Diagnosis and Management of Pulmonary Hypertension: The State of the Science
Credit(s): 1.00 (60 min)
Release Date: Jun 20, 2019
Expiration Date: Jun 20, 2020
CME / AMA PRA Category 1 Credit™
MOC / ABIM MOC Part 2 Credit
Pulmonary hypertension (PH) comprises a group of disorders that reflect an increase in pulmonary arterial pressure. The World Health Organization (WHO) has identified 5 etiologies/types of PH, based on the underlying pathological mechanisms. Initial symptoms of PH are shortness of breath (which often comes on precipitously) and exertional dyspnea. Left untreated, PH ultimately leads to right-heart failure.
A number of therapeutic specialists (cardiology, pulmonology, and primary care, especially internal medicine) are involved in the diagnosis and care of PH. Because symptoms are nonspecific, most patients with PH are not correctly diagnosed for 2 to 5 years after symptom onset, and life expectancy is only approximately 3-5 years after diagnosis. Diagnosis and Management of Pulmonary Hypertension: The State of the Science is designed to help improve the diagnosis of PH by exploring its complex nature and poor prognosis. The education will help clinicians recognize suspected PH and refer those patients to a PH specialty center, where interdisciplinary teams are available and newer treatments can be offered to prolong life and improve QoL.
Welcome and Introduction
Pathobiology of Pulmonary Hypertension
Specific Advanced Drug Therapies
The intended audiences for this educational initiative include community-based cardiologists, internal medicine specialists, and other healthcare providers who manage PH patients.
This program is designed to address the following NAM competencies: provide patient-centered care and employ evidence-based practice.
At the conclusion of this activity, participants should be able to demonstrate the ability to:
Conduct prompt diagnostic evaluation of patients suspected of having PH, and arrange for prompt diagnosis
Describe the clinical properties of specific advanced drug therapies, and explain the rationale for early treatment initiation by specialty centers to achieve the best clinical outcomes
The Potomac Center for Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Potomac Center for Medical Education designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
ABIM MOC DESIGNATION STATEMENT
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
To receive CME credit and/or MOC points, you MUST pass the post-test and complete the evaluation. For ABIM MOC points, your information will be shared with the ABIM through PCME’s ACCME Program and Activity Reporting System (PARS). Please allow 6-8 weeks for your MOC points to appear on your ABIM records.
Bradley A. Maron, MD Assistant Professor of Medicine
Harvard Medical School
Associate Physician, Division of Cardiovascular Medicine, Brigham and Women’s Hospital
Co-Director, Pulmonary Vascular Disease Center Boston VA Healthcare System
Bradley A. Maron, MD is an Assistant Professor of Medicine at Harvard Medical School, Associate Physician in the Division of Cardiovascular Medicine at Brigham and Women’s Hospital, and Co-director of the Pulmonary Vascular Disease Center at the Boston VA Healthcare System. His epidemiological work has aided in clarifying the spectrum of clinical risk related to cardiopulmonary hemodynamics in pulmonary hypertension. His laboratory focus involves utilizing network and systems methodologies to characterize the pathobiological mechanisms underpinning pulmonary vascular disease, and in collaborative projects his group developed a novel risk-assessment code for patients with exercise intolerance that was based on a network analysis of patient-level clinical data.
Dr. Maron has co-authored numerous scientific manuscripts and is the lead editor of a recently published textbook on pulmonary vascular disease. His work is funded by the National Institutes of Health, American Heart Association, Cardiovascular Medical Research and Education Foundation, Scleroderma Foundation, and the Klarman Family Foundation. He is also the recipient of the distinguished Eleanor and Miles Shore Scholar in Medicine, American Society of Clinical Investigator Young Physician-Scientist Award, and the Harvard Medical School Excellence in Teaching award.
John J. Ryan, MD, MRCPI, FACC, FAHA Associate Professor
Director, Dyspnea & Pulmonary Hypertension Centers
Director, Cardiovascular Medicine Unit
University of Utah
Salt Lake City, UT
John J. Ryan, MD, MRCPI, FACC, FAHA is a cardiologist at the University of Utah with extensive training and experience in research investigation and clinical patient care. He is an internationally renowned specialist in pulmonary hypertension and is board-certified in internal medicine, cardiovascular medicine, advanced heart failure and transplant cardiology, echocardiography and nuclear cardiology. Dr. Ryan is the Director of the University of Utah Pulmonary Hypertension Center and is also Sports Cardiology Consultant for the United States Olympic Committee, the National Basketball Association, the Utah Jazz, and the University of Utah Utes. He is also the Director of Cardiology Curriculum for the University of Utah School of Medicine.
Program Faculty Disclosures
The program faculty reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:
Bradley A. Maron, MD – Nothing to disclose
John J. Ryan, MD, MRCPI, FACC, FAHA – Advisory Board: Bayer
Non-faculty Content Contributors Disclosures
Non-faculty content contributors and/or reviewers reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:
Terry Ann Glauser, MD, MPH; Blair St. Amand; Lindsay Scott, PT, DPT, ATC; Ashley Marostica, RN, MSN, CCM – Nothing to disclose
The contents of some CME/CE activities may contain discussions of non-approved or off-label uses of some agents mentioned. Please consult the prescribing information for full disclosure of approved uses.
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INSTRUCTIONS FOR PARTICIPANTS AND OBTAINING CME CREDIT
There is no fee for this activity. To receive credit, participants must take the pre-test, view this CME activity in its entirety, and then complete the post-test, with a score of 80% or better, and evaluation. The estimated time for completion of this activity is 1 hour. To receive their certificates, participants must demonstrate mastery of the presented material via the post-test. Participants are allowed to take the post-test multiple times.
INSTRUCTIONS FOR OBTAINING MOC Points
Physicians seeking ABIM MOC Points will be required to provide:
ABIM six-digit ID number
First and last name
Date of birth (mm/dd)
I would also like to point out that the hemodynamic definition of PH and PAH are both different, but also ultimately are required to make an appropriate diagnosis. On the one hand, PH describes an elevation in the mean pulmonary arterial pressure diagnosed by invasive right heart catheterization performed on a patient supine while at rest. The current standard or traditional standard for defining PH using this criterion was 25 millimeters of mercury or greater. We’ll get back to that in just a moment. On the other hand, pulmonary arterial hypertension, abbreviated as PAH, includes patients who have PH defined by an elevated mean pulmonary artery pressure, but also requires two additional hemodynamic values for diagnosis. First, the pulmonary capillary wedge pressure, which assesses the left-sided heart filling pressures must be equal to or less than 15 millimeters of mercury. The pulmonary vascular resistance, which is dependent on the mean pulmonary artery pressure, the pulmonary capillary wedge pressure, as well as the cardiac output must be greater than three Wood Units. Over the past 10 years, there has been interest in understanding whether the spectrum of risk related to mean pulmonary artery pressure should be reconsidered. Data from catheterization registries and smaller clinical studies suggest that patients may be at higher clinical risk when mean pulmonary artery pressure is higher than around 19 to 20 millimeters of mercury. Exactly the role of this revised definition and how patients are diagnosed and certainly, whether or not this should be used in any decision-making relative to treatment remains both controversial and a moving target.
For a full transcript, click here.
Provided by Potomac Center for Medical Education
This activity is supported by an educational grant from Actelion Pharmaceuticals US, Inc. and Bayer US.
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