PDE-5 Inhibitor Prescribing Trends in US Veterans With Pulmonary Hypertension

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.

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