title: Parenteral Prostanoid Use at a Tertiary Referral Center: A Retrospective Cohort Study.
abstract: BACKGROUND
  Evidence-based guidelines recommend the use of parenteral prostaglandin (PP) therapy in patients with advanced pulmonary arterial hypertension (PAH). Despite this, many patients with PAH die without PP therapy. We sought to examine the frequency of PP use at a large referral center and characterize patients with PAH who died without receiving PP.
  
  
  METHODS
  We conducted a single-center retrospective cohort analysis of consecutive patients with PAH between 2008 and 2012. Clinical data and cause of death were compared between patients with PAH treated with PP (PAH-PP) and those who were not but were not documented as poor PP candidates (PAH-nonPP).
  
  
  RESULTS
  Of the 101 patients who received a diagnosis of PAH and died, 61 received PP therapy. Of the 40 patients not treated with PP, 10 did not have documented evaluations for PP therapy (PAH-nonPP) whereas 30 were not considered candidates or refused PP therapy. Compared with PAH-PP, PAH-nonPP had a longer 6-min walk distance, had a longer duration between time of diagnosis and date of worse functional class visit, were less likely to be diagnosed as functional class IV, and had significantly lower right atrial pressure. None of the PAH-nonPP died of progressive PAH.
  
  
  CONCLUSIONS
  We found that most patients who die with PAH are evaluated for PP therapy at a large referral center and the small minority of PAH-nonPP tended to have less severe disease and die of non-PAH-related causes. Our data suggest that at large pulmonary hypertension (PH) centers, the vast majority of patients who are appropriate candidates receive PP therapy.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Hay
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Pugh
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Robbins
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: anna.r.hemnes@vanderbilt.edu.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Hemnes
mesh_terms: D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D003240:Connective Tissue Diseases / Q000150:complications; D003645:Death, Sudden; D065128:Endothelin Receptor Antagonists / Q000627:therapeutic use; D065627:Familial Primary Pulmonary Hypertension / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000150:complications; D006330:Heart Defects, Congenital / Q000150:complications; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011453:Prostaglandins / Q000627:therapeutic use*; D058996:Quality Improvement; D012189:Retrospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers
chemical_list: D065128:Endothelin Receptor Antagonists; D058986:Phosphodiesterase 5 Inhibitors; D011453:Prostaglandins
keywords: pulmonary arterial hypertension; pulmonary hypertension; quality improvement