When a patient develops pulmonary arterial hypertension (PAH)—a form of heart failure related to high blood pressure in lung circulation—it’s often life-threatening. But the earlier PAH is detected, the more treatable it can be. That’s why new research published by Anjali Vaidya, MD, FACC, FASE, FACP and her team is changing the game for heart failure and pulmonary vascular care.
The recent American Heart Journal study shows that when the team’s virtual echocardiography screening tool (VEST) is incorporated into an electronic medical records (EMR) system, it’s “highly accurate in identifying patients likely to have PAH,” as Dr. Vaidya explains. That means patients can be singled out for follow-up testing and treatment much earlier, connecting them to expert care when there’s the greatest chance of success.
“Pulmonary arterial hypertension can be very difficult to detect, and a lot of people are falling through the cracks,” says Dr. Vaidya, who is the Co-Director of the Advanced Pulmonary Hypertension, Right Heart Failure, & Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Program at Temple University Hospital and Professor of Medicine at the Lewis Katz School of Medicine. “Even in the U.S., the average time it takes for a patient to go from experiencing their first symptom to receiving an accurate diagnosis is about 2.8 years.”
“The primary symptom of PAH is shortness of breath, which can be very difficult to live with,” Dr. Vaidya continues. “By the time most patients are diagnosed, they’re usually short of breath sitting at rest or walking to the door. Every day, patients tell me, ‘I’ve felt short of breath for years, but I’m just getting the correct diagnosis now.’ That’s why I wanted to create VEST: to use innovation and expertise to identify patients and expedite their care at accredited pulmonary hypertension (PH) centers.”
Saving Lives with Earlier Treatment
When they first developed VEST, Dr. Vaidya and her colleagues from the Advanced Pulmonary Hypertension Program and Division of Cardiology—including Suneesh Anand, MD; Gabriela Narowska, DO; Chethan Gangireddy, MD, MBA; Martin Keane, MD, FACC, FAHA; Daniel Edmundowicz, MD, MBA, FACP, FACC; Paul Forfia, MD; and John Enevoldsen, MSE—analyzed echocardiogram data, which estimates pressure in the pulmonary artery and detects heart changes that suggest further testing is needed. The goal was to determine the criteria for what they called a VEST score.
In another study, published in the American Journal of Cardiology, the team analyzed prior echocardiograms of patients who had since been diagnosed with PAH. They found that these patients had positive VEST scores more than 200 days before they were referred to an accredited PH center to confirm and receive treatment for their diagnosis. “By that time, 72% of those patients were at intermediate to high risk of death,” Dr. Vaidya explains.
In other words, there was a clear opportunity to use VEST to identify and refer PAH patients for treatment far earlier—and in doing so, to save lives.
Identifying and Addressing Care Gaps
That’s why Dr. Vaidya and her team built an electronic medical records-based algorithm that automatically calculates a patient’s VEST score. “No one has ever created an algorithm like this before,” Dr. Vaidya explains.
“We applied it to nearly 3,500 patients who’d undergone echocardiograms—not just patients in our program, but from across the Health System,” she continues. “If they had a high estimated pulmonary pressure, we automatically calculated their VEST score. Then we compared the scores from the algorithm to manually calculated VEST scores and found that the algorithm’s scores were 100% accurate.”
The team then isolated the patients with +3 scores, who had the highest risk for PAH. “We wanted to see how many of them had actually been referred to an accredited PAH specialist for treatment in accordance with standards of care,” Dr. Vaidya says. “The numbers were really shocking: a third of them hadn’t received that referral.”
Very few of the patients who were not referred to Temple Cardiology’s accredited PH Center of Comprehensive Care received gold standards of testing, let alone treatment. But when patients were referred to an accredited PH center, nearly all were tested and diagnosed with PAH—highlighting how VEST could guide timely, lifesaving care.
Making a Global Impact
Because of VEST’s potential to transform patient care and pulmonary hypertension as a field, Dr. Vaidya says, “People across the country have expressed significant interest in incorporating this into their health systems.”
“We’ve already made VEST a part of Temple Health’s Epic systems, and we’re now in the process of collaborating with other centers, both nationally and internationally, to facilitate its implementation elsewhere,” she explains. “I’ve been invited to speak about VEST countries that are under-resourced for PH care.”
“I think there’s a lot of opportunity for global collaboration, especially in areas where there’s less PAH expertise and access to testing,” Dr. Vaidya continues. “I would be really proud of my team, and of Temple Health, if we could make an impact and help patients on such a broader scale.”