WATCH: The Importance of Returning to In-Person Care and Structured Risk Assessment in the Post-COVID Era
Hear Dr Raymond Benza, MD, FACC, discuss issues that providers in the PAH community continue to face in the wake of the COVID-19 pandemic. While exploring data about PAH treatment before and during the pandemic, Dr Benza will illustrate the importance of returning to in-person care and structured risk assessment, such as REVEAL 2.0.
The COVID-19 Landscape for Patients With PAH1
- Frequent follow-up visits are often recommended for patients with pulmonary arterial hypertension (PAH) due to the ongoing risk of disease progression
- Patients may need to rely on telemedicine for formal risk assessments if they are advised against nonessential travel
An Analysis in Patients With PAH Using Real-World Retrospective Claims2
All patients with Symphony Health claims data*
n = ~16.2M
n = ~16.2M
Patients with an RHC claim and a diagnosis code for either primary or secondary PAH
n = ~1.17M
n = ~1.17M
Patients with an RHC claim, a diagnosis code for PAH, and a claim for PDE-5i, ERA, or prostacyclin products
n = ~71,000
n = ~71,000
Adult patients (18 years or older) who met predetermined diagnosis and treatment criteria (data available for an RHC claim, a diagnosis code for PAH, and a claim for PDE-5i, ERA, or prostacyclin products) for PAH†
n = ~30,000
n = ~30,000
Adult patients (18 years or older) diagnosed and treated with approved treatment claims (PDE-5i, ERA, and/or prostacyclin) from January 2019 to April 2021
n = ~24,000
n = ~24,000
Adult patients (18 years or older) diagnosed and treated with approved treatment claims (PDE-5i, ERA, and/or prostacyclin) from January 2019 to December 2019
n = ~15,000
n = ~15,000
- The pre-pandemic period was set as January 2019–December 2019
- The pandemic period was set as January 2020–January 2021
- Other factors that could contribute to care disruptions have not been studied in the analysis. It is possible that care disruptions are driven by healthcare professional, patient, and/or additional considerations
*Claims data were purchased by Janssen. The time period for all claims data ranged from January 2016 to June 2021.
†Patients with claims associated with secondary PAH, male erectile dysfunction, and other distinct therapy areas with an overlapping set of claims related to PAH were excluded.
1 in 2 Adult Patients With PAH
Experienced Treatment Disruptions During the Pandemic2
Claims data were analyzed across the pre-pandemic (January 2019–December 2019) and pandemic period (January 2020–January 2021) in the final population of 14,934 adult patients with PAH. Here are the results:
of these adult patients had care discontinuations‡
Adult patients who discontinued care also completely stopped therapy during the pandemic
of these adult patients had a disruption in their PAH care team§
Adverse Health Outcomes in Adult Patients Who Experienced Care Team Disruptions and Those Who Did Not2||
| Adult patients with care team disruptions | Adult patients without care team disruptions | |
|---|---|---|
| Hospitalized, % | 20% (n = ~540) | 16% (n = ~1184) |
| Experienced at least 1 visit to the emergency room, % | 22% (n = ~594) | 18% (n = ~1332) |
| Experienced right ventricular failures, % | 7% (n = ~189) | 4% (n = ~296) |
No statistical comparisons have been made between patients who experienced care team disruptions and those who did not. The patient population numbers listed in the table were calculated based on the following estimations. The claims data analysis identified ~2700 adult patients with care team disruptions and ~7400 adult patients without care team disruptions.
Caring for patients with PAH should include timely diagnosis, regular follow-up visits for structured risk assessments, and thorough evaluations. Providing a high level of care for PAH is essential for patients experiencing treatment disruptions1-3
Importance of Risk Assessment in PAH
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‡Care discontinuation was defined as a complete discontinuation in PAH care, including no follow-ups, diagnostic procedures, and treatment refills.
§Care team disruption was defined as a change in the primary treating healthcare professional from the pre-pandemic period.
||Hospitalizations and emergency room visits were not specific to PAH.
ERA=endothelin receptor antagonist; PDE-5i=phosphodiesterase type-5 inhibitor; RHC=right heart catheterization.
References: 1. Ryan JJ, Melendres-Groves L, Zamanian RT, et al. Care of patients with pulmonary arterial hypertension during the coronavirus (COVID-19) pandemic. Pulm Circ. 2020;10(2):2045894020920153. doi:10.1177/2045894020920153 2. Data on file, Janssen. 3. Lau EM, Humbert M, Celermajer DS. Early detection of pulmonary arterial hypertension. Nat Rev Cardiol. 2015;12(3):143-155.