title: Provider recognition and response to echocardiographic findings indicating pulmonary hypertension in the Veterans affairs medical center population.
abstract: PH occurs alone or in association with many disorders. Many patients with transthoracic echocardiography (TTE) findings suggesting PH never receive additional evaluation. Patient characteristics and echocardiographic data associated with increased recognition of PH have not been fully evaluated. We evaluated TTE reports at the Cincinnati Veterans Affairs Medical Center from 2005 to 2006 retrospectively for findings highly indicative of PH: Estimated systolic pulmonary artery pressure (sPAP) ≥40 mmHg, increased right atrial or right ventricular (RV) size, or reduced RV function. Only patients with left ventricular ejection fraction (LVEF) ≥50% and no known diagnosis of PH were included. Patient characteristics, TTE findings, provider recognition rates, and subsequent referral for additional evaluation were assessed. A total of 227 of 3,960 (5.7%) TTE reports revealed findings indicating possible PH. Providers acknowledged possible PH in 53 (23.4%) reports. Recognized PH was predicted by increased RV size (odds ratio (OR) = 5.07, P < 0.001), increased right atrial dimension (OR = 6.45, P < 0.001), decreased RV function (OR = 8.86, P < 0.001), and increased PAP (OR = 1.04 corresponding to each unit increase of PAP, P < 0.01). Patients with comorbid obstructive sleep apnea (OSA), interstitial lung disease, and dyspnea were also more likely to be recognized (OR = 3.63, P = 0.021; OR = 10.98, P = 0.004; OR = 2.39, P = 0.007, respectively). The 12-month mortality rate for recognized patients, 11.3% (7/53), was lower than for unrecognized patients, 25.3% (44/174; P = 0.03). Providers recognized less than one in four patients with echocardiographic evidence suggesting PH. Echocardiography reports revealing higher PAP and right heart dilation and dysfunction are associated with increased acknowledgement of possible PH.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA ; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA ; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Kingrey
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Panos
authors.forename: Jun
authors.initials: J
authors.lastname: Ying
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Meganathan
authors.forename: Robin
authors.initials: R
authors.lastname: Vandivier
authors.forename: Jean M
authors.initials: JM
authors.lastname: Elwing
keywords: disease recognition; echocardiography; pulmonary hypertension