Risk assessment in Pulmonary Arterial Hypertension (PAH) based on the Simplified French Model: A single centre experience

Abstract

Background: PAH patients are currently risk stratified by using ERS/ESC risk assessment table or REVEAL 2 score. At Follow up their use is limited by the need for invasive tests. The Simplified French model is a non-invasive risk stratification tool¹, utilising 3 low-risk criteria: WHO FC 1 or 2, 6-minute walk distance (6MWD) >440 meters, and BNP <50 ng·L−1 or NT-proBNP <300 ng·L⁻¹.

Aim: We evaluated the application of this approach to our PAH patients at the Freeman Hospital in Newcastle, UK.

Method: Prospectively collected data of incident Group 1 PAH patients from 2012-2017 on our local database was reviewed. The score was applied at baseline, first follow up (3-6 months) and at 12 months. Survival outcomes at 1, 3 and 5 years were analysed.

Result: 152 patients were included (mean age 65 years, 71 % females & 61% Idiopathic PAH). From baseline to final follow-up, 6.6% of the patients worsened, 65% remained unchanged and 28% improved their number of low-risk criteria. Patients who achieved 2 low-risk criteria at first follow up had a survival of 100% at 1 year, 92% at 3 years and 81% at 5 years. Similarly, patients able to attain 2 features by the annual follow up had a comparable survival of 100% at year 1, 96% at year 3 and 81% at year 5. Patients who fulfilled all 3 risk factors at either first or the annual follow up had a survival of 100% throughout 5 years.

Conclusion: Achieving 2 or more low-risk criteria within 12 months significantly improves 5-year survival. Early attainment of change in clinical risk outcomes should remain the treatment goal.

Reference: 1.Hoeper M, et al. Risk assessment in pulmonary arterial hypertension. Eur Respir J 2018; 51: 1702606