Diagnostic delay in PAH persists, linked to lower survival

Despite increased community awareness, diagnostic delays persist among patients with pulmonary arterial hypertension (PAH), claims a recent study, noting that those who experience longer diagnostic interval are at higher risk of mortality.

Moreover, age, cardiovascular and respiratory comorbidities are significantly associated with longer time to diagnosis.

To assess the magnitude, risk factors, and survival impact of diagnostic delay in Australian and New Zealand, the authors performed a cohort study of PAH patients from the PHSANZ Registry diagnosed from 2004 to 2017.

Diagnostic interval referred to the time from symptom onset to diagnostic right heart catheterization as recorded in the registry. A multivariate logistic regression model was generated to analyse the factors associated with diagnostic delay. Kaplan–Meier method and Cox regression were used to compare survival rates across patients based on the time to diagnosis.

A total of 2,044 PAH patients were eligible for the analysis. Median age at diagnosis was 58 years (interquartile range [IQR], 43–69 years); female-to-male ratio was 2.8:1, and majority of the patients (82 percent) were classified as having New York Heart Association functional classification III–IV.

The median diagnostic interval was 1.2 years (IQR, 0.6–2.7 years). A diagnostic interval of ≥1 year was independently predicted by the following factors: age, congenital heart disease-PAH, obstructive sleep apnoea, and peripheral vascular disease.

There has been no improvement in diagnostic interval during the study period. Furthermore, an association was found between longer diagnostic delay and reduced 5-year survival.