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. 2023 Nov 30;13(4):e12314.
doi: 10.1002/pul2.12314. eCollection 2023 Oct.

Risk assessment in pulmonary arterial hypertension patients with multiple comorbidities and/or advanced age-Where do we stand and what's next?

Abdulla Ahmed  1   2   3 , Salaheldin Ahmed  1   2   3 , Göran Rådegran  1   2
Affiliations

Risk assessment in pulmonary arterial hypertension patients with multiple comorbidities and/or advanced age-Where do we stand and what's next?

Abdulla Ahmed et al. Pulm Circ. .
No abstract available

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Conflict of interest statement

Abdulla Ahmed and Salaheldin Ahmed report no conflicts of interest. Göran Rådegran reports unrestricted research grants from ALF, Go Rad Care AB, and Nordic Infucare, as well as a noninterventional investigator‐initiated study research grant from Janssen‐Cilag AB, during the conduct of this work. Abdulla Ahmed and Salaheldin Ahmed report personal lecture fees from Janssen‐Cilag AB and Nordic Infucare outside the submitted work. Göran Rådegran reports personal lecture fees from Actelion Pharmaceuticals Sweden AB, Bayer Health Care, GlaxoSmithKline, Janssen‐Cilag AB, Merck Sharp & Dohme AB, Nordic Infucare, and Orion Pharma outside the submitted work. Göran Rådegran is and has been the primary, or co‐, investigator in clinical PAH trials for Acceleron, Actelion Pharmaceuticals Sweden AB, Bayer, Janssen‐Cilag AB, Merck Sharp & Dohme AB, Pfizer, and United Therapeutics and in clinical heart transplantation immuno‐suppression trials for Novartis.

Figures

Figure 1
Figure 1
Suggestion of a modified risk assessment and prognostic evaluation approach in PAH patients with respect to comorbidity burden, demographics, and frailty. Apart from comorbidity burden, demographic characteristics, and frailty, treatment goals should be based on life expectancy. The ESC/ERS guidelines recommend the use of a three‐strata instrument (original SPAHR/COMPERA) at baseline assessments. At follow‐up assessments, the guidelines recommend the use of the three‐parametric four‐strata instrument (COMPERA 2.0), while acknowledging that more parameters should be included if needed, without addressing how this should be performed. The Updated SPAHR instrument can, however, employ additional parameters by using the three‐strata table to calculate a four‐strata score, as shown in the last row. The updated SPAHR instrument with divided intermediate risk category therefore offers as a complement to COMPERA 2.0. In patients with frailty, multiple comorbidities, and/or elderly, the 1‐year mortality rates are likely higher than in those without comorbidities (denoted by *) due to lower life expectancy. Frailty is a state of increased vulnerability to stressors due to depleted physiologic reserves and is considered as a distinct entity from comorbidities. Further validation of these instruments are warranted. First published in European Heart Journal Open, 2023. Illustrated and modified by Abdulla Ahmed.
See this image and copyright information in PMC

References

    1. Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger R, Brida M, Carlse J, Coats AJS, Escribano‐Subia P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke‐Zaba J, Quint JK, Rådegran G, Simonneau G, Tonia T, Toshner M, Vachiery VL, Vonk NA, Rosenkranz S, Delcroix M. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43:3618–3731. 10.1093/eurheartj/ehac237 - DOI - PubMed
    1. Hjalmarsson C, Rådegran G, Kylhammar D, Rundqvist B, Multing J, Nisell MD, Kjellström B. Impact of age and comorbidity on risk stratification in idiopathic pulmonary arterial hypertension. Eur Respir J. 2018;51:1702310. 10.1183/13993003.02310-2017 - DOI - PubMed
    1. Hoeper MM, Pausch C, Grünig E, Klose H, Staehler G, Huscher D, Pittrow D, Olsson KM, Vizza CD, Gall H, Benjamin N, Distler O, Opitz C, Gibbs JSR, Delcroix M, Ghofrani HA, Rosenkranz S, Ewert R, Kaemmerer H, Lange TJ, Kabitz HJ, Skowasch D, Skride A, Jureviciene E, Paleviciute E, Miliauskas S, Claussen M, Behr J, Milger K, Halank M, Wilkens H, Wirtz H, Pfeuffer‐Jovic E, Harbaum L, Scholtz W, Dumitrescu D, Bruch L, Coghlan G, Neurohr C, Tsangaris I, Gorenflo M, Scelsi L, Vonk‐Noordegraaf A, Ulrich S, Held M. Idiopathic pulmonary arterial hypertension phenotypes determined by cluster analysis from the COMPERA registry. J Heart Lung Transplant. 2020;39:1435–1444. 10.1016/j.healun.2020.09.011 - DOI - PubMed
    1. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross‐sectional study. The Lancet. 2012;380:37–43. 10.1016/S0140-6736(12)60240-2 - DOI - PubMed
    1. Hoeper MM, Dwivedi K, Pausch C, Lewis RA, Olsson KM, Huscher D, Pittrow D, Staehler EG, Vizza CD, Gall H, Distler O, Opitz C, Gibb JSR, Delcroix M, Park D‐H, Ghofrani HA, Ewert R, Kaemmerer H, Kabitz H‐J, Skowasch D, Behr H, Milger K, Lange TJ, Wilkens H, Seyfarth H‐J, Held M, Dumitrescu D, Tsangaris I, Vonk‐Noordegraaf A, Ulrich S, Klose H, Claussen M, Eisenmann S, Schmidt K‐H, Swift AJ, Thompson AAR, Elliot CA, Rosenkranz S, Condliffe R, Kiely DG, Halank M. Phenotyping of idiopathic pulmonary arterial hypertension: a registry analysis. Lancet Respir Med. 2022;10:937–948. 10.1016/S2213-2600(22)00097-2 - DOI - PMC - PubMed