Exercise rehabilitation low among US veterans with pulmonary hypertension

Few patients with primary pulmonary arterial hypertension were treated with exercise rehabilitation in the form of pulmonary or cardiac rehabilitation, according to data scheduled for presentation at the American Thoracic Society International Conference.

Researchers evaluated Veterans Affairs electronic medical records from 2010 to 2016 for 111,356 U.S. veterans with PAH. Of those, 7% had WHO group 1 primary PAH, 64.3% had WHO group 2 secondary pulmonary hypertension due to left-sided heart disease, 38.7% had WHO group 3 secondary pulmonary hypertension due to chronic lung disease, 3.7% had WHO group 4 secondary pulmonary hypertension due to chronic thromboembolic disease and 15.2% had PAH of unknown etiology.

Exercise rehabilitation was used in just 1.6% of patients in the year after PAH diagnosis, the researchers reported.

From 2010 to 2016, use of exercise rehabilitation increased (P < .001). However, this increase was not observed across all etiologies of PAH. The researchers reported no increase in use of exercise rehabilitation in patients with primary PAH (P = .09) or for those with secondary pulmonary hypertension due to chronic thromboembolic disease (P = .87).

The results were published in an abstract in an online supplement of the American Journal of Respiratory and Critical Care Medicine.

“In the largest study of practice patterns among pulmonary hypertension patients in the United States, we found low use of exercise rehabilitation for the treatment of pulmonary hypertension across all etiologies and did not find increasing use among group 1 or 4 patients. Taken together, there is an opportunity to improve optimal medical care of patients with pulmonary hypertension,” Thomas Cascino, MD, MSc, cardiovascular disease fellow at the University of Michigan, and colleagues at the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center wrote in the abstract.

Insurance reimbursement alone does not appear to be the primary reason for low use of exercise rehabilitation, according to the researchers. In an ATS press release, Cascino said he is an advocate for increased provider and patient awareness of the benefits of exercise rehabilitation, while also working to better understand and adapt to factors at the patient, provider and system levels that affect use.

“For example, we are doing a trial of home-based rehab using wearable technology as a means to expand access for people unable to come to center-based rehab for a variety of reasons,” Cascino said in the release.

Reference:

Cascino T, et al. A94. Expanding Our Horizons; Leading Research in Pulmonary Rehabilitation: 2020. Presented at: American Thoracic Society International Conference (virtual).