Directing Therapy in Pulmonary Arterial Hypertension Using a Target 6 Min Walk Distance

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dc.contributor.authorPorhownik, Nancy Rose
dc.contributor.authorMyers, Renelle
dc.contributor.authorBshouty, Zoheir
dc.date.accessioned2016-06-07T19:06:36Z
dc.date.available2016-06-07T19:06:36Z
dc.date.issued2013-1-1
dc.date.updated2016-06-07T06:54:01Z
dc.description.abstractBACKGROUND: The most effective approaches to escalating advanced therapies in pulmonary arterial hypertension (PAH) are controversial.OBJECTIVE: To compare outcomes before and after introducing a target 6 min walk distance (6MWD) treatment strategy in PAH using registry data.METHODS: From 2001 to 2005, WHO class II to IV patients were treated with bosentan or prostanoids. In July 2005, a target 6MWD strategy was adopted. Monotherapy continued if 6MWD remained >350 m. For patients in whom 6MWD was ≤350 m, sildenafil was added. If 6MWD remained ud_less_than350 m, prostanoids were considered. Changes in 6MWD, WHO class and survival rate were compared between periods.RESULTS: Before using the 6MWD strategy, there was a statistically significant improvement in mean WHO class at six, nine and 12 months (2.5±0.8 [Pud_less_than0.015]; 2.5±0.8 [Pud_less_than0.005]; and 2.5±0.9 [Pud_less_than0.03], respectively) compared with baseline (2.9±0.9). There was a statistically significant increase in mean 6MWD at three, six, nine and 12 months (383±113 m [Pud_less_than0.005]; 401±102 m [Pud_less_than0.006]; 400±109 m [Pud_less_than0.001]; and 399±110 m [Pud_less_than0.004], respectively) compared with baseline (321±119 m). The survival rate was 95% at one and two years. From 2005 to 2009, there was a statistically significant improvement in mean WHO class at three, six, nine and 12 months (2.6±0.8 [Pud_less_than0.05]; 2.3±0.9 [Pud_less_than0.0001]; 2.3±0.9 [Pud_less_than0.0001]; and 2.3±1.0 [Pud_less_than0.0005], respectively) compared with baseline (2.8±0.7). There was statistically significant improvement in 6MWD at six months (381±126 m [Pud_less_than0.05]), followed by a decline toward baseline (354±117 m). One- and two-year survival rates in the 6MWD target era were 95% and 80%, respectively.CONCLUSION: Based on registry data, adoption of this strategy did not affect survival rates, nor cause a sustained improvement in 6MWD by 12 months. WHO class improved similarly in both treatment groups.
dc.description.versionPeer Reviewed
dc.identifier.citationNancy Rose Porhownik, Renelle Myers, and Zoheir Bshouty, “Directing Therapy in Pulmonary Arterial Hypertension Using a Target 6 Min Walk Distance,” Canadian Respiratory Journal, vol. 20, no. 2, pp. 111-115, 2013. doi:10.1155/2013/474703
dc.identifier.urihttp://dx.doi.org/10.1155/2013/474703
dc.identifier.urihttp://hdl.handle.net/1993/31347
dc.language.rfc3066en
dc.rightsopen accessen_US
dc.rights.holderCopyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.titleDirecting Therapy in Pulmonary Arterial Hypertension Using a Target 6 Min Walk Distance
dc.typeJournal Article
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