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      Understanding the impact of pulmonary arterial hypertension on patients' and carers' lives

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          Abstract

          Pulmonary arterial hypertension (PAH) is a rare, debilitating and rapidly progressive disease. Although there have been important medical advances in PAH management, the search for a cure continues. Despite an increased understanding of the disease, data on the wider effect of PAH on patients and carers, beyond the clinical symptoms, are still limited. In order to explore this, a large-scale international survey investigated four key areas affected by PAH (physical and practical, emotional, social, and information needs) and provides new insight into patients’ and carers’ experiences of living with the disease. The results from the survey highlight not only the limited ability of patients to carry out everyday tasks, but also the financial impact and social isolation experienced by both patients and carers. The study confirmed that a decline in a patient’s World Health Organization functional class, which indicates an increase in clinical severity of the disease, is associated with greater limitations. Results from the survey demonstrate the need for multidisciplinary PAH management and a comprehensive standard of care to assess and improve all aspects of well-being for both patients and carers. In addition, they underline the need for updated PAH guidelines that address these needs.

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          Most cited references35

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          Pulmonary arterial hypertension: baseline characteristics from the REVEAL Registry.

          The Registry to EValuate Early And Long-term pulmonary arterial hypertension disease management (REVEAL Registry) was established to provide updated characteristics of patients with pulmonary arterial hypertension (PAH) and to improve diagnosis, treatment, and management. Fifty-four US centers enrolled consecutively screened patients with World Health Organization group I PAH who met expanded hemodynamic criteria of mean pulmonary arterial pressure (PAP) > 25 mm Hg at rest (30 mm Hg with exercise), pulmonary capillary wedge pressure (PCWP) or= 240 dynes x s x cm(-5). Patients meeting the traditional hemodynamic definition (PCWP
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            Primary pulmonary hypertension. A national prospective study.

            A national registry was begun in 1981 to collect data from 32 centers on patients diagnosed by uniform criteria as having primary pulmonary hypertension. Entered into the registry were 187 patients with a mean age (+/- SD) of 36 +/- 15 years (range, 1 to 81), and a female-to-male ratio of 1.7:1 overall. The mean interval from onset of symptoms to diagnosis was 2 years. The most frequent presenting symptoms included dyspnea (60%), fatigue (19%), and syncope (or near syncope) (13%). Raynaud phenomenon was present in 10% (95% of whom were female) and a positive antinuclear antibody test, in 29% (69% female). Pulmonary function studies showed mild restriction (forced vital capacity [FVC], 82% of predicted) with a reduced diffusing capacity for carbon monoxide (DLCO), and hypoxemia with hypocapnia. The mean (+/- SD) right atrial pressure was 9.7 +/- 6 mm Hg; mean pulmonary artery pressure, 60 +/- 18 mm Hg; cardiac index, 2.3 +/- 0.9 L/min X m2; and pulmonary vascular resistance index, 26 +/- 14 mm Hg/L/min X m2 for the group. Although no deaths or sustained morbid events occurred during the diagnostic evaluation of the patients, the typically long interval from initial symptoms to diagnosis emphasizes the need to develop strategies to make the diagnosis earlier.
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              Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT).

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                Author and article information

                Journal
                Eur Respir Rev
                Eur Respir Rev
                err
                European Respiratory Review
                European Respiratory Society (442 Glossop Road, Sheffield, S10 2PX, UK )
                0905-9180
                1600-0617
                December 2013
                : 22
                : 130
                : 535-542
                Affiliations
                [1 ]Service de Médecine Interne, Hôpital Cochin , Paris, France. [2 ]Pulmonary Hypertension Association UK , Rotherham, and [4 ]National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College London , London, UK. [3 ]Pulmonary Hypertension Association US , Silver Spring, MD, [6 ]Division of Rheumatology , Dept of Medicine, National Jewish Health, Denver, CO, [7 ]UCSD Medical Center , San Diego, CA, and [8 ]Woodhull Medical Center, New York University , New York, NY, USA. [5 ]Lung Allergy Clinic, Karolinska University Hospital , Stockholm, Sweden. [9 ]Pulmonary Hypertension Association Europe , Vienna, Austria.
                Author notes
                L. Guillevin, Service de Médecine Interne, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, F-75014 Paris, France. E-mail: loic.guillevin@ 123456cch.ap-hop-paris.fr
                Article
                err0057-2013
                10.1183/09059180.00005713
                9639179
                24293469
                7572570c-4b9f-485c-bc47-73e20b3a67b6
                ©ERS 2013

                ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 3.0.

                History
                : 27 August 2013
                : 16 October 2013
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