Are Additional Educational Efforts Needed for Patient Referral to Pulmonary Hypertension Centers?

Patients referred to pulmonary hypertension centers for diagnosis and treatment are often referred late, receive misdiagnoses, and are inappropriately prescribed medications, according to a study published on April 8 in JAMA Internal Medicine.

The multicenter, cross-sectional study looked at 140 patients with a mean age of 56 years who had been referred to pulmonary hypertension centers. Of the 98 patients who received a definitive diagnosis before the referral, 32 (33 percent) received a misdiagnosis. Of the 38 patients who underwent catheterization of the right side of the heart, 14 (37 percent) received a different diagnosis after undergoing the procedure, while of the 21 patients who underwent catheterization of both sides of the heart, 11 (52 percent) received a different diagnosis after undergoing the procedures.

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Further, 42 patients (30 percent) had started receiving pulmonary artery hypertension-specific medications before referral, with 24 of the prescriptions (57 percent) contrary to guidelines and prescribed inappropriately.

"Optimally, patients with a diagnosis of pulmonary artery hypertension should be referred to the pulmonary hypertension centers for confirmation and joint management so as to provide experienced care including earlier initiation of advanced therapies, potential enrollment in studies of novel or approved therapies, and consideration for transplant listing," the authors note. They conclude that current educational efforts have not been effective in promoting early diagnosis and referral, and that it is necessary to reevaluate these approaches "to improve the care of patients with pulmonary hypertension."

Keywords: Diagnostic Errors, Early Diagnosis, Cross-Sectional Studies, Referral and Consultation, Catheterization, Internal Medicine, Pulmonary Artery, Hypertension, Diagnosis, Differential

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