ArticleCirculation. Cardiovascular quality and outcomes2020
Factors Associated With Potentially Inappropriate Phosphodiesterase-5 Inhibitor Use for Pulmonary Hypertension in the United States, 2006 to 2015.
Article in Circulation. Cardiovascular quality and outcomes, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Cluster analysis identifies novel real-world lung disease-pulmonary hypertension subphenotypes: implications for treatment response.ERJ open research · 2024Article
- Organization of pulmonary hypertension care in non-expert care settings: Lessons learned from a multi-site study.Health services research · 2023Article
- Socioeconomically disadvantaged veterans experience treatment delays for pulmonary arterial hypertension.Pulmonary circulation · 2022Article
- Variable Monitoring of Veterans with Group 3 Pulmonary Hypertension Treated with Off-Label Pulmonary Vasodilator Therapy.Annals of the American Thoracic Society · 2022Article
- Tadalafil for veterans with chronic obstructive pulmonary disease-pulmonary hypertension: A multicenter, placebo-controlled randomized trial.Pulmonary circulation · 2022Article
- Outcomes of pulmonary vasodilator use in Veterans with pulmonary hypertension associated with left heart disease and lung disease.Pulmonary circulationArticle
- Real-world use of initial combination treatment in the management of pulmonary arterial hypertension.Therapeutic advances in respiratory diseaseArticle
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
backgroundUse of phosphodiesterase-5 inhibitors (PDE5i) for groups 2 and 3 pulmonary hypertension (PH) is rising nationally, despite guidelines recommending against this low-value practice. Although receiving care across healthcare systems is encouraged to increase veterans' access to specialists critical for PH management, receiving care in 2 systems may increase risk of guideline-discordant prescribing. We sought to identify factors associated with prescribing of PDE5i for group 2/3 PH, particularly, to test the hypothesis that veterans prescribed PDE5i for PH in the community (through Medicare) will have increased risk of subsequently receiving potentially inappropriate treatment in Veterans Health Administration (VA). METHODS AND
resultsWe constructed a retrospective cohort of 34 775 Medicare-eligible veterans with group 2/3 PH by linking national patient-level data from VA and Medicare from 2006 to 2015. We calculated adjusted odds ratios (ORs) of receiving daily PDE5i treatment for PH in VA using multivariable models with facility-specific random effects. In this cohort, 1556 veterans received VA prescriptions for PDE5i treatment for group 2/3 PH. Supporting our primary hypothesis, the variable most strongly associated with PDE5i treatment in VA for group 2/3 PH was prior treatment through Medicare (OR, 6.5 [95% CI, 4.9-8.7]). Other variables strongly associated with increased likelihood of VA treatment included more severe disease as indicated by recent right heart failure (OR, 3.3 [95% CI, 2.8-3.9]) or respiratory failure (OR, 3.7 [95% CI, 3.1-4.4]) and prior right heart catheterization (OR, 3.8 [95% CI, 3.4-4.3]).
conclusionsOur data suggest a missed opportunity to reassess treatment appropriateness when pulmonary hypertension patients seek prescriptions from VA-a relevant finding given policies promoting shared care across VA and community settings. Interventions are needed to reinforce awareness that pulmonary vasodilators are unlikely to benefit group 2/3 pulmonary hypertension patients and may cause harm.
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