title: Assessing response to therapy in idiopathic pulmonary arterial hypertension: a consensus survey of Canadian pulmonary hypertension physicians.
abstract: BACKGROUND
  Many treatment options are now available for patients with idiopathic pulmonary arterial hypertension (IPAH). Data regarding the optimal combination of therapies are lacking, as is consensus on how to assess response to therapy and when to change therapeutic regimens.
  
  
  OBJECTIVE
  To gather the opinions of Canadian pulmonary hypertension (PH) experts regarding standard practice in the care of IPAH patients after therapy is initiated.
  
  
  METHODS
  Canadian PH physicians were surveyed using short questionnaires to assess their opinions and practices in the care of IPAH patients. A Delphi forecasting approach was used to gain consensus among Canadian physicians on the most important clinical parameters to consider when assessing patients after the initiation of therapy.
  
  
  RESULTS
  Twenty-six of 37 Canadian PH experts who were invited to participate completed the study. All endorsed the use of combination therapy for IPAH patients despite the lack of universal provincial coverage for this approach. By consensus, WHO functional class, 6 min walk distance and hospitalization for right heart failure were the most important clinical parameters. The most highly rated physical examination parameters were jugular venous pressure, peripheral edema, the presence of ascites and body weight.
  
  
  CONCLUSIONS
  The overall approach to care of IPAH patients is similar across PH centres in Canada. A limited number of clinical and physical examination parameters were considered to be most important to reassess patients after therapy is initiated. These parameters, along with definition of threshold values, will facilitate the development of standard practice guidelines for IPAH patients in Canada.
authors: University of British Columbia, Vancouver, British Columbia. switson@interchange.ubc.ca
authors: Adrienne E
authors: AE
authors: Borrie
authors: David N
authors: DN
authors: Ostrow
authors: Robert D
authors: RD
authors: Levy
authors: John R
authors: JR
authors: Swiston
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002170:Canada; D003697:Delphi Technique; D019468:Disease Management; D016903:Drug Monitoring / Q000379:methods / Q000592:standards; D004359:Drug Therapy, Combination / Q000379:methods / Q000592:standards; D017079:Exercise Tolerance; D005104:Expert Testimony; D065627:Familial Primary Pulmonary Hypertension; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D054539:Medication Therapy Management / Q000592:standards*; D010808:Physical Examination / Q000379:methods / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents