CHEST Pulmonary Arterial Hypertension Immersion Program October 25, 2023-Risk Assessment

Risk Assessment - Rajagopal

Pdf Summary

Risk assessment is crucial in determining the appropriate therapy for patients with pulmonary arterial hypertension (PAH). Various risk assessment tools have been developed to evaluate the severity and prognosis of PAH patients. These tools include functional class (FC), 6-minute walk distance (6MWD), right atrial pressure (RAP), cardiac index (CI), N-terminal pro-brain natriuretic peptide (NT-proBNP), and oxygen saturation (SvO2). Several registries and studies have demonstrated the effectiveness of risk assessment in predicting patient outcomes and guiding therapy decisions.<br /><br />The ESC/ERS guidelines recommend a three-strata model at baseline and a four-strata model at follow-up. These models classify patients into low, intermediate, and high-risk categories based on their clinical parameters. Patients who achieve or maintain a low-risk status generally have better survival rates. However, it is important to note that some patients may not be able to achieve low-risk status and there can be limitations to risk assessment tools.<br /><br />The REVEAL 2.0 risk scoring system has been shown to be superior to other baseline models and provides a more accurate assessment of PAH risk. Additionally, REVEAL Lite 2 is a non-invasive risk assessment tool that incorporates modifiable parameters that can be updated at each clinic visit.<br /><br />It is important to personalize therapy based on individual patient risk assessments. Treatment decisions may be influenced by factors such as genetic risk factors (e.g., BMPR2 mutation) and additional information from imaging. Risk assessments can help guide therapy decisions and identify patients who may benefit from combination therapy or other interventions.<br /><br />In conclusion, risk assessment plays a crucial role in guiding therapy decisions for patients with PAH. While current risk assessment tools have limitations, they provide valuable information about a patient's prognosis and can help tailor treatment strategies. It is important for healthcare providers to regularly perform risk assessments to optimize patient outcomes.

Keywords

risk assessment

pulmonary arterial hypertension

PAH

therapy

severity

prognosis

functional class

6-minute walk distance

right atrial pressure

cardiac index