Evolving Concepts in Pulmonary Hypertension: Implementation Challenges of the Current Guidelines and Proceedings in the United States.

Abstract

Pulmonary hypertension (PH) represents a pathophysiologically diverse and clinically intricate spectrum of disorders characterized by elevated pulmonary arterial pressures and progressive right ventricular dysfunction. The management of PH has evolved considerably over recent decades; these developments underscore the dynamic nature of the field and the necessity for continual reappraisal of diagnostic and therapeutic frameworks. The European Society of Cardiology/European Respiratory Society and the World Symposium on Pulmonary Hypertension were pivotal in addressing key PH topics, including hemodynamic definitions, disease classification, risk stratification, and evolving therapeutic agents, and generating consensus-driven recommendations that shape global clinical practice. The ability to translate these global recommendations to clinical practice within the United States may be limited by inherent differences in health care access, population-specific disease modifiers, unique pulmonary arterial hypertension subtypes, clinical practice preferences, and comorbidities. The recent clinical trials have introduced new therapies and indications that are reshaping the treatment landscape; however, these developments have not been addressed in guidelines or reviews from professional societies in the United States. The purpose of this review is to synthesize and interpret the latest international recommendations from a US perspective. We discuss multiple barriers to implementation of these recommendations, addressing racial, ethnic, and geographic disparities, treatment costs, and insurance limitations that are unique to the US health care system, and its effects on treatment delays and patient outcomes. Ultimately, this provides a framework for the development of a roadmap to increasing the quality of PH care in the United States.