1
|
Preston IR, Howard LS, Langleben D, Lichtblau M, Pulido T, Souza R, Olsson KM. Management of pulmonary hypertension in special conditions. Eur Respir J 2024:2401180. [PMID: 39209477 DOI: 10.1183/13993003.01180-2024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 09/04/2024]
Abstract
Care of pulmonary hypertension (PH) patients in special situations requires insightful knowledge of the pathophysiology of the cardiopulmonary system and close interaction with different specialists, depending on the situation. The role of this task force was to gather knowledge about five conditions that PH patients may be faced with. These conditions are 1) perioperative care; 2) management of pregnancy; 3) medication adherence; 4) palliative care; and 5) the influence of climate on PH. Many of these aspects have not been covered by previous World Symposia on Pulmonary Hypertension. All of the above conditions are highly affected by psychological, geographical and socioeconomic factors, and share the need for adequate healthcare provision. The task force identified significant gaps in information and research in these areas. The current recommendations are based on detailed literature search and expert opinion. The task force calls for further studies and research to better understand and address the special circumstances that PH patients may encounter.
Collapse
Affiliation(s)
- Ioana R Preston
- Pulmonary, Critical Care and Sleep Division, Tufts University School of Medicine, Boston, MA, USA
| | - Luke S Howard
- Imperial College London, National Pulmonary Hypertension Service, London, UK
| | - David Langleben
- Center for Pulmonary Vascular Disease, Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Mona Lichtblau
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Tomas Pulido
- Ignacio Chávez National Heart Institute, México City, Mexico
| | - Rogerio Souza
- Pulmonary Department - Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Karen M Olsson
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| |
Collapse
|
2
|
Le Bozec A, Korb-Savoldelli V, Boiteau C, Dechartres A, Al Kahf S, Sitbon O, Montani D, Jaïs X, Guignabert C, Humbert M, Savale L, Chaumais MC. Medication adherence, related factors and outcomes among patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension: a systematic review. Eur Respir Rev 2024; 33:240006. [PMID: 38960611 PMCID: PMC11220621 DOI: 10.1183/16000617.0006-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/04/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are life-threatening conditions that can progress to death without treatment. Although strong medication adherence (MA) is known to enhance outcomes in chronic illnesses, its association with PAH and CTEPH was sporadically explored. This study aims to examine the MA of patients with PAH or CTEPH, identify factors associated with low adherence and explore the resulting outcomes. METHODS A systematic review was conducted by searching multiple databases (Medline, Embase, Cochrane Central, ClinicalTrials.gov, Scopus, Web of Science and Google Scholar) from 6 March 1998 to 6 July 2023. We included studies reporting MA as primary or secondary end-points. Study selection, data extraction and methodological quality assessment were performed in duplicate. RESULTS 20 studies involving 22 675 patients met the inclusion criteria. Heterogeneity was observed, particularly in the methods employed. MA means ranged from 0.62 to 0.96, with the proportion of patients exhibiting high MA varying from 40% (95% CI 35-45%) to 94% (95% CI 88-97%). Factors associated with low adherence included increased treatment frequency, time since diagnosis and co-payment. High MA seems to be associated with reduced hospitalisation rates, inpatient stays, outpatient visits and healthcare costs. CONCLUSIONS This systematic review underscores the heterogeneity of MA across studies. Nevertheless, the findings suggest that high MA could improve patients' clinical outcomes and alleviate the economic burden. Identifying factors consistently associated with poor MA could strengthen educational efforts for these patients, ultimately contributing to improved outcomes.
Collapse
Affiliation(s)
- Antoine Le Bozec
- Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Saclay, Service de Pharmacie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie Clinique, Université Paris Saclay, Orsay, France
| | - Virginie Korb-Savoldelli
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie Clinique, Université Paris Saclay, Orsay, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Cité, Service de Pharmacie, Hôpital Européen Georges Pompidou, Paris, France
| | - Claire Boiteau
- Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Saclay, Service de Pharmacie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Paris, France
| | - Salma Al Kahf
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - David Montani
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Xavier Jaïs
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Christophe Guignabert
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Pneumologie et soins intensifs, centre de référence de l'hypertension pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Marie-Camille Chaumais
- Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Saclay, Service de Pharmacie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, Inserm, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Le Kremlin-Bicêtre, France
- Université Paris Saclay, Faculté de Pharmacie, Département de Pharmacie Clinique, Université Paris Saclay, Orsay, France
| |
Collapse
|
3
|
Nikitin D, Lin GA, Whittington MD, Nhan E, Kayali Y, Rind DM, Pearson SD, Agboola F. The effectiveness and value of sotatercept for pulmonary arterial hypertension: A summary from the Institute for Clinical and Economic Review's Midwest Comparative Effectiveness Public Advisory Council. J Manag Care Spec Pharm 2024; 30:491-495. [PMID: 38701024 PMCID: PMC11068652 DOI: 10.18553/jmcp.2024.30.5.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
| | - Grace A. Lin
- Institute for Clinical and Economic Review, Boston, MA
| | - Melanie D. Whittington
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, MA
| | - Emily Nhan
- Institute for Clinical and Economic Review, Boston, MA
| | | | - David M. Rind
- Institute for Clinical and Economic Review, Boston, MA
| | | | | |
Collapse
|