Once the diagnosis of pulmonary arterial hypertension (PAH) has been made treatment needs to be initiated promptly. However, deciding on the most appropriate therapeutic approach requires a careful assessment of the patient’s mortality risk. A three strata approach that includes clinical parameters, exercise testing, biomarkers, imaging and haemodynamics is used at initial assessment to determine if the one-year risk of mortality is low (<5%), intermediate (5-20%) or high (>20%). Perhaps even more important than the initial risk assessment is the first follow up visit, at around three months, where the impact of the chosen therapy is evaluated. A new validated four strata approach allows a more granular assessment of risk and helps decide if treatment escalation is required. Treatment strategies for PAH have evolved over the past few years to emphasize the importance of combination therapy and early escalation. More recently there has been a focus on patients with PAH and cardiopulmonary comorbidities where a more individualised approach to treatment and escalation is advised. New therapies are under active investigation currently, but we need ongoing vigilance to use the therapies we currently have as promptly and efficiently as possible to insure better long term outcomes for our patients.
Reference
Humbert, M et al European Heart Journal, 2022;, ehac237, https://doi.org/10.1093/eurheartj/ehac237