Pub Date : 2023-11-01DOI: 10.21693/1933-088x-22.3.121
Marc A. Simon, Richard A. Krasuski
{"title":"Guest Editors’ Memo","authors":"Marc A. Simon, Richard A. Krasuski","doi":"10.21693/1933-088x-22.3.121","DOIUrl":"https://doi.org/10.21693/1933-088x-22.3.121","url":null,"abstract":"","PeriodicalId":92747,"journal":{"name":"Advances in pulmonary hypertension","volume":"27 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135614565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Therapies currently available to pulmonary arterial hypertension (PAH) patients do not reverse the disease; however, they improve pulmonary hemodynamics, offer symptomatic relief, and lengthen the time to clinical worsening. These therapies do not come without their challenges, which include side effects and compliance with challenging titration regimens. Health care providers, particularly nurses, play a significant role in improving patient medication adherence. In-home nurse visits offer disease state education, set medication expectations, and provide support tools for patients when experiencing adverse events that may lead to therapy discontinuation. The purpose of this study is to determine the impact that in-home, face-to-face nursing visits have on optimal adherence to oral PAH therapies. Methods We identified patients who received an oral PAH drug (riociguat, selexipag, or treprostinil) supported by a nursing program (study group) and patients who received an oral PAH drug (bosentan, ambrisentan, or macitentan) not supported by a nursing program (control group) using CVS Health pharmacy data from January 1, 2018, to June 30, 2019. A logistic regression model examined demographic and medication factors associated with adherence. Results From January 2018 to June 2019, we identified 107 patients in the study group and 213 patients in the control group. After 6 months, patients in the study group reported 0.6 more fill counts (5.1 vs 4.5; P = .002) and an 11% higher medication possession ratio (MPR) than those in the control group (86.4% vs 75.0%; P = .001). After adjusting for patient characteristics, control patients tended to be more likely to drop therapy in the first 6 months after the index fill (hazard ratio = 1.52; P = .064). After 6 months, the study group reported higher rates of therapy persistence than the control group (72.0% vs 60.6%; P < .05). Conclusions Patients receiving oral PAH therapies (riociguat, selexipag, or treprostinil) supported through a visiting nurse program had significantly higher rates of optimal adherence as demonstrated by a statistically significant improvement in the MPR and a higher prescription fill count than a control group. Ultimately, a multidisciplinary approach supporting the patient and providing patient education, proper motivation, and face-to-face nursing may support improved patient outcomes.
背景:目前用于肺动脉高压(PAH)患者的治疗方法不能逆转该疾病;然而，它们改善了肺血流动力学，缓解了症状，延长了临床恶化的时间。这些疗法并非没有挑战，包括副作用和对具有挑战性的滴定方案的依从性。卫生保健提供者，特别是护士，在改善患者服药依从性方面发挥着重要作用。家庭护士访问提供疾病状态教育，设定药物预期，并在患者经历可能导致治疗中断的不良事件时提供支持工具。本研究的目的是确定在家中，面对面的护理访问对口服多环芳烃治疗的最佳依从性的影响。方法:利用2018年1月1日至2019年6月30日CVS Health药房数据，我们确定了在护理计划支持下接受口服PAH药物(利奥西格特、selexipag或treprostinil)的患者(研究组)和在护理计划支持下接受口服PAH药物(波生坦、ambrisentan或macitentan)的患者(对照组)。逻辑回归模型检验了与依从性相关的人口统计学和药物因素。结果2018年1月至2019年6月，研究组107例，对照组213例。6个月后，研究组患者报告的填充计数多0.6个(5.1 vs 4.5;P = .002)，药物持有率(MPR)比对照组高11% (86.4% vs 75.0%;P = .001)。在调整患者特征后，对照组患者在指数填充后的前6个月内更有可能放弃治疗(风险比= 1.52;P = .064)。6个月后，研究组报告的治疗坚持率高于对照组(72.0% vs 60.6%;P, lt;. 05)。结论:与对照组相比，在访护计划支持下接受口服PAH治疗(瑞西格特、selexipag或treprostiil)的患者在MPR和更高的处方填充计数方面有统计学意义上的显著改善，这表明患者的最佳依从率明显更高。最终，多学科的方法支持患者，提供患者教育，适当的动机和面对面的护理可以支持改善患者的结果。
{"title":"Effects of Face-to-Face Nursing Support on Optimal Adherence to Oral Titratable PAH Therapies","authors":"Evangelia Sourounis, Pavlo Kyrychenko, Elisea Avalos-Reyes, Denise Bagford, Rashmi Grover, Lucia Feczko, Kjel Johnson","doi":"10.21693/1933-088x-22.3.144","DOIUrl":"https://doi.org/10.21693/1933-088x-22.3.144","url":null,"abstract":"Background Therapies currently available to pulmonary arterial hypertension (PAH) patients do not reverse the disease; however, they improve pulmonary hemodynamics, offer symptomatic relief, and lengthen the time to clinical worsening. These therapies do not come without their challenges, which include side effects and compliance with challenging titration regimens. Health care providers, particularly nurses, play a significant role in improving patient medication adherence. In-home nurse visits offer disease state education, set medication expectations, and provide support tools for patients when experiencing adverse events that may lead to therapy discontinuation. The purpose of this study is to determine the impact that in-home, face-to-face nursing visits have on optimal adherence to oral PAH therapies. Methods We identified patients who received an oral PAH drug (riociguat, selexipag, or treprostinil) supported by a nursing program (study group) and patients who received an oral PAH drug (bosentan, ambrisentan, or macitentan) not supported by a nursing program (control group) using CVS Health pharmacy data from January 1, 2018, to June 30, 2019. A logistic regression model examined demographic and medication factors