Telephone Monitoring Programs Improve CTEPH Diagnosis
Early detection of chronic thromboembolic pulmonary hypertension (CTEPH) is vital to addressing and potentially preventing the most common cause of severe pulmonary hypertension. A number of clinical diagnostic parameters have been studied and effectively practiced, but detection can extend beyond the doctor’s office. A study presented at the Annual Congress of the European Respiratory Society in Barcelona, Spain, identified the benefits of a telephone monitoring program in helping to diagnose CTEPH in its early stages following a diagnosis of pulmonary embolism.
Pulmonary embolism results in CTEPH as often as 0.5-8% of the time, further prompting the need to follow patients to ensure lasting health. Unfortunately, there are no standing programs to follow patients following their initial diagnosis of pulmonary embolism. “There is a need to recognize patients at risk for CTEPH and to initiate appropriate investigations if these patients do not fully recover or develop exertional limitation following an episode of acute pulmonary embolism,” said Dr. John Swiston, Director of the Pulmonary Hypertension Program at Vancouver General Hospital, in a news report.
To implement a telephone monitoring, patient-centric approach, a team from Germany followed over 100 patients for three years using a five-item questionnaire administered via a telephone call. Based on the responses patients gave to the questions, further evaluation was used to determine if patients truly showed signs of CTEPH. A positive response to at least one item warranted further studies. These studies consisted of echocardiography and/or cardiopulmonary exercise testing (CPET) with follow-up imaging studies and right heart catheterization if either echocardiography or CPET suggested abnormalities.
Patient contact was made at time-points of three, six, 12, 24, and 36 months after patients agreed to participating in the study. At the three-month check-in, 32 out of 104 of patients were suggested to show abnormalities. Of these patients, pathological echocardiography was detected in seven. Twenty patients underwent CPET, and seven were pathological. Further evaluation of 15 of the telephone-abnormal patients identified seven cases of CTEPH. This number rose to ten cases of CTEPH with an interim analysis conducted after 18 months.
These diagnoses may not have been possible without the telephone monitoring program and follow-up CPET, suggesting the techniques may be helpful in diagnosing CTEPH early on for patients who have a pulmonary embolism. Indeed, three cases of CTEPH were diagnosed via CPET when echocardiography showed negative results.
Importantly, clinicians support the use of such a monitoring program. According to Dr. John Granton, Director of the Pulmonary Hypertension Program at Toronto General Hospital, who is quoted from a news report, “Strategies to properly identify patients at risk for or who have CTEPH are needed. This condition is likely under appreciated and as a result patients may be losing the opportunity to benefit from surgical intervention–a potentially curative procedure.”