Pulmonary arterial hypertension (PAH) risk assessment tools remain underused, despite the variety currently available, researchers report in the Pulmonary Circulation journal.

“Routinely, clinicians assess patients during clinical visits based on their gestalt which may or may not incorporate patient’s history, laboratory and ambulatory tests, right heart catheterization hemodynamics, and imaging studies into decision making,” explained Sahay et al, who conducted a survey-based study to investigate the potential reasons for the low adherence to PAH risk assessment tools in clinical practice.

Of the 112 experienced PAH clinicians participating in the study, 71 (63%) reported using any PAH risk stratification tools in their practice, which suggests a suboptimal use of the currently available tools.

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The updated version of the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL 2.0) was the most commonly used PAH risk assessment tool (n=49), followed by the European Society of Cardiology/European Respiratory Society (ESC/ERS) Pulmonary Hypertension Guidelines (n=43).

Sixty-six clinicians used these PAH risk assessment tools for baseline risk assessment and 57 said they use them during follow-up visits, with about half using them on every visit. In both cases, the clinicians mostly agreed the tools impacted their clinical decisions, in particular those concerning PAH treatment medications (44 at baseline risk assessment and 40 at follow-up visits).

According to 41 clinicians, the creation of risk assessment tools with the hospital electronic medical records (EMR) support team was the greatest barrier to the use of PAH risk assessment tools on initial or follow-up visits. Twelve clinicians mentioned time barriers, while 3 believed that performing risk assessment using these tools has little impact on patient management. For 4 clinicians, there were not any barriers highlighted.

Forty-eight clinicians believe that the incorporation of PAH risk assessment tools into the EMR would facilitate the tracking and comparison of patients’ risk assessments, thereby improving patient care.


Sahay S, Balasubramanian V, Memon H, et al. Utilization of risk assessment tools in management of PAH: a PAH provider survey. Pulm Circ. Published online March 16, 2022. doi:10.1002/pul2.12057