• James R Klinger, C Gregory Elliott, Deborah J Levine, Eduardo Bossone, Laura Duvall, Karen Fagan, Julie Frantsve-Hawley, Steven M Kawut, John J Ryan, Erika B Rosenzweig, Nneka Sederstrom, Virginia D Steen, and David B Badesch.
• Brown University, Providence, RI.
• Chest. 2019 Mar 1; 155 (3): 565-586.

BackgroundPulmonary arterial hypertension (PAH) carries a poor prognosis if not promptly diagnosed and appropriately treated. The development and approval of 14 medications over the last several decades have led to a rapidly evolving approach to therapy, and have necessitated periodic updating of evidence-based treatment guidelines. This guideline statement, which now includes a visual algorithm to enhance its clinical utility, represents the fourth iteration of the American College of Chest Physicians Guideline and Expert Panel Report on Pharmacotherapy for PAH.MethodsThe guideline panel conducted an updated systematic review to identify studies published after those included in the 2014 guideline. A systematic literature search was conducted using MEDLINE via PubMed and the Cochrane Library. The quality of the body of evidence was assessed for each critical or important outcome of interest using the Grading of Recommendations Assessment, Development and Evaluation approach. Graded recommendations and ungraded consensus-based statements were developed and voted on using a modified Delphi technique to achieve consensus.ResultsTwo new recommendations on combination therapy and two ungraded consensus-based statements on palliative care were developed. An evidence-based and consensus-driven treatment algorithm was created to guide the clinician through an organized approach to management, and to direct readers to the appropriate area of the document for more detailed information.ConclusionsTherapeutic options for the patient with PAH continue to expand through basic discovery, translational science, and clinical trials. Optimal use of new treatment options requires prompt evaluation at an expert center, utilization of current evidence-based guidelines, and collaborative care using sound clinical judgment.Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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