Frequency and predictors of pulmonary rehabilitation referrals among patients with pulmonary arterial hypertension: an analysis of the pulmonary hypertension association registry

SESSION TITLE: Health Disparities in Pulmonary Hypertension SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:55 pm - 01:40 pm PURPOSE: Pulmonary arterial hypertension (PAH) is a complex cardiopulmonary disease with patients often reporting exertional dyspnea and poor quality of life despite medical therapy. Pulmonary rehabilitation (PR), a supervised exercise program for patients with chronic lung disease, has been associated with significant improvements in symptoms, quality of life and exercise capacity. Despite these established clinical benefits, there is a paucity of data regarding utilization of PR and a lack of understanding regarding factors associated with PR referrals among patients with PAH. METHODS: We performed a retrospective analysis of the Pulmonary Hypertension Association Registry (PHAR) database in order to determine the frequency of PR referrals among patients with PAH and to identify factors associated with PR referrals. Adult patients with a diagnosis of PAH and at least one follow-up visit after enrollment were included. Patients referred to PR by the time of the second followup visit were compared to patients never referred to PR using a t-test or Chi-squared test as appropriate. RESULTS: Referral to PR was reported among 16.3% of patients at the first follow-up visit (n=1660), 25.2% at the second follow-up visit (n=1268), and 31.3% at the third follow-up visit (n=948). The frequency of PR referrals was significantly decreased at study visits post-COVID (12.1%) versus pre-COVID (17.8%), p<0.001. Compared to patients who had never been referred to PR, those who were referred were older (58.3 ± 15.9 years), p<0.001, more likely to be female (82.1%), p=0.01, less likely to be employed (25%), p=0.005 and had significant racial and geographic differences. In a multivariable model, age, sex, race, geographic region and employment status remained significant independent predictors of PR referral. Compared to patients never referred to PR, those referred also had significant differences in PAH etiology (higher referral rates among patients with connective tissue disease associated PAH), worse functional class, quality of life and 6-minute walk distance at baseline with higher rates of supplemental oxygen use and similar pulmonary hemodynamics and use of PAH therapy. CONCLUSIONS: Despite well-established benefits, referral to PR is low among patients with PAH and is significantly impacted by socioeconomic factors such as age, sex, race, and employment status as well as disease characteristics. CLINICAL IMPLICATIONS: Improved understanding and awareness of PR referral clinical practices in PAH could help address barriers to PR participation and improve access to this underutilized resource. DISCLOSURES: Consultant relationship with Accelerant / Merck Please note: Last 5 years Added 04/14/2023 by David Badesch, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with PHA / Cornerstone Communications Please note: Last 5 Years Added 04/14/2023 by David Badesch, source=Web Response, value=Honoraria Owner/Founder relationship with Johnson Please note: Many years Added 04 /14 /2023 by David Badesch, source=Web Response, value=Common stock in family trust Clinical research funding relationship with Atavant Please note: Last 3 years Added 04/14/2023 by David Badesch, source=Web Response, value=Clinical research Removed 04/14/2023 by David Badesch, source=Web Response Clinical research relationship with Arena / United Therapeutics Please note: Last 5 years Added 04/14/2023 by David Badesch, source=Web Response, value=Clinical research funding Clinical Research relationship with Altavant Please note: Last 3 years Added 04/14/2023 by David Badesch, source=Web Response, value=Clinical research funding Clinical research relationship with Imari Please note: Last 6-7 years Added 04/14/2023 by David Badesch, source=Web Response, value=Clinical research funding Removed 04/14/2023 by David Badesch, source=Web Response Clinical research relationship with Ikaria Please note: Last 6-7 years Added 04/14/2023 by David Badesch, source=Web Response, value=Clinical research funding No relevant relationships by Morgan Bailey No relevant relationships by Charles Burger No relevant relationships by Thomas Cascino My spouse/partner as a Study PI relationship with CareDx Please note: 5/25/2019-5/31/2025 Added 03/10/2023 by Teresa De Marco, source=Web Response, value=reasearch support for conduct of study Consultant relationship with Tectonic Please note: 12/2022 to present Added 03/31/2023 by Teresa De Marco, source=Web Response, value=Consulting fee Consultant relationship with Natera Please note: 1/14/2022-6/15/2022 Added 03/10/2023 by Teresa De Marco, source=Web Response, value=Consulting fee My spouse/partner as a Research =study PI relationship with Trio Health Please note: 5/1/2019-7/31/2020 Added 03/10/2023 by Teresa De Marco, source=Web Response, value=Grant/Research Support My spouse/partner as a researcher relationship with Acceleron Please note: 8/5/2018-12/31/2022 Added 03/10/2023 by Teresa De Marco, source=Web Response, value=Grant support for clinical trial Consultant relationship with Scope-Bial Please note: 2019-2022 Added 03/10/2023 by Teresa De Marco, source=Web Response, value=Consulting fee Consultant relationship with NXT Please note: 2020-present Added 03/10/2023 by Teresa De Marco, source=Web Response, value=Consulting fee Consultant relationship with Aerovate Please note: 11/8/21 to present Added 11/09/2022 by Teresa De Marco, source=Web Response, value=Consulting fee Consultant relationship with Pulnovo Please note: 9/1/22 to present Added 11/09/2022 by Teresa De Marco, source=Web Response, value=Consulting fee Research PI relationship with Acceleron Please note: >$100000 by Teresa De Marco, value=Grant/Research Removed 03/10/2023 by Teresa De Marco, source=Web Response My spouse/partner as a Research grant relationship with Pfizer Please note: 8/2/2016-6/30/2022 Added 03/10/2023 by Teresa De Marco, value=Grant/Research Support Speaker/Speaker's Bureau relationship with Novartis Please note: $5001 - 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