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dc.contributor.authorAnderson, James-
dc.contributor.authorLavender, Melanie-
dc.contributor.authorLau, Edmund-
dc.contributor.authorCelermajer, David-
dc.contributor.authorCollins, Nicholas-
dc.contributor.authorDwyer, Nathan-
dc.contributor.authorFeenstra, John-
dc.contributor.authorHorrigan, Mark-
dc.contributor.authorKeating, Dominic-
dc.contributor.authorKeogh, Anne-
dc.contributor.authorKotlyar, Eugene-
dc.contributor.authorNg, Benjamin-
dc.contributor.authorProudman, Susanna-
dc.contributor.authorSteele, Peter-
dc.contributor.authorThakkar, Vivek-
dc.contributor.authorWeintraub, Robert-
dc.contributor.authorWhitford, Helen-
dc.contributor.authorWilliams, Trevor-
dc.contributor.authorWrobel, Jeremy-
dc.contributor.authorStrange, Geoff-
dc.identifier.citationHeart, Lung & Circulation 2020; 29(10): 1459-1468en_US
dc.description.abstractCombination 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.en_US
dc.subjectPulmonary hypertensionen_US
dc.titlePharmacological Treatment of Pulmonary Arterial Hypertension in Australia: Current Trends and Challenges.en_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleHeart, Lung & Circulationen_US
dc.identifier.affiliationDepartment of Rheumatology, Liverpool Hospital, Liverpool, NSW, Australiaen_US
dc.identifier.affiliationMacquarie University, Department of Clinical Medicine, Macquarie Park, NSW, Australiaen_US
dc.identifier.affiliationUniversity of New South Wales, Sydney, NSW, Australiaen_US
dc.identifier.affiliationHeart and Lung Transplant Unit and Cardiology Department, St Vincent's Hospital, Sydney, NSW, Australiaen_US
dc.identifier.affiliationMonash University, Melbourne, Vic, Australiaen_US
dc.identifier.affiliationRespiratory Department, Alfred Hospital, Melbourne, Vic, Australiaen_US
dc.identifier.affiliationDepartment of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australiaen_US
dc.identifier.affiliationSydney Medical School, University of Sydney, Camperdown, NSW, Australiaen_US
dc.identifier.affiliationDepartment of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australiaen_US
dc.identifier.affiliationRespiratory Department, Sunshine Coast University Hospital, Birtinya, Qld, Australiaen_US
dc.identifier.affiliationDepartment of Cardiovascular Services, Royal Adelaide Hospital, Adelaide, SA, Australiaen_US
dc.identifier.affiliationMurdoch Children's Research Institute, Melbourne, Vic, Australiaen_US
dc.identifier.affiliationRoyal Children's Hospital, Melbourne, Vic, Australiaen_US
dc.identifier.affiliationRheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australiaen_US
dc.identifier.affiliationUniversity of Melbourne, Melbourne, Vic, Australiaen_US
dc.identifier.affiliationAdvanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australiaen_US
dc.identifier.affiliationJohn Hunter Hospital, Newcastle, NSW, Australiaen_US
dc.identifier.affiliationUniversity of Notre Dame, Perth, WA, Australiaen_US
dc.identifier.affiliationCardiology Department, Royal Hobart Hospital, Hobart, Tas, Australiaen_US
dc.identifier.affiliationThoracic Medicine, The Prince Charles Hospital, Brisbane, Qld, Australiaen_US
dc.identifier.affiliationAustin Healthen_US
dc.identifier.affiliationNepean Hospital, Sydney, NSW, Australiaen_US
dc.type.austinJournal Article-, Mark
item.openairetypeJournal Article-
item.fulltextNo Fulltext-
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