American College of Chest Physicians and American Thoracic Society

View all recommendations from this society

Released October 27, 2013

Don’t routinely offer pharmacologic treatment with advanced vasoactive agents approved only for the management of pulmonary arterial hypertension to patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases (Groups II or III pulmonary hypertension).

Evidence and clinical practice guidelines have not established benefits of vasoactive agents (e.g., prostanoids, phosphodiesterase inhibitors, endothelin antagonists) for patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases. Moreover, the use of these agents may cause harm in certain situations and incurs substantial cost and resource utilization. Patients should be carefully assessed (including at a minimum right heart catheterization, echocardiography, chest CT, six minute walk test and pulmonary function testing) to confirm that they have symptomatic pulmonary arterial hypertension prior to having approved agents initiated.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

This document was prepared as a joint initiative of the American College of Chest Physicians and the American Thoracic Society. A taskforce with members from both societies was selected, including individuals from diverse backgrounds and clinical areas of expertise. Taskforce members initially proposed 30 items for consideration. The taskforce debated the impact of each based on five criteria (Evidence, Prevalence, Cost, Relevance, Innovation), and agreed to narrow the list to 10 items to explore in greater depth. Following an in-depth evidence review and consultation with external content experts for each item, the taskforce together reviewed and debated the compiled information for all 10 items. Subsequently, taskforce members independently scored each item on a scale of 1–5, rating each item on its overall impact as well as on each of the five criteria. The 5 items with the best mean overall scores were retained in the “penultimate” list. The taskforce then reviewed and edited the wording of items on the penultimate list, and submitted it to both societies’ executive committees. The executive committees sought feedback from additional experts in the field, debated the items, and provided written comments to the taskforce. The taskforce deliberated and incorporated these suggestions where appropriate to create the final list, resolving any conflicts through discussion. Both Societies elected to endorse the final list.

Members of the Task Force were: Renda Soylemez Wiener, MD, MPH (Co-Chair), Scott D. Halpern, MD, PhD (Co-Chair), Daniel R. Ouellette, MD, FCCP (Co-Chair), Edward Diamond, MD, MBA, FCCP, Vincent S. Fan, MD, MPH, Janet R. Maurer, MD, FCCP, Richard A. Mularski, MD, MSHS, MCR, FCCP and Jay I. Peters, MD, FCCP.

Sources

McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, Mathier MA, McGoon MD, Park MH, Rosenson RS, Rubin LJ, Tapson VF, Varga J. ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developedin collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association. J Am Cardiol. 2009;53:1573.

Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2009;30:2493–537.

Hoeper MM, Barbera JA, Channick RN, Hassoun PM, Lang IM, Manes A, Martinez FJ, Naeije R, Olschewski H, Pepke-Zaba J, Redfield MM, Robbins IM, Souza R, Torbicki A, McGoon M. Diagnosis, assessment, and treatment of non-pulmonary arterial hypertension pulmonary hypertension. J Am Coll Cardiol. 2009;54(1 Suppl):S85–96.