CHEST Guidelines-Response_chest

Response_chest_20 (2)

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The document details a correspondence between medical professionals about the 2019 updated guidelines for managing pulmonary arterial hypertension (PAH), specifically addressing concerns related to geriatric care. Drs. Jameel Durrani and Amit Toor highlight the lack of guidance for administering advanced therapies to elderly patients (aged 70-90), who often suffer comorbid conditions complicating PAH management. Key issues they raise include the applicability of vasoreactivity testing in older adults, the suitability of 6-minute walk tests given common mobility issues, and the consideration of secondary PAH due to prevalent cardiac and pulmonary comorbidities in this age group.<br /><br />In response, Dr. James R. Klinger and colleagues acknowledge these gaps, noting insufficient evidence to support specific recommendations for this demographic. They clarify that the CHEST guidelines primarily focus on evidence-based approaches and therefore cannot definitively guide PAH treatment in patients over 70. They address concerns as follows:<br /><br />1. There's inadequate data on vasoreactivity testing's efficacy or safety for the elderly.<br />2. Alternate testing is recommended for those with mobility impairments.<br />3. Treatment value varies depending on individual health conditions.<br />4. No defined age cap exists for disqualifying PAH treatment.<br /><br />The team stresses that treatment should not be restricted by age alone; rather, it should be based on diagnostic criteria and symptomatology consistent with PAH. They note that elderly inclusion in clinical trials remains limited, leaving these issues largely unresolved in current evidence-based guidelines. Without adequate trial data, defining care strategies for this group remains a challenge. Thus, clinical judgment and consensus are necessary to navigate PAH management in the elderly.

Keywords

pulmonary arterial hypertension

PAH management

geriatric care

advanced therapies

vasoreactivity testing

6-minute walk test

secondary PAH

cardiac comorbidities

pulmonary comorbidities

clinical trials