Why should I refer?

Time lost because of delayed diagnosis cannot be regained

Vascular damage and functional deterioration occur early in PAH, so it is crucial for physicians to act early before more damage is done.1,2 Prompt diagnosis and treatment offers the best chance to delay disease progression, and may improve outcomes in PAH.2

Refer to a PAH expert centre as soon as possible2–4

Due to the complex diagnosis and management of PAH, prescription of PAH-specific therapies has been restricted to clinicians practising at Medicare-approved PAH Designated Centres.5,6 These centres have the required experience, expertise and resources for diagnosing and managing patients with PAH, including:3,5
  • Diagnostic services and expertise with procedures
    • PAH expert centres can promptly perform further necessary tests such as right heart catheterisation (RHC), exercise tolerance, CT scanning/imaging, ventilation/perfusion scan, MRI, etc.
  • PAH nursing and patient support services
  • Access to ongoing medical management via a multidisciplinary team, including relevant allied healthcare professionals
  • PAH management services and clinics, including special access schemes and clinical trials
  • Medicare authorisation to prescribe PAH-specific pharmacological treatment
What to expect after referring your patient to a PAH expert centre

After referral, a shared-care team approach between the referring physician and PAH expert centre is ideal for appropriate ongoing patient management3

References
  1. Strange G, et al. Pulm Circ 2013; 3:89–94.
  2. Lau EMT, et al. Eur Heart J 2011; 32:2489–98.
  3. Galie N, et al. Eur Heart J 2016; 37:67–119.
  4. Frost A, et al. Eur Respir J 2018; in press [https://doi.org/10.1183/13993003.01904-2018].
  5. Department of Human Services. Pulmonary arterial hypertension designated centres. Available at: https://www.humanservices.gov.au/organisations/health-professionals/enablers/pulmonary-arterial-hypertension-designated-centres. Accessed August 2019.
  6. Department of Human Services. Pulmonary hypertension – arterial. Available at: https://www.humanservices.gov.au/organisations/health-professionals/enablers/pulmonary-arterial-hypertension. Accessed August 2019.
Footnotes
CT=computed tomography; MRI=magnetic resonance imaging; PAH=pulmonary arterial hypertension; PH=pulmonary hypertension; RHC=right heart catheterisation.

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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