associated with adherence. Results From January 2018 to June 2019, we identified 107 patients in the study group and 213 patients in the control group. After 6 months, patients in the study group reported 0.6 more fill counts (5.1 vs 4.5; P = .002) and an 11% higher medication possession ratio (MPR) than those in the control group (86.4% vs 75.0%; P = .001). After adjusting for patient characteristics, control patients tended to be more likely to drop therapy in the first 6 months after the index fill (hazard ratio = 1.52; P = .064). After 6 months, the study group reported higher rates of therapy persistence than the control group (72.0% vs 60.6%; P &lt; .05). Conclusions Patients receiving oral PAH therapies (riociguat, selexipag, or treprostinil) supported through a visiting nurse program had significantly higher rates of optimal adherence as demonstrated by a statistically significant improvement in the MPR and a higher prescription fill count than a control group. Ultimately, a multidisciplinary approach supporting the patient and providing patient education, proper motivation, and face-to-face nursing may support improved patient outcomes.","PeriodicalId":92747,"journal":{"name":"Advances in pulmonary hypertension","volume":"26 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135614567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.21693/1933-088x-22.2.98
{"title":"PH Roundtable: The Role of Caregivers in Pulmonary Hypertension Care","authors":"","doi":"10.21693/1933-088x-22.2.98","DOIUrl":"https://doi.org/10.21693/1933-088x-22.2.98","url":null,"abstract":"","PeriodicalId":92747,"journal":{"name":"Advances in pulmonary hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42197956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.21693/1933-088x-22.2.106
Natalie M. Taylor, G. Heresi
Current pharmacologic treatments for pulmonary arterial hypertension lead to vasodilation of the pulmonary arteries, increasing cardiac output and reducing pulmonary vascular resistance in patients with pulmonary arterial hypertension. Right ventricular failure is a leading cause of death in patients with pulmonary arterial hypertension, but there remain no promising leads in the treatment of right ventricular failure. Current research demonstrates that metabolic abnormalities, particularly regarding insulin resistance and glucose intolerance, may be pathologic in the development of right ventricular failure in patients with pulmonary arterial hypertension. In this review, we will address the potential role diet and exercise may play in improving right ventricular failure in patients with pulmonary arterial hypertension.
{"title":"Diet and Exercise Intervention in Pulmonary Hypertension","authors":"Natalie M. Taylor, G. Heresi","doi":"10.21693/1933-088x-22.2.106","DOIUrl":"https://doi.org/10.21693/1933-088x-22.2.106","url":null,"abstract":"Current pharmacologic treatments for pulmonary arterial hypertension lead to vasodilation of the pulmonary arteries, increasing cardiac output and reducing pulmonary vascular resistance in patients with pulmonary arterial hypertension. Right ventricular failure is a leading cause of death in patients with pulmonary arterial hypertension, but there remain no promising leads in the treatment of right ventricular failure. Current research demonstrates that metabolic abnormalities, particularly regarding insulin resistance and glucose intolerance, may be pathologic in the development of right ventricular failure in patients with pulmonary arterial hypertension. In this review, we will address the potential role diet and exercise may play in improving right ventricular failure in patients with pulmonary arterial hypertension.","PeriodicalId":92747,"journal":{"name":"Advances in pulmonary hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41858163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.21693/1933-088x-22.2.92
D. Lachant, R. White
Wearable technologies (accelerometers) are currently being evaluated as an alternative to the 6-minute walk test as an objective measure of functional status in pulmonary arterial hypertension (PAH). Multiple observational studies incorporating accelerometers have shown patients with PAH have low physical activity (PA) time. Despite widespread use of accelerometers, PA has not been shown to increase after adding vasodilator therapy, which suggests a behavioral component influencing activity. A decrease in PA from baseline may identify clinical worsening and someone at risk for future hospitalization. Cardiac Effort, the number of heart beats used during the 6-minute walk test/6-minute walk distance (beats per meter), has less variability than 6-minute walk distance and provides a comparable clinic measurement in the home setting. Cardiac Effort may provide a better remote measurement than changes in total daily activity when evaluating for clinical improvement. The amount and duration of PA achieved in patients with PAH is likely related to a combination of right ventricular (RV) function, deconditioning, and environmental factors. Strategies to target all aspects are needed to improve PA. Further studies are needed to determine the optimal remote measure and monitoring period.
