Program Overview

Pulmonary arterial hypertension (PAH) is a complex disease with multiple etiologies. The IMPACT PH program was established to afford physicians and allied health professionals up-to-date information on this disease in order to facilitate patient identification, establish an effective diagnosis and to understand the risks and benefits of the various treatments now available.

The learning modules in this suite cover a range of topics, from the more general aspects of PAH to specific situations, such as pulmonary hypertension associated with connective tissue diseases, like scleroderma. A module specifically oriented towards allied health professionals covers the general aspects of PAH (etiology, prevalence), reviews fundamental tools in the differential diagnosis and places emphasis on the safety concerns when using parenteral prostacyclin analogues to treat PAH. Whenever practical, a case-based approach is used so that health professionals can follow the diagnostic pathway, using the appropriate tools, to finally arrive at the PAH diagnosis.

While each module addresses a set of core learning objectives, the content is scalable to meet the needs of each individual audience. 

Target Audience
This activity has been designed to meet the educational needs of physicians, registered nurses, and other healthcare professionals involved in the care of patients with pulmonary hypertension. 

Educational Objectives

After completing this activity, the participant should be better able to:

• Describe the classification, epidemiology and fundamentals of PAH disease etiology
• Review the diagnostic tools available to the clinician that lead to a differential diagnosis of PAH, including how these tests can be used to rule out diseases with similar presentation to PAH
• Utilize team-based approaches to the diagnosis and management of PAH
• Discuss current treatment goals utilizing approved medical and surgical therapies including safety issues associated with these approaches
• Review pulmonary hypertension arising from specific situations such as chronic thromboembolic pulmonary hypertension or connective tissue diseases
• Examine emerging PAH therapies including novel mechanistic approaches to PAH treatment
• Explain trends in new clinical trial designs

Available Topics

Getting Aggressive in PAH: Setting Goals and Escalating Care

Program Summary

This program is designed to update pulmonologists and all healthcare providers involved in the implementation and design of treatment strategies for patients with PAH. The program reviews the historical rationale for sequential add-on therapeutic strategies and moves on to consider more recent updates in clinical guidelines that recommend more aggressive approaches to PAH patient care. Whenever possible, clinical trial evidence is used to provide support for these recent guideline changes. Finally, the potential impact of utilizing early, more aggressive combination therapy approaches on patient morbidity and mortality is considered in light of recent clinical trial evidence.

Learning Objectives

• Discuss the rationale behind the historical perspective of sequential add-on PAH therapy
• Review recent changes in the guidelines for treating PAH recommending more aggressive early intervention
• List key, recent, clinical trial evidence supporting the changes in recommendations for treating PAH
• Review the current thinking on therapeutic goals for PAH
• Describe how early aggressive therapy may yield benefits to patient morbidity and mortality

Group 1 and Beyond: Case Studies in Pulmonary Hypertension

Program Summary

This program is intended for all healthcare practitioners involved in the identification, diagnosis and treatment of patients with PAH. The case-based program begins with a consideration of the diagnosis of a patient with PAH and the specific, and definitive tests required to secure the diagnosis. Emphasis is placed on the necessity of the right heart catheterization as the defining diagnostic test. Additional cases are available for presentation, based on the audience make-up, and include patients with CTEPH, scleroderma and PH due to left heart disease. In each case presentation, treatment options are considered.

Learning Objectives

• Describe the signs and symptoms of pulmonary hypertension
• Discuss the most current diagnostic algorithm for pulmonary hypertension
• Compare the key diagnostic tests for pulmonary hypertension and the role of right heart catheterization in confirming PH diagnosis
• Discuss the characteristics, diagnosis and treatment of CTEPH
• Differentiate between left heart disease, PH due to left heart disease, and pulmonary arterial hypertension
• Discuss the current treatment algorithm for pulmonary hypertension and the available treatments

Management Approaches in the Hospitalized PAH Patient

Program Summary

This multi-modular program takes a look at the management of patients with PAH hospitalized for various causes. Cardiologists and PH specialists will find this program useful as it explores the management of the PAH patient hospitalized for right heart failure. Other sections of the available program cover patients with infection, pregnancy and undergoing surgery. The program is adaptable to a variety of audiences, based on specializations and in some sections includes short reviews of non-pharmacologic options for patient care.

Learning Objectives

• Identify reasons for hospitalization in PAH
• Identify triggers for right heart failure and how they influence patient management and outcomes
• Outline the pre-operative and perioperative assessment and management of the PAH patient
• Describe how PAH complicates pregnancy and what treatment options apply to the pregnant PAH patient
• Review systemic infection in PAH, its management, and how to avoid sepsis

20 Years of Prostanoids: Spanning the Continuum of Care in PAH

Program Summary

This program is intended for pulmonologists, allied health professionals, general practitioners and other medical specialties, particularly oriented towards those new to the treatment of pulmonary arterial hypertension. The program focuses on the involvement of prostacyclin in the etiology of PAH and provides emphasis on the essential clinical data supporting use of prostanoid-based therapies in treatment of PAH. New therapeutic directions for exploiting the prostanoid axis of the PAH disease process are considered. Prostanoid use in combination therapy approaches are explored. Finally, the underutilization of prostanoid-based therapies is considered with focus on potential barriers to physicians' adoption of these potent therapeutic entities in treating even the more advanced PAH patient.

Learning Objectives

• Discuss the role of prostacyclin in the etiology of PAH
• Explain the current positioning of prostanoids in the PAH treatment algorithm proposed by the ACCP
• Outline the fundamental findings from pivotal studies of currently approved prostanoids in PAH and in hard-to-treat patients
• Describe perceived barriers to the use of prostanoids in modern practice leading to underutilization
• Review recent new prostanoid formulations and emerging PC analogs, their use in mono- and combination-therapy
• Explain the benefits of prostanoid use, alone and in combination, to improve morbidity and mortality across the spectrum of PH severity

Understanding the Diagnosis and Treatment of Pulmonary Arterial Hypertension

Program Summary

Pulmonologists, primary care physicians, nurses and