title: Breaking Down the Barriers: Why the Delay in Referral for Pulmonary Arterial Hypertension?
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) is a rare and fatal disease. While many treatment options have been shown to improve quality of life, exercise tolerance, and hemodynamics in PAH, survival remains poor, in part due to the advanced stage at which patients present to PAH specialists.
  
  
  METHODS
  This perspective paper explores challenges related to the timing of referral, diagnosis, and initiation of therapy.
  
  
  RESULTS
  Multiple factors account for the delay in referral, including fallacies in physician education, commercial influence resulting in inappropriate prescribing practices, and barriers in access to care.
  
  
  CONCLUSIONS
  Improving physician education, encouraging the prescription of PAH medications to be done predominantly by PAH specialists, overcoming barriers to care, and promoting screening for PAH will help ensure early referral, diagnosis, and treatment.
authors.affiliation: Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Mandras
authors.affiliation: Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Hector O
authors.initials: HO
authors.lastname: Ventura
authors.affiliation: University of Newcastle, Newcastle on Tyne, United Kingdom.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Corris
keywords: Delayed diagnosis; early diagnosis; health services accessibility; hypertension–pulmonary; inappropriate prescribing; pulmonary medicine; referral and consultation