In the largest study of practice patterns among US pulmonary hypertension patients, researchers found low use of pulmonary rehabilitation therapy across all types of this increasingly common serious heart condition. The study was posted online in the Abstract Issue of the American Journal of Respiratory and Critical Care Medicine. [1]

Exercise-based cardiopulmonary rehabilitation is beneficial and recommended for the treatment of pulmonary arterial hypertension, pulmonary hypertension due to left-side heart disease or chronic lung disease and chronic thromboembolic pulmonary hypertension. Although the incidence of these conditions is expanding, little is known about how many of these patients receive recommended exercise rehabilitation.

To find the answer to this question, Thomas Cascino, MD, MSc, cardiovascular disease fellow at the University of Michigan, and colleagues from the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, examined Veterans Administration electronic health records spanning 2010 to 2016 to identify vets with pulmonary hypertension, and to further classify them by the type of pulmonary hypertension they had. They found 111,356 cases of pulmonary hypertension among these veterans.

They discovered that only 1,737 (1.6%) of these pulmonary hypertension patients received pulmonary rehabilitation, although the use of pulmonary rehabilitation increased slightly for some groups between 2010 and 2016. 

“The goal of all our treatments is to help people feel better and live longer,” said Dr Cascino. “Exercise therapy is safe and effective at improving outcomes that matter to people living with pulmonary hypertension, such as quality of life and exercise endurance. Recognizing that it is being underutilized is a necessary first step in working toward increasing patients’ access to rehab.”

There was no increase in exercise increase for patients with pulmonary arterial hypertension or those with thromboembolic pulmonary hypertension.

“These last two conditions are not as well understood as the others, which have been researched for decades,” stated Cascino. “Our hope is that, through research like this, we will increase awareness and improve access to evidence-based care for patients with all groups of pulmonary hypertension.”

Cascino noted that it is necessary to improve access to pulmonary rehabilitation through broader insurance coverage.  He also stated that insurance reimbursement alone is not the sole reason for low pulmonary rehabilitation use.  He advocated for increased provider and patient awareness of the benefits of rehab while also working to better understand and adapt to patient-, provider-, and system-level factors that impact use.

“For example, we are doing a trial of home-based rehab using wearable technology as a means to expand access for people unable to come to center-based rehab for a variety of reasons,” he explained.

The number of people diagnosed with pulmonary hypertension has been increasing in recent years. One reason may be improved awareness of the disease. More frequent screening tests such as echocardiograms may pick up this condition. Advancing treatment options and the growing burden of left-sided heart disease leading to pulmonary hypertension are also contributing factors.

  1. Abstract #8081. “Use of Exercise Rehabilitation Among 111,356 Veterans With Pulmonary Hypertension.”