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Title: Pharmacological Treatment of Pulmonary Arterial Hypertension in Australia: Current Trends and Challenges.
Austin Authors: Anderson, James;Lavender, Melanie;Lau, Edmund;Celermajer, David;Collins, Nicholas;Dwyer, Nathan;Feenstra, John;Horrigan, Mark ;Keating, Dominic;Keogh, Anne;Kotlyar, Eugene;Ng, Benjamin;Proudman, Susanna;Steele, Peter;Thakkar, Vivek;Weintraub, Robert;Whitford, Helen;Williams, Trevor;Wrobel, Jeremy;Strange, Geoff
Affiliation: Department of Rheumatology, Liverpool Hospital, Liverpool, NSW, Australia
Macquarie University, Department of Clinical Medicine, Macquarie Park, NSW, Australia
University of New South Wales, Sydney, NSW, Australia
Heart and Lung Transplant Unit and Cardiology Department, St Vincent's Hospital, Sydney, NSW, Australia
Monash University, Melbourne, Vic, Australia
Respiratory Department, Alfred Hospital, Melbourne, Vic, Australia
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Respiratory Department, Sunshine Coast University Hospital, Birtinya, Qld, Australia
Department of Cardiovascular Services, Royal Adelaide Hospital, Adelaide, SA, Australia
Murdoch Children's Research Institute, Melbourne, Vic, Australia
Royal Children's Hospital, Melbourne, Vic, Australia
Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
University of Melbourne, Melbourne, Vic, Australia
Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia
John Hunter Hospital, Newcastle, NSW, Australia
University of Notre Dame, Perth, WA, Australia
Cardiology Department, Royal Hobart Hospital, Hobart, Tas, Australia
Thoracic Medicine, The Prince Charles Hospital, Brisbane, Qld, Australia
Austin Health
Nepean Hospital, Sydney, NSW, Australia
Issue Date: Oct-2020
Date: 2020-03-06
Publication information: Heart, Lung & Circulation 2020; 29(10): 1459-1468
Abstract: Combination drug therapy for pulmonary arterial hypertension (PAH) is the international standard of care for most patients, however in Australia there are barriers to drug access. This study evaluates current treatment of PAH patients in Australia and the consistency of therapy with international guidelines. Cross-sectional analysis of patients with Group 1 PAH enrolled in the Pulmonary Hypertension Society of Australia and New Zealand Registry (PHSANZ) at 31 December 2017. Drug treatment was classified as monotherapy or combination therapy and adequacy of treatment was determined by risk status assessment using the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) 2.0 risk calculator. Predictors of monotherapy were assessed using a generalised linear model with Poisson distribution and logarithmic link function. 1,046 patients met the criteria for analysis. Treatment was classified as monotherapy in 536 (51%) and combination therapy in 510 (49%) cases. Based on REVEAL 2.0, 184 (34%) patients on monotherapy failed to meet low-risk criteria and should be considered inadequately treated. Independent predictors of monotherapy included age greater than 60 years (risk ratio [RR] 1.23, 95% confidence interval [CI] 1.09-1.38; p=0.001), prevalent enrolment in the registry (RR 1.21 [95%CI 1.08-1.36]; p=0.001) and comorbid systemic hypertension (RR 1.17 [95%CI 1.03-1.32]; p=0.014), while idiopathic/heritable/drug-induced PAH subtype (RR 0.85 [95%CI 0.76-0.96]; p=0.006), functional class IV (RR 0.50 [95%CI 0.29-0.86]; p=0.012), increased right ventricular systolic pressure (RR 0.99 [95%CI 0.99-1.00]; p<0.001) and increased pulmonary vascular resistance (RR 0.96 [95%CI 0.95-0.98]; p<0.001) were less likely to be associated with monotherapy. Most Australian PAH patients are treated with monotherapy and a significant proportion remain at risk of poor outcomes. This is below the standard of care recommended by international guidelines and at risk patients should be escalated to combination therapy.
DOI: 10.1016/j.hlc.2020.01.017
Journal: Heart, Lung & Circulation
PubMed URL: 32280014
Type: Journal Article
Subjects: PAH
Pulmonary hypertension
Appears in Collections:Journal articles

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