Risk Stratification—What's My Risk? A Practitioner's Tool

At the 6th World Symposium on Pulmonary Hypertension, the task force on clinical risk stratification and medical therapy in pulmonary arterial hypertension (PAH) reviewed the latest developments published in the field of therapeutics since the previous meeting and presented their consensus opinions to an audience of 1376 participant attendees between February 27 and March 1, 2018, in Nice, France. After participants’ input was incorporated, the final recommendations were published in the European Respiratory Journal. In the past several years, treatment for PAH was based on several parameters to determine the severity of the disease and risk of progression and poor outcome. These parameters included New York Heart Association Functional Class (NYHA FC), exercise capacity represented by the 6-minute walk distance (6MWD), and echocardiographic and hemodynamic measurements. Until recently, the guidelines for initiation and escalation of therapy relied mostly upon NYHA FC. However, data from 3 independent registries demonstrate the importance of a methodical risk assessment and treatment strategy in PAH patients. All registries prove that, in order to obtain a good outcome (assessed as event-free survival at 1 year), patients need to achieve a low-risk status.