Challenges and Special Aspects of Pulmonary Hypertension in Middle- to Low-Income Regions: JACC State-of-the-Art Review

Babar Hasan; Georg Hansmann; Werner Budts; Alexandra Heath; Zahra Hoodbhoy; Zhi-Cheng Jing; Martin Koestenberger; Katharina Meinel; Ana Olga Mocumbi; Ganna D Radchenko; Hannes Sallmon; Karen Sliwa; R Krishna Kumar; European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, CSC, PASCAR, PCS, and PCSI

doi:10.1016/j.jacc.2020.03.047

Challenges and Special Aspects of Pulmonary Hypertension in Middle- to Low-Income Regions: JACC State-of-the-Art Review

J Am Coll Cardiol. 2020 May 19;75(19):2463-2477. doi: 10.1016/j.jacc.2020.03.047.

Authors

Affiliations

¹ Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan. Electronic address: babar.hasan@aku.edu.
² Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany. Electronic address: georg.hansmann@gmail.com.
³ Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.
⁴ Division of Pediatric Cardiology, Kardiozentrum, La Paz, Bolivia.
⁵ Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
⁶ Department of Cardiology, Peking Union Medical College Hospital & Key Lab of Pulmonary Vascular Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁷ Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria.
⁸ Instituto Nacional de Saúde, Vila de Marracuene, Maputo, Mozambique.
⁹ Secondary Hypertension Department with Pulmonary Hypertension Center, State Institute National Scientific Center, MD Strazhesko Institute of Cardiology of Ukrainian National Academy of Medical Science, and Bogomolets National Medical University, Kyiv, Ukraine.
¹⁰ Department of Pediatric Cardiology, Charité University Medical Center, Berlin, Germany.
¹¹ Hatter Institute for Cardiovascular Research in Africa, Departments of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
¹² Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

PMID: 32408981
DOI: 10.1016/j.jacc.2020.03.047

Abstract

Challenges and special aspects related to the management and prognosis of pulmonary hypertension (PH) in middle- to low-income regions (MLIRs) range from late presentation to comorbidities, lack of resources and expertise, cost, and rare options of lung transplantation. Expert consensus recommendations addressing the specific challenges for prevention and therapy of PH in MLIRs with limited resources have been lacking. To date, 6 MLIR-PH registries containing mostly adult patients with PH exist. Importantly, the global prevalence of PH is much higher in MLIRs compared with high-income regions: group 2 PH (left heart disease), pulmonary arterial hypertension associated with unrepaired congenital heart disease, human immunodeficiency virus, or schistosomiasis are highly prevalent. This consensus statement provides selective, tailored modifications to the current PH guidelines to address the specific challenges faced in MLIRs, resulting in the first pragmatic and cost-effective consensus recommendations for PH care providers, patients, and their families.

Keywords: consensus statement; middle- and low-income countries; pulmonary hypertension.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Cardiology / economics
Cardiology / trends
Heart Defects, Congenital / economics
Heart Defects, Congenital / epidemiology
Heart Defects, Congenital / therapy
Humans
Hypertension, Pulmonary / economics*
Hypertension, Pulmonary / epidemiology
Hypertension, Pulmonary / therapy*
Lung Transplantation / economics
Lung Transplantation / trends
Poverty / economics*
Poverty / trends*
Registries
Review Literature as Topic