New screening tool enhances early detection of pulmonary hypertension

A novel screening approach developed by physicians at the Lewis Katz School of Medicine at Temple University shows significant promise for improving the detection of pulmonary arterial hypertension (PAH)-a life-threatening form of heart failure related to high blood pressure in the lung circulation that is often overlooked due to vague symptoms such as fatigue and shortness of breath.

The new research, published online April 5 in the American Heart Journal, shows that the virtual echocardiography screening tool (VEST), when incorporated into the electronic medical record (EMR) system, can generate accurate PAH risk scores-without the need for time-consuming manual calculations. The approach is the first of its kind in the field of pulmonary vascular medicine.

"Our EMR-based VEST tool proved highly accurate in identifying individuals likely to have PAH," said Anjali Vaidya, MD, FACC, FASE, FACP, Co-Director of the Advanced Pulmonary Hypertension, Right Heart Failure & Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Program at Temple University Hospital; Professor of Medicine at the Lewis Katz School of Medicine and lead author on the new study. According to Dr. Vaidya, the novel technology could be game-changing for heart failure and pulmonary vascular care. By embedding a simple but powerful screening tool into everyday hospital workflows, PAH can be caught earlier, when treatment has the greatest chance of success.

In previous work, Dr. Vaidya and colleagues applied VEST scoring to echocardiogram data, which provides estimates on pressure in the pulmonary artery and detects heart changes that suggest further testing is needed. They found that most patients had positive VEST scores more than 200 days before they received a referral to an accredited pulmonary hypertension (PH) center to confirm and treat their PAH diagnosis. The majority were calculated to have a high risk of mortality by the time they were referred for expert PH care.

For their latest study, Dr. Vaidya's team developed the EMR-based VEST algorithm and then tested it in nearly 5,000 patients who had undergone an echocardiogram. VEST scores automatically calculated by the algorithm were then compared to manually calculated VEST scores and used to identify patients at highest risk for PAH. Individuals with high risk scores were further analyzed to determine whether they had been referred to a PH center or had undergone right heart catheterization, which is the gold standard for PH diagnosis.

Among the highest-risk patients flagged by the tool, degree of PH was severe-but a third had never been referred to a PH specialist."

Dr. Anjali Vaidya, MD, FACC, FASE, FACP, Co-Director of the Advanced Pulmonary Hypertension, Right Heart Failure & Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Program at Temple University Hospital, Professor of Medicine at the Lewis Katz School of Medicine

When patients were referred for expert PH care, nearly all underwent confirmatory testing and were diagnosed with serious disease, highlighting how the tool can guide timely, life-saving referrals. Among patients that were not referred for expert care, very few received right heart catheterization for diagnostic testing, let alone treatment.

The simplicity of VEST, along with its ability to accurately detect patients at high risk of PAH, render it highly adoptable for widespread application.

"VEST has already been adopted at Temple, and we are now in the process of collaborating with other centers, nationally and internationally, to facilitate its implementation elsewhere," Dr. Vaidya added.

The hope is that with broad uptake of the automated EMR-VEST algorithm, more patients will receive earlier diagnoses and expert care-ultimately improving survival and quality of life for those living with PAH.

Other researchers involved in the study included Suneesh Anand, Gabriela Narowska, Chethan Gangireddy, Martin Keane, Daniel Edmundowicz, Paul Forfia and John Enevoldsen from the Advanced Pulmonary Hypertension Program and Division of Cardiology at the Lewis Katz School of Medicine.