PAH in 2019 - What Are the Basics? A New Look at PAH Pathology and Definitions of This Disease
In 2018, the World Symposium on Pulmonary Hypertension (WSPH) met in Nice, France to discuss the state of understanding of pulmonary hypertension and its management. Central to the consensus panels’ work was a new look at the underlying mechanisms of disease, the tissue and cellular level changes that contribute to pulmonary hypertension and most importantly the hemodynamic definition of the disease. In light of these new consensus opinions, the algorithm for pulmonary hypertension has been modified into 2-part approach. This program looks at some of the central, new, consensus findings of the 2018 WSPH, including the revised hemodynamic definition of PH, and the tissue- and gene-level perturbations that are now thought to contribute to the etiology of pulmonary hypertension. These new consensus findings are presented in light of the revised algorithm and procedures for diagnosing pulmonary hypertension.
- Review the basic presenting symptoms for PAH
- Examine the update on pathobiology of the pulmonary vasculature
- Briefly discuss the genetic contributions to pathogenesis of PAH and their testing
- Debate the revised hemodynamic definition of PAH based on findings from the 6th WSPH consensus panel and the ERS
- Discuss the impact of the new definition on diagnosis of PH, including use of exercise testing and in light of current and traditional diagnostic procedures
Guideline Update: What Do I Need to Know About the Diagnosis and Classification of PH?
Since the early 1970s pulmonary hypertension (PH) has been arbitrarily defined as a mean pulmonary artery pressure (mPAP) of >25 mmHg as measured by right heart catheterization. However, data acquired in healthy individuals indicates a normal mPAP to be 14 + 3 mmHg. This has led the recent World Symposium on Pulmonary Hypertension (WSPH) to reexamine the definition of PH and recommend a new 2-part algorithm for diagnosing this disease. This program reviews the consensus findings of the recent 6th WSPH and its recommendations on the definition, classification and diagnosis of PH. The program includes a patient case, which highlights concepts around the screening, diagnosis and treatment of a patient with “borderline” PH.
- Discuss the recent revision of the hemodynamic definition of PAH by the World Symposium on Pulmonary Hypertension and how this new definition impacts identification of pre-capillary hypertension patients
- Review how the new hemodynamic definition of pulmonary hypertension has impacted on the classification of PH
- Debate the 2018 WSPH revision of the PH diagnostic algorithms as they are influenced by the new hemodynamic definition of PH
- Discuss the 2018 WSPH recommendations on screening for PAH, particularly in high risk groups
How Sick is my Patient? Assessing Risk and Implementing a Treatment Plan
The expanding array of PAH medications has dramatically improved the treatment of PAH. In spite of this, patients continue to experience morbidity and mortality risks. The 2018 World Symposia on Pulmonary Hypertension (WSPH) devoted an entire consensus task force on the issues of patient risk assessment and treatment. This emphasized the critical importance of thorough and regular risk assessments of PAH patients before and during their treatment course. This program examines the benefits and measurements of risk in the PAH patient, the various models available to assess risk and explores how treatment strategies are now based on a risk assessment strategy. Participants will have the opportunity to examine a risk-based case management and discuss options and choices for treatment.
- Review the importance of and methods for patient risk assessment following diagnosis of PAH
- Discuss how periodic risk assessment can be used to determine and guide patient treatment
- Review the revised PAH treatment algorithm as proposed by the 6th WSPH consensus panel
- Discuss options when medical therapy does not lead to improvement
Is My Patient Well Enough? Understanding Treatment Goals and Escalating Care
The concepts underlying pulmonary hypertension are changing as the field gains new, more expansive knowledge of the pathophysiology and management of the disease. At the recent 6th WSPH conference, new definitions and concepts of PH were proposed. How these new concepts may affect the assessment of patient risk and the management of PH treatment are of critical importance for the future of the PH patient. This program examines the newly proposed definitions of PAH, risk assessment and the goals and escalation of treatment. These emerging, revised concepts are examined in light of an actual patient case where treatment adjustments are required to progress the patient toward current goals.
- Discuss the rationale and changes for the hemodynamic definition of PAH, as proposed by the 2018 WSPH consensus guidelines
- Review the importance of periodic risk assessment and how this pertains to current goals for PAH treatment
- Describe how the level of a patient’s risk for clinical worsening is used to guide PAH treatment and escalation of that treatment in the event of worsening of risk status
- Review the 2018 WSPH consensus recommendations for initial therapy and escalation of PAH therapy when patients fail to improve towards established treatment goals
Improving the Patient Experience in PAH: A Road Map to Better Patient Outcomes
The recent World Symposium for Pulmonary Hypertension met in 2018 to reexamine the hemodynamic definition of PAH and its diagnostic and treatment algorithms. This program considers these new consensus findings and factors for the provider to consider in applying new medical treatment concepts the PAH patient in a risk-based management strategy. The effect of treatment choices are considered in light of potential side effects and their impact on the quality of life of the patient. A patient case is presented to highlight these new diagnosis and treatment concepts in a real-world situation.
- Review definition, diagnosis and management of pulmonary hypertension from the 6th World Symposium
- Review patient’s needs, expectations and perspectives regarding diagnosis, disease process, and treatment
- Examine how team-oriented dialogue can potentially improve patient compliance and minimize burden of disease
- Discuss management of PAH medication side effects as one way to to improve quality of life