Demographic and clinical characteristics of pulmonary hypertension cases and the awareness of the disease among chest physicians in Abassia Chest Hospital

RationalTo date in Egypt there is no available national registry for PH cases therefore this study had two objectives, first to record the clinical characteristics and demographics of PH cases in a single center study that hopefully could be a stepping stone in the development of a national registry. The second objective was to assess the awareness of the physicians of the disease.MethodsIt included two parts, the first a retrospective descriptive study of 52 patients diagnosed as PH who were admitted to Abassia Chest Hospital in the period between January 2011 and December 2012. The second part comprised a prospective assessment of the awareness of 40 specialized chest physicians who worked in Abassia Chest Hospital using a questionnaire.ResultsAmong the 52 patients the mean age was 55.8 ± 13.25 years, 28 females (53.8%) and 24 males (46.2%) and a mean cigarette smoking index of 78.5 (±33.3). The patients suffered from slight respiratory acidosis with a mean pH of 7.3 (±0.03) explained by the elevated mean PaCO2 of 49.9 (±8.6) mmHg and hypoxemia explained by a mean PaO2 of 73.6 (±12.7) mmHg, and a mean SO2 of 83.9 (±5)%. According to NYHA, 40 (76.9%) presented in FC III and 12 (23.1%) FC IV. ECHO assessment records revealed an elevated right ventricular systolic pressure (RVSP) with an estimated mean of 61.4 (±12.4) mmHg, tricuspid regurge was the most common valve affection in 38 (73%) of the cases while 18 (34.6%) had left ventricular diastolic dysfunction and left ventricular hypertrophy. Almost all of the diagnosed patients with PH 43/52 (82.6%) were classified as group 3 that is PH due to lung diseases and/or hypoxemia. COPD contributed to slightly more than half of the 29 (55.7%) cases meanwhile the other half was shared between variable lung diseases. PH due to left sided heart failure (group 2) was the second common cause 5/52 (9.6%) followed equally by patients with chronic thromboembolism (CTEPH) (group 4) 2/52 (3.8%) and patients with idiopathic pulmonary hypertension (group 1) 2/52 (3.8%). Among the 40 physicians enrolled in the survey only 15 (37.5%) acknowledged that they found PH a commonly diagnosed disease in their practice. As regards the method of investigation; 34 (85%) decided on ECHO only but 5 (12.5%) recommended both ECG and ECHO. To reach a confirmed diagnosis of PH only 2 (5%) selected right heart catheterization while 35 (87.5%) chose elevated RVSP > 25 mmHg and 3 (7.5%) didn’t know. None of the physicians conducted clinical trials on PH medications also none of them have previously referred any of the PH cases for heart and lung transplant and only 1 physician referred 1 case for thrombo-endarterectomy. Lastly 34 (85%) of the physicians didn’t attend any educational meeting concerning PH, the remaining 4 (10%) attended one meeting and 2 (5%) attended two meetings.ConclusionIn conclusion the study provides information on the clinical and epidemiological features of PH in Egypt as a primary pilot study. It highlights the fact that awareness about the disease is still lacking among physicians and/or health care providers and late detection continues to be a threat for optimum management of PH.Clinical impactIt unveiled the urgent need for a large scale registry not only national but also regional using uniform diagnostic criteria based on the latest published guidelines.