{"title":"Wearable Devices in Pulmonary Arterial Hypertension: What Are We Trying to Learn?","authors":"D. Lachant, R. White","doi":"10.21693/1933-088x-22.2.92","DOIUrl":"https://doi.org/10.21693/1933-088x-22.2.92","url":null,"abstract":"\u0000 \u0000 Wearable technologies (accelerometers) are currently being evaluated as an alternative to the 6-minute walk test as an objective measure of functional status in pulmonary arterial hypertension (PAH). Multiple observational studies incorporating accelerometers have shown patients with PAH have low physical activity (PA) time.\u0000 \u0000 \u0000 \u0000 Despite widespread use of accelerometers, PA has not been shown to increase after adding vasodilator therapy, which suggests a behavioral component influencing activity. A decrease in PA from baseline may identify clinical worsening and someone at risk for future hospitalization. Cardiac Effort, the number of heart beats used during the 6-minute walk test/6-minute walk distance (beats per meter), has less variability than 6-minute walk distance and provides a comparable clinic measurement in the home setting. Cardiac Effort may provide a better remote measurement than changes in total daily activity when evaluating for clinical improvement.\u0000 \u0000 \u0000 \u0000 The amount and duration of PA achieved in patients with PAH is likely related to a combination of right ventricular (RV) function, deconditioning, and environmental factors. Strategies to target all aspects are needed to improve PA. Further studies are needed to determine the optimal remote measure and monitoring period.\u0000","PeriodicalId":92747,"journal":{"name":"Advances in pulmonary hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46020837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.21693/1933-088x-22.2.111
R. Bernardo, A. Jose, J. Elwing
There is increasing awareness on the significance of socioeconomic status, social determinants of health, and the role of ethnicity and race in clinical outcomes of patients with pulmonary arterial hypertension. However, to date, underrepresentation of minorities in pulmonary hypertension clinical trials and registries remains. In the present review, we summarize the current knowledge on race, ethnicity, traditional and novel socioeconomics and social determinants of health, and its association with clinical outcomes in patients with pulmonary arterial hypertension. We present case examples on the interplay of these factors for specific disease phenotypes and discuss strategies for addressing these variables at the patient care level.
{"title":"Socioeconomic and Social Determinants of Health: Effects on Pulmonary Arterial Hypertension Care","authors":"R. Bernardo, A. Jose, J. Elwing","doi":"10.21693/1933-088x-22.2.111","DOIUrl":"https://doi.org/10.21693/1933-088x-22.2.111","url":null,"abstract":"There is increasing awareness on the significance of socioeconomic status, social determinants of health, and the role of ethnicity and race in clinical outcomes of patients with pulmonary arterial hypertension. However, to date, underrepresentation of minorities in pulmonary hypertension clinical trials and registries remains. In the present review, we summarize the current knowledge on race, ethnicity, traditional and novel socioeconomics and social determinants of health, and its association with clinical outcomes in patients with pulmonary arterial hypertension. We present case examples on the interplay of these factors for specific disease phenotypes and discuss strategies for addressing these variables at the patient care level.","PeriodicalId":92747,"journal":{"name":"Advances in pulmonary hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43637666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.21693/1933-088x-22.2.87
Lillian Hansen, J. Brewer
Pulmonary hypertension is a complex and progressive disease. Patients suffering from pulmonary hypertension may also experience mental health issues. Screening and treatment for mental health issues in the pulmonary hypertension population is imperative but remains a challenge. Advanced practice registered nurses and registered nurses are key to overcoming these challenges.
{"title":"PH Professional Network: Mental Health and PH: APRNs and RNs Having a Positive Effect","authors":"Lillian Hansen, J. Brewer","doi":"10.21693/1933-088x-22.2.87","DOIUrl":"https://doi.org/10.21693/1933-088x-22.2.87","url":null,"abstract":"Pulmonary hypertension is a complex and progressive disease. Patients suffering from pulmonary hypertension may also experience mental health issues. Screening and treatment for mental health issues in the pulmonary hypertension population is imperative but remains a challenge. Advanced practice registered nurses and registered nurses are key to overcoming these challenges.","PeriodicalId":92747,"journal":{"name":"Advances in pulmonary hypertension","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41823592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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