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oa Risk Stratification in Pulmonary Hypertension in the UAE
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- 27 May 2024
- 24 Oct 2024
- 16 Dec 2024
Abstract
Risk stratification in pulmonary arterial hypertension is critical in determining therapeutic strategies for patients. Patients are stratified into low-, intermediate-, and high-risk groups based on determinants of prognosis like clinical assessment, exercise tests, biochemical markers, echocardiography, and haemodynamic tests. The primary objective of treatment is to shift each of the component tests into a low-risk zone either by treatment escalation alone, as in the case of intermediate-risk patients, or by a combination of treatment escalation and repeat evaluation by right heart catheterisation in high-risk patients. Low-risk patients should be clinically assessed at least every 3 months, but follow-up is more frequent for intermediate- and high-risk patients. Apart from improving survival rates, health-related quality of life is also assessed at baseline and follow-up visits, which may predict the prognosis. Additionally, therapeutic drug monitoring is also essential during visits due to the risk of major side effects during treatment initiation or dose escalation. Initial and follow-up risk stratification can prevent delays in the intensification of therapy, but insurance denials act as a barrier to this approach. Therefore, a dedicated insurance team is required for approval of testing and therapies and a fast-track process to communicate with the pulmonary hypertension expert centre. It can be concluded that risk stratification improves the treatment approach and helps make individualised treatment decisions. It also helps healthcare professionals better allocate treatment resources in cases of scarcity.
