Darren B Taichman1, Joe Ornelas2, Lorinda Chung3, James R Klinger4, Sandra Lewis5, Jess Mandel6, Harold I Palevsky1, Stuart Rich7, Namita Sood8, Erika B Rosenzweig9, Terence K Trow10, Rex Yung11, C Gregory Elliott12, David B Badesch13. 1. University of Pennsylvania, Philadelphia, PA. 2. CHEST, Glenview, IL. Electronic address: jornelas@chestnet.org. 3. Stanford University and Palo Alto VA Health Care System, Palo Alto, CA. 4. Brown University, Providence, RI. 5. CHEST, Glenview, IL. 6. University of California, San Diego, CA. 7. University of Chicago, Chicago, IL. 8. Ohio State University, Columbus, OH. 9. Columbia University Medical Center, New York, NY. 10. Yale University, New Haven, CT. 11. Johns Hopkins University, Baltimore, MD. 12. Intermountain Medical Center and the University of Utah, Murray, UT. 13. University of Colorado, Denver, CO.
Abstract
OBJECTIVE: Choices of pharmacologic therapies for pulmonary arterial hypertension (PAH) are ideally guided by high-level evidence. The objective of this guideline is to provide clinicians advice regarding pharmacologic therapy for adult patients with PAH as informed by available evidence. METHODS: This guideline was based on systematic reviews of English language evidence published between 1990 and November 2013, identified using the MEDLINE and Cochrane Library databases. The strength of available evidence was graded using the Grades of Recommendations, Assessment, Development, and Evaluation methodology. Guideline recommendations, or consensus statements when available evidence was insufficient to support recommendations, were developed using a modified Delphi technique to achieve consensus. RESULTS: Available evidence is limited in its ability to support high-level recommendations. Therefore, we drafted consensus statements to address many clinical questions regarding pharmacotherapy for patients with PAH. A total of 79 recommendations or consensus statements were adopted and graded. CONCLUSIONS: Clinical decisions regarding pharmacotherapy for PAH should be guided by high-level recommendations when sufficient evidence is available. Absent higher level evidence, consensus statements based upon available information must be used. Further studies are needed to address the gaps in available knowledge regarding optimal pharmacotherapy for PAH.
OBJECTIVE: Choices of pharmacologic therapies for pulmonary arterial hypertension (PAH) are ideally guided by high-level evidence. The objective of this guideline is to provide clinicians advice regarding pharmacologic therapy for adult patients with PAH as informed by available evidence. METHODS: This guideline was based on systematic reviews of English language evidence published between 1990 and November 2013, identified using the MEDLINE and Cochrane Library databases. The strength of available evidence was graded using the Grades of Recommendations, Assessment, Development, and Evaluation methodology. Guideline recommendations, or consensus statements when available evidence was insufficient to support recommendations, were developed using a modified Delphi technique to achieve consensus. RESULTS: Available evidence is limited in its ability to support high-level recommendations. Therefore, we drafted consensus statements to address many clinical questions regarding pharmacotherapy for patients with PAH. A total of 79 recommendations or consensus statements were adopted and graded. CONCLUSIONS: Clinical decisions regarding pharmacotherapy for PAH should be guided by high-level recommendations when sufficient evidence is available. Absent higher level evidence, consensus statements based upon available information must be used. Further studies are needed to address the gaps in available knowledge regarding optimal pharmacotherapy for PAH.
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