European Society of Cardiology quality indicators for the care and outcomes of adults with pulmonary arterial hypertension. Developed in collaboration with the Heart Failure Association of the European Society of Cardiology

Suleman Aktaa; Chris P Gale; Margarita Brida; George Giannakoulas; Gabor Kovacs; Yochai Adir; Raymond L Benza; Michael Böhm; Andrew Coats; Michele D'Alto; Pilar Escribano-Subias; Pisana Ferrari; Nazzareno Galiè; J Simon R Gibbs; Wendy Gin-Sing; Marius M Hoeper; Marc Humbert; Irene M Lang; Bradley A Maron; Gergely Meszaros; Anton Vonk Noordegraaf; Laura C Price; Joanna Pepke-Zaba; Göran Rådegran; Abilio Reis; Olivier Sitbon; Adam Torbicki; Silvia Ulrich; Stephan Rosenkranz; Marion Delcroix

doi:10.1002/ejhf.2830

European Society of Cardiology quality indicators for the care and outcomes of adults with pulmonary arterial hypertension. Developed in collaboration with the Heart Failure Association of the European Society of Cardiology

Eur J Heart Fail. 2023 Apr;25(4):469-477. doi: 10.1002/ejhf.2830. Epub 2023 Apr 4.

Authors

Suleman Aktaa^{1

2

3}, Chris P Gale^{1

2

3}, Margarita Brida^{4

5}, George Giannakoulas⁶, Gabor Kovacs⁷, Yochai Adir⁸, Raymond L Benza⁹, Michael Böhm¹⁰, Andrew Coats¹¹, Michele D'Alto¹², Pilar Escribano-Subias¹³, Pisana Ferrari¹⁴, Nazzareno Galiè^{15

16}, J Simon R Gibbs¹⁷, Wendy Gin-Sing¹⁸, Marius M Hoeper^{19

20}, Marc Humbert²¹, Irene M Lang²², Bradley A Maron²³, Gergely Meszaros²⁴, Anton Vonk Noordegraaf^{25

26}, Laura C Price^{27

28}, Joanna Pepke-Zaba²⁹, Göran Rådegran^{30

31}, Abilio Reis^{32

33}, Olivier Sitbon²¹, Adam Torbicki³⁴, Silvia Ulrich³⁵, Stephan Rosenkranz^#³⁶, Marion Delcroix^#^{37

38}

Affiliations

¹ Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
² Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
³ Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁴ Department of Medical Rehabilitation, Medical Faculty University of Rijeka, Rijeka, Croatia.
⁵ Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys and St Thomas' NHS Trust, London, UK.
⁶ Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
⁷ Department of Pulmonology, University Clinic of Internal Medicine, Medical University of Graz, and the Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
⁸ Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine Technion Institute of Technology, Haifa, Israel.
⁹ Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
¹⁰ Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany.
¹¹ University of Warwick, Coventry, UK.
¹² Department of Cardiology, University "L. Vanvitelli" - Monaldi Hospital, Naples, Italy.
¹³ Pulmonary Hypertension Unit, Department of Cardiology, CIBER-CV, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain.
¹⁴ AIPI, Associazione Ipertensione Polmonare Italiana (Italian Pulmonary Hypertension Association), Padua, Italy.
¹⁵ Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
¹⁶ Dipartimento DIMES, University of Bologna, Bologna, Italy.
¹⁷ National Heart & Lung Institute, Imperial College London, London, UK.
¹⁸ Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
¹⁹ Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
²⁰ German Centre of Lung Research, DZL, Hannover, Germany.
²¹ Université Paris-Saclay, INSERM UMR_S 999, Assistance Publique Hôpitaux de Paris (AP-HP), Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
²² Division of Cardiology, Medical University of Vienna, Vienna, Austria.
²³ Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
²⁴ European Pulmonary Hypertension Association (PHA Europe), Vienna, Austria.
²⁵ Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
²⁶ Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands.
²⁷ National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK.
²⁸ Honorary Senior Clinical Lecturer, Imperial College London, London, UK.
²⁹ Royal Papworth Hospital, Cambridge University Hospital, Cambridge, UK.
³⁰ Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden.
³¹ Hemodynamic Lab, Section for Heart Failure and Valvular Disease, VO. Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden.
³² Department of Medicine, PVDU, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal.
³³ Department of Cardiovascular Research, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
³⁴ Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center for Postgraduate Medical Education, ECZ-Otwock, Otwock, Poland.
³⁵ Department of Pulmonology, University and University Hospital of Zurich, Zurich, Switzerland.
³⁶ Department of Cardiology, Heart Center at the University of Cologne, and Cologne Cardiovascular Research Center (CCRC), Cologne, Germany.
³⁷ Clinical Department of Respiratory Diseases, University Hospitals of Leuven, Leuven, Belgium.
³⁸ Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium.

^# Contributed equally.

PMID: 36924171
DOI: 10.1002/ejhf.2830

Abstract

Aims: To develop a suite of quality indicators (QIs) for the evaluation of the care and outcomes for adults with pulmonary arterial hypertension (PAH).

Methods and results: We followed the European Society of Cardiology (ESC) methodology for the development of QIs. This included (i) the identification of key domains of care for the management of PAH, (ii) the proposal of candidate QIs following systematic review of the literature, and (iii) the selection of a set of QIs using a modified Delphi method. The process was undertaken in parallel with the writing of the 2022 ESC/European Respiratory Society (ERS) guidelines for the diagnosis and treatment of pulmonary hypertension and involved the Task Force chairs, experts in PAH, Heart Failure Association (HFA) members and patient representatives. We identified five domains of care for patients with PAH: structural framework, diagnosis and risk stratification, initial treatment, follow-up, and outcomes. In total, 23 main and one secondary QIs for PAH were selected.

Conclusion: This document presents the ESC QIs for PAH, describes their development process and offers scientific rationale for their selection. The indicators may be used to quantify and improve adherence to guideline-recommended clinical practice and improve patient outcomes.

Keywords: Accountability; Clinical practice guidelines; Outcomes; Pulmonary arterial hypertension; Quality indicators; Treatment.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiology*
Heart Failure* / complications
Heart Failure* / diagnosis
Heart Failure* / therapy
Humans
Hypertension, Pulmonary* / diagnosis
Hypertension, Pulmonary* / therapy
Pulmonary Arterial Hypertension* / diagnosis
Quality Indicators, Health Care