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首页> 外文期刊>Pulmonary Circulation >The Heterogeneity of Clinical Practice Patterns among an International Cohort of Pulmonary Arterial Hypertension Experts:
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The Heterogeneity of Clinical Practice Patterns among an International Cohort of Pulmonary Arterial Hypertension Experts:

机译：临床实践模式的异质性肺动脉高压专家队列中的临床实践模式：

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The extent to which pulmonary arterial hypertension (PAH) experts share common practice patterns that are in alignment with published expert consensus recommendations is unknown. Our objective was to characterize the clinical management strategies used by an international cohort of self-identified PAH experts. A 32-item questionnaire composed mainly of rank order or Likert scale questions was distributed via the Internet (August 5, 2013, through January 20, 2014) to four international pulmonary vascular disease organizations. The survey respondents (N = 105) were field experts reporting 11.6 ± 8.7 years of PAH experience. Likert scale responses (1 = disagree, 7 = agree) were 3.0–5.0, indicating a disparity in opinions, for 78% of questions. Respondent (dis)agreement scores were 4.4 ± 2.2 for use of expert recommendations to determine catheterization timing in PAH. For PAH patients without cardiogenic shock or known vasoreactivity status, the most and least preferred first-line therapies (1 = most preferred, 5 = least preferred) were phosphodiesterase type 5 inhibitors (PDE-Vi) and subcutaneous prostacyclin analogues, respectively (1.4 ± 0.8 vs. 4.0 ± 1.1; P 0.05). Compared with US-practicing clinicians (N = 46), non-US-practicing clinicians (N = 57) favored collaboration between cardiology and pulmonary medicine for clinical decision making (1 = disagree, 7 = agree; 3.1 ± 2.2 vs. 4.8 ± 2.2; P 0.0001) and PDE-Vi (6.5% vs. 22.4%) as first-line therapy for PAH patients with cardiogenic shock but were less likely to perform vasoreactivity testing in patients with lung disease–induced pulmonary hypertension (4.3 ± 2.1 vs. 2.2 ± 1.6; P 0.0001). In conclusion, practice patterns among PAH experts diverge from consensus recommendations and differ by practice location, suggesting that opportunity may exist to improve care quality for this highly morbid cardiopulmonary disease.
机译：肺动脉高压（PAH）专家分享与已发表的专家共识建议一致的常见实践模式的程度是未知的。我们的目标是，以自我确定的PAH专家队列使用的临床管理策略为特征。一个32项问卷主要由排名令或李克特规模问题组成，通过互联网（2013年8月5日，2014年1月20日）到四个国际肺血管疾病组织。调查受访者（n = 105）是现场专家报告11.6±8.7岁的PAH经验。李克特缩放响应（1 =不同意，7 =同意）为3.0-5.0，表明意见的差异，为78％的问题。受访者（DIS）协议分数为4.4±2.2，用于使用专家建议，以确定PAH中的导尿时间。对于没有心形成休克或已知的血管反应性状态的PAH患者，最多和最常见的优选的第一线疗法（1 =最优选的，5 =最不优选）分别是磷酸二酯酶类型5抑制剂（PDE-VI）和皮下前列环素类似物（1.4± 0.8与4.0±1.1; p <0.05）。与美国练习临床医生（n = 46）相比，非美国练习临床医生（n = 57）对心脏病学和肺药之间的合作有利，用于临床决策（1 =不同意，7 =同意; 3.1±2.2与4.8± 2.2; p＆ 0.0001）和PDE-VI（6.5％vs.2.4％）作为PAH患者的患者患者的一线治疗，但不太可能对肺病诱导的肺动脉高压患者进行血管反应性试验（4.3± 2.1与2.2±1.6; P <0.0001）。总之，PAH专家的实践模式从共识建议中分歧并通过实践地点差异，表明可能存在机会来改善这种高度病态的心肺病的护理品质。

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