When should I refer?

One of the reasons for the significant delay to diagnosis of PAH is delays in specialist referrals to PAH expert centres.1 That’s why if you suspect PAH based on your key investigations, the best practice is to refer your patient to a PAH expert centre as soon as possible.2,3

When to consider referring a patient with suspected PAH to a PAH expert centre2,3
When to consider referring a patient with suspected PAH to a PAH expert centre
Adapted from Galiè N, et al. 2016, and Frost A, et al. 2018.2,3
CP-92533 – NSW PAH referral card
References
  1. Strange G, et al. Pulm Circ 2013; 3:89–94.
  2. Galiè N, et al. Eur Heart J 2016; 37:67–119.
  3. Frost A, et al. Eur Respir J 2018; in press [https://doi.org/10.1183/13993003.01904-2018].
Footnotes
CT=computed tomography; CHD=congenital heart disease; CTD=connective tissue disease; CTEPH=chronic thromboembolic pulmonary hypertension; DLCO=diffusing capacity of the lung for carbon monoxide; ECG=electrocardiogram; HRCT=high-resolution computed tomography; MPAP=mean pulmonary artery pressure; PAH=pulmonary arterial hypertension; PAWP=pulmonary artery wedge pressure; PVR=pulmonary vascular resistance; RHC=right heart catheterisation; SSc=systemic sclerosis.

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This content is intended for Australian healthcare professionals. For more information on pulmonary hypertension, please contact your healthcare professional.
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World Health Organization functional class (WHO-FC) for patients with PH3,5

This system grades PH severity according to the patient’s functional status, by linking symptoms with activity limitations. WHO-FC remains a powerful predictor of outcomes in patients with PAH.

WHO - FC Description
I
Patients with PH in whom there is no limitation of usual physical activity; ordinary physical activity does not cause increased dyspnoea, fatigue, chest pain, or presyncope.
II
Patients with PH who have mild limitation of physical activity. There is no discomfort at rest, but normal physical activity causes increased dyspnoea, fatigue, chest pain, or presyncope.
III
Patients with PH who have a marked limitation of physical activity. There is no discomfort at rest, but less than ordinary activity causes increased dyspnoea, fatigue, chest pain, or presyncope.
IV
Patients with PH who are unable to perform any physical activity at rest and who may have signs of right ventricular failure. Dyspnoea and/or fatigue may be present at rest, and symptoms are increased by almost any physical activity.
Adapted from McGoon M, et al. 2004.5
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This website is intended for Australian healthcare professionals only