March 19, 2018
During the study, the number of potentially inappropriately treated patients with PH increased substantially per year.
Among US veterans with pulmonary hypertension (PH), nearly two-thirds of phosphodiesterase-5 (PDE-5) inhibitor prescriptions are inconsistent with PH guidelines, according to the results of a retrospective cohort analysis published in the Annals of the American Thoracic Society.
The investigators sought to determine the national patterns of PDE-5 inhibitor prescribing habits in patients with PH in the Veterans Health Administration (VA). Veterans who had been prescribed a PDE-5 inhibitor at any VA site between 2005 and 2012 were evaluated. The primary outcome of the study was the proportion of patients who were prescribed potentially inappropriate PDE-5 inhibitors, as determined by guideline recommendations (group 1 PH: appropriate; groups 2/3 PH: potentially inappropriate; groups 4/5 PH: uncertain value). Secondary study outcomes included the proportion of treated participants who received guideline-recommended right heart catheterization.
Of 108,777 veterans with PH, 2.6% received daily PDE-5 inhibitor therapy (95% CI, 2.5%-2.7%). Of these treated patients, 19.4% received appropriate therapy (95% CI, 18.0%-20.9%), 61.3% received potentially inappropriate therapy (95% CI, 59.5%-63.1%), and 12.8% received treatment of uncertain value (95% CI, 11.6%-14.1%). During the course of the study, the number of potentially inappropriately treated patients per year increased substantially, from 53 in 2005 to 748 in 2012.