CHEST Guidelines-Request-to-“Update”-the-2019-Update-

Request-to-“Update”-the-2019-Update-

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In a correspondence to the CHEST journal, Dr. Jameel Durrani and Dr. Amit Toor express concerns about the March 2019 guidelines for managing pulmonary arterial hypertension (PAH), particularly in the geriatric population. They acknowledge the panel's work but highlight the absence of guidance for patients aged 70 to 90, a demographic they frequently encounter in their practice. They pose questions about the appropriateness of current vasoreactivity testing and the 6-minute walk test for elderly patients, many of whom suffer from ambulatory dysfunction due to conditions like arthritis. Moreover, they seek clarification on the use of advanced therapies in elderly patients with comorbidities that may mimic or contribute to pulmonary hypertension. Recognizing the limitations of existing research trials, which often exclude older patients, they call for consensus-based guidelines about when such complex diagnostic and treatment processes should cease to be recommended for aged patients.<br /><br />The authors request a consensus statement on the advanced diagnosis and treatment recommendations for elderly patients, considering the exclusion of this age group from clinical trials. They emphasize that a lack of clear guidance on these issues makes it difficult to apply advanced PAH therapies appropriately in their practice.<br /><br />In response, the guideline authors acknowledge the criticism, agreeing that the updated guidelines do not specifically address treatments for the elderly PAH population. They clarify that PAH is rarer in older individuals, who more frequently suffer from other comorbidities like chronic heart and lung diseases, categorized under WSPH group 2 and 3. The authors caution against using PAH-specific therapies in these groups due to the potential for harm. This discussion highlights the need for further research and tailored guidance for managing PAH in elderly patients.

Keywords

pulmonary arterial hypertension

geriatric population

vasoreactivity testing

6-minute walk test

comorbidities

advanced therapies

clinical trials

consensus guidelines

elderly patients

treatment recommendations