Rana Awdish

PH Roundtable: Center-based Care

As guest editor of this issue, Dr Chakinala organized a group of individuals who each had different perspectives and relationships to Pulmonary Hypertension Care Centers. In conversation among the physicians, nurse, social worker, and patient, they touch on the evolution of care of pulmonary hypertension patients over the past 20 years and the complexity of care that new medications and their side effects create. They discuss the advantages that centers of care can bring to the patients and to the field as a whole from access to experts to multidisciplinary care and clinical research during their lively conversation.

Recommendations for the clinical management of patients receiving macitentan for pulmonary arterial hypertension (PAH): A Delphi consensus document

In patients treated with macitentan (Opsumit®, Actelion Pharmaceuticals Ltd., Basel, Switzerland) for pulmonary arterial hypertension (PAH), prevention and/or effective management of treatment-related adverse events may improve adherence. However, management of these adverse events can be challenging and the base of evidence and clinical experience for macitentan is limited. In the absence of evidence, consensus recommendations from physicians experienced in using macitentan to treat PAH may benefit patients and physicians who are using macitentan. Consensus recommendations were developed by a panel of physicians experienced with macitentan and PAH using a modified Delphi process. Over three iterations, panelists developed and refined a series of statements on the use of macitentan in PAH and rated their agreement with each statement on a Likert scale. The panel of 18 physicians participated and developed a total of 118 statements on special populations, add-on therapy, drug–drug interactions, warnings and precautions, hospitalization and functional class, and adverse event management. The resulting consensus recommendations are intended to provide practical guidance on real-world issues in using macitentan to treat patients with PAH.

Management of Decompensated Right Ventricular Failure in the Intensive Care Unit

Acute on chronic decompensation of right heart failure can present many challenges to the critical care practitioner that require an understanding of the effect of right heart failure on resuscitation endpoints and hemodynamic monitoring. In this chapter, we review principles of management of decompensated right heart failure using an illustrative case followed by a review of the evidence regarding monitoring, pharmacotherapy, and supportive care of these patients.

Low Rate of Adverse Events Associated with Inpatient Parenteral Prostacyclins

Abstract: Parenteral prostacyclin is the most-effective therapy for patients with pulmonary arterial hypertension. Administration is complex, and administration errors are potentially life threatening. Hospital policies to minimize the risk to patients are necessary, but their effectiveness has not been well studied. We quantified the adverse event incident rate per at-risk patient day in a tertiary care hospital with an established parenteral prostacyclin policy. Patients on parenteral prostacyclin including new initiations from January 2003 to January 2013 were identified, encompassing 386 discrete admissions. Reports of adverse events were obtained from the inpatient risk feedback–reporting process and detailed chart review. Policy-divergent events were analyzed both categorically and by the degree of severity. Overall, 153 total policy-divergent events were identified. Data analysis indicated an incident rate of 45.9 per 1,000 patient days. In total, 21 of 153 potential errors reached the patient, translating to an incident rate of 6.3 per 1,000 patient days. Incident rate for “serious symptomatic” or “catastrophic” policy-divergent events was 3.3 per 1,000 patient days. Even with specific prostacyclin training and administration policy, there remains a small risk of adverse events in hospitalized pulmonary hypertension patients receiving parenteral prostacyclin.