Location of Care Delivery for Pulmonary Arterial Hypertension in the United States

Rationale: Guidelines recommend patients with pulmonary arterial hypertension (PAH) be referred to pulmonary hypertension (PH) centers, but little is known about where care is actually delivered in the United States (US).

Objectives: To use prescription patterns to estimate the proportion of PAH care delivered at US PH centers and explore factors associated with location of care.

Methods: This retrospective study analyzed claims from the Komodo database in adults who received ≥1 PAH prescription between March 2021 and February 2022. A PH center was defined as accredited (Pulmonary Hypertension Association accreditation), high-volume (≥10 patients receiving parenteral prostacyclin), or a composite including either definition.

Measurements and main results: Analyses included 12,137 patients. Only 37.1% of patients received PAH-specific prescriptions from PH centers. A minority of patients on monotherapy (31.8%) received prescriptions from PH centers. A greater fraction of patients on triple therapy (61.8%) received prescriptions from PH centers. Patients on monotherapy were less likely to receive prescriptions from a PH center if they were older, male, had a higher comorbidity burden, had Medicaid, resided in the South or West, or lived in a 3-digit ZIP code without a PH center. Fewer characteristics were associated with PH center-based care for patients on dual or triple therapy; however, ZIP code and insurance status were associated with center-based care for these patients.

Conclusions: A minority of US patients received PAH-specific prescription from a PH center. This potential guideline discordance warrants further exploration and may require guidelines to be revisited or the health system to adapt.