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New Insights into Inpatient Symptom Burden in Pulmonary Arterial Hypertension

Mahesh Chandrasekhar

Hunter Groninger

Laura Bryan

Christopher Barnett

Lisa Peters

Julie Dias

Sara Ahmed

Selma Mohammed

Spencer Liu

Anil Jonnalagadda


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Conference: 2017 PH Professional Network Symposium

Release Date: 10.06.2017

Presentation Type: Abstracts

File Download: 2017 PHPN Abstract 1019

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Abstract presented at the 2017 PH Professional Network Symposium held in Bethesda, MD on October 5-7,2017


To present insights into the inpatient symptom burden in pulmonary arterial hypertension, and identify whether palliative care can play an important role in this patient population.


Pulmonary arterial hypertension (PAH) is a progressive illness resulting from various conditions, which can lead to a high symptom burden and mortality. Severity of functional impairment has been compared to patients with spinal cord injuries or with cancer unresponsive to chemotherapy. Nearly half of PAH patients note profound deficiency in overall quality of life (QOL) and emotional well-being. Palliative Care is transdisciplinary care that aims to prevent or relieve suffering in patients with a serious progressive illness like PAH. Despite expert opinion encouraging Palliative Care consultation for patients with PAH, little data guides this clinical intervention.


A retrospective chart review was performed on all PAH patients receiving inpatient Palliative Care consultation from January 2015 to December 2015. Data was collected from Palliative Care assessments and included relevant clinical issues, reason for consultation, prognosis, disposition, and symptom burden at baseline and 48 hours (recorded using Edmonton Symptom Assessment Scale). Types of Palliative Care interventions included such things as advanced care planning, spiritual counseling, disease state education, medical proxy determination, and intimacy counseling. Also categorized were details about the hospitalizations, such as length of stay and time to consultation.


Palliative care inpatient consults were performed on 11 PAH patients (median hospital length-of-stay 6 days). Two patients developed PAH secondary to scleroderma, one patient developed PAH secondary to systemic sclerosis, and the rest of the cohort had idiopathic PAH. Predominant reasons for consultation were to establish goals of care and for pain control. The retrospective analysis shows that forty-eight hours following consultation, there was an overall improvement in patient-reported pain, dyspnea, and depression scores. Importantly, the Palliative Care team’s transdisciplinary interventions were diverse, including advance care planning, spiritual care, psychosocial counseling, and introducing hospice services. Of the patients seen by Palliative Care, 55% were discharged home, 18% to Nursing Home, 18% to Nursing home with outpatient palliative care, and 9% were Lost-to-follow up. By introducing Palliative Care services as part of best PAH care at our institution, patients readily accepted these interventions.


This case series suggests that inpatient Palliative Care consultation is not only effective for managing important disease-related symptoms, but also important to providing holistic support in the shape of clarifying medical decision-making and advance care planning, as well as introducing concepts relevant to end-of-life care.