Dr Amresh Raina on the Importance of Treating Dominant Disease Physiology in Comorbid HF

In this interview with The American Journal of Managed Care^®, Amresh Raina, MD, director of the advanced heart failure (HF) and pulmonary hypertension (PH) program at Allegheny General Hospital and the Allegheny Health Network in Pittsburgh, Pennsylvania, discusses why when mapping out treatment strategy it is important to first establish dominant disease physiology in patients who have comorbid HF and PH so quality of life (QOL) and physical concerns are addressed.

Transcript

What are top concerns when formulating a treatment plan that adequately addresses physical and QOL concerns from comorbid HF and PH?

With regards to coming up with a treatment plan, the first portion is to really identify what the dominant physiology of the patient is. Do they have pulmonary hypertension due to the left-sided congestive heart failure? Do they have pulmonary arterial hypertension or a pulmonary vascular process, such as chronic thromboembolic pulmonary hypertension? First and foremost, one has to really drill down on the diagnosis and the physiology of the individual patient. But it’s also really important to address any of the comorbidities that the patient may have, because this may impact the treatment strategies as well as response to therapy.

For example, if patients have sleep apnea or sleep-disordered breathing, that can exacerbate both pulmonary hypertension and left heart failure, so those are important to treat. Similarly, if patients are overweight or if they have high blood pressure, diabetes, treating those entities is important in terms of treating the overall patient and helping the patient improve from a symptomatic standpoint.

The next thing I will say is that patients are very different in terms of their functional limitations and their tolerance of various medicines. For pulmonary hypertension, a lot of the medications can have significant side effects or require the patients to be fairly facile with regard to management of devices, pumps, etc. And so, with regards to each individual patient, one has to assess their ability to tolerate the medications as well as to be able to handle some of the more complex therapies that we have. Because the medicines can improve their quality of life from a functional standpoint, but we have to make sure that we appropriately minimize side effects or other things, such as multiple-times-a-day drugs or IV [intravenous] lines or continuous IV infusions, which may be required, but they may also impact a patient’s ability to function on a daily basis.