Dealing with High Mortality Rates of Pulmonary Hypertension
A recent study by CDC investigators revealed that the number of deaths due to pulmonary arterial hypertension (PAH) has increased significantly over the past decade (2001-2010). PAH is characterized by high blood pressure in the arteries which carry oxygen as well as blood from the heart to the lungs so that the right side of the heart needs to work harder to pump blood across the body. This condition normally occurs along with other diseases including heart and blood vessel diseases, lung diseases and liver diseases and other conditions including pregnancy, sleep apnea, birth defects of the heart and certain autoimmune disorders. Though this is an uncommon disease affecting 1 to 2 people in every 1 million in the U.S., the complexity of the nature of the disease makes it hard to diagnose and provide appropriate treatment at the right time, thus leading to increased deaths. How to deal with high mortality rates of PAH? Before going to the measures that address high mortality rate, here’s a look at the major findings of the study that analyzed mortality data from the National Vital Statistics System and data from the National Hospital Discharge Survey that will help understand the intensity of mortality rates.
The declining death rates associated with pulmonary hypertension in men during 1980 to 2005 has reversed and now exhibits a significant increasing trend.
The death rates from PAH increased 2.5% per year for women during 20012010, while the mortality rates increased 0.9% per year for men during the same period.
In the case of individuals aged 85 years and above, the death rates from PAH increased by more than 65%.
It is found that the PAH-related hospitalization rates increased by 52% for women and by 33% for men. The hospitalization rates have nearly doubled for individuals aged 85 years and over. This condition is considered as the most commonly reported prime diagnosis at the time of discharge.
Reducing PAH-related Hospitalizations The major step towards lowering PAH mortality rates is to reduce hospitalizations. A recent study recommends the following action plans to reduce hospitalizations for chronic obstructive pulmonary disease including pulmonary hypertension:
Structured patient education
Early initiation of OCSs
Oral antibiotics
Frequent telephone reinforcement
Support from case management
The FDA has approved two drugs namely, Adempas and Opsumit for the treatment of patients with PAH and it was found that these drugs were effective in reducing hospitalizations. Researches are still going on in this field to find out effective medication and treatment for PAH. However, the most important necessity is the availability of proper care at the early stage of this disease. Early diagnosis of PAH can help to find an effective therapy earlier and thereby reduce the severity of this condition and avoid hospitalizations. The role of family practice physicians is quite evident with regard to early diagnosis and treatment. A detailed history, thorough physical examination and a high index of suspicion is very necessary to diagnose PAH. The suspicion should be high for patients suffering from conditions associated with pulmonary hypertension including sickle cell anemia, HIV and systemic sclerosis. This kind of nonspecific manifestation of this condition demands healthcare professionals with comprehensive knowledge about PAH at primary care settings. Once the disease is detected, family physicians should confirm it through further tests, provide treatment according to the specific condition of the patient and refer the patient to the specialist if the condition is serious. Due to the complexity of treatment, patients are required to be followed up regularly. Family physicians should be well aware of PAH treatment and their adverse effects to manage those visits effectively.
Importance of Accurate Clinical Documentation Though early diagnosis and treatment of PAH is very important for optimizing patient outcomes, timely diagnosis is challenging as its common symptoms including dyspnea and fatigue are also associated with various other conditions. Physicians can confirm this with the medical documents that describe the patient’s details and the results of their tests. The transcripts of history and physical examination reports and laboratory reports should be accurate so that the physicians can reach the right conclusion. They should also accurately transcribe details of the drug dose they prescribe and referral notes so as to help the specialists understand the actual condition of the patient and provide appropriate treatment. Overall, clinical documentation and its accuracy play a crucial role in PAH diagnosis and treatment. A new study reveals that it is possible to identify patients with undiagnosed hypertension in primary care settings successfully by reviewing their Electronic Health Records (EHRs) using algorithms with a high level of accuracy. This study stresses the benefits of complete and concise patient data within EHR. Of course, clinical documentation is easy and efficient with digital health records and we can improve its efficiency. However, the limitations of point-and-click technology and inadvertent copy-paste errors can turn the advantages to disadvantages quickly. Accurate documentation with EHR is possible only if the data entered is free from errors. Here, physicians can utilize the services of a reliable medical transcription service that offers efficient EHR interfacing that would maximize clinician productivity and medical facility while maintaining meaningful use.
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