Volume 22: Issue 2

Pulmonary hypertension is a complex and progressive disease. Patients suffering from pulmonary hypertension may also experience mental health issues. Screening and treatment for mental health issues in the pulmonary hypertension population is imperative but remains a challenge. Advanced practice registered nurses and registered nurses are key to overcoming these challenges.

Background

Wearable technologies (accelerometers) are currently being evaluated as an alternative to the 6-minute walk test as an objective measure of functional status in pulmonary arterial hypertension (PAH). Multiple observational studies incorporating accelerometers have shown patients with PAH have low physical activity (PA) time.

Implications for clinicians

Despite widespread use of accelerometers, PA has not been shown to increase after adding vasodilator therapy, which suggests a behavioral component influencing activity. A decrease in PA from baseline may identify clinical worsening and someone at risk for future hospitalization. Cardiac Effort, the number of heart beats used during the 6-minute walk test/6-minute walk distance (beats per meter), has less variability than 6-minute walk distance and provides a comparable clinic measurement in the home setting. Cardiac Effort may provide a better remote measurement than changes in total daily activity when evaluating for clinical improvement.

Conclusions

The amount and duration of PA achieved in patients with PAH is likely related to a combination of right ventricular (RV) function, deconditioning, and environmental factors. Strategies to target all aspects are needed to improve PA. Further studies are needed to determine the optimal remote measure and monitoring period.

This spring, Dr Hilary DuBrock, Mayo Clinic, Rochester, and Dr Charles D. Burger, Mayo Clinic, Jacksonville, Florida, gathered to discuss the role of caregivers in pulmonary hypertension care with Michele Freeman, Eric Olayos, Jenna Olitsky, Dr Scott Olitsky, and LaKeshia Orr.

Dr Hilary DuBrock: Welcome, everyone, to our roundtable discussion with caregivers for patients with pulmonary hypertension. Dr Burger and I are serving as guest editors for an issue of Advances in Pulmonary Hypertension focused on the societal and multifaceted aspects of pulmonary hypertension beyond diagnosis and treatment: topics such as mental health, diet, and exercise, and

Current pharmacologic treatments for pulmonary arterial hypertension lead to vasodilation of the pulmonary arteries, increasing cardiac output and reducing pulmonary vascular resistance in patients with pulmonary arterial hypertension. Right ventricular failure is a leading cause of death in patients with pulmonary arterial hypertension, but there remain no promising leads in the treatment of right ventricular failure. Current research demonstrates that metabolic abnormalities, particularly regarding insulin resistance and glucose intolerance, may be pathologic in the development of right ventricular failure in patients with pulmonary arterial hypertension. In this review, we will address the potential role diet and exercise may play in improving right ventricular failure in patients with pulmonary arterial hypertension.

Full Issue PDF

Guest Editors’ Memo

PH Professional Network: Mental Health and PH: APRNs and RNs Having a Positive Effect

Wearable Devices in Pulmonary Arterial Hypertension: What Are We Trying to Learn?

Background

Implications for clinicians

Conclusions

PH Roundtable: The Role of Caregivers in Pulmonary Hypertension Care

Diet and Exercise Intervention in Pulmonary Hypertension

Socioeconomic and Social Determinants of Health: Effects on Pulmonary Arterial Hypertension Care

Conference Abstracts

Guest Editor’s Memo

A Roundtable Discussion Addressing Patient-Centered Care and Quality of Life in Patients With Pulmonary Arterial Hypertension

Editor’s Memo

Pulmonary Hypertension Associated With Parenchymal Lung Disease