospitalization optimization on clinical and economic outcomes,” the authors said.


Ogbomo A, Tsang Y, Kariburyo F, Tsai W-L, Panjabi S. Realworld analysis of treatment patterns among hospitalized patients with pulmonary arterial hypertension. Pulm Ther. Published online October 26, 2021. doi:10.1007/s41030-021-00173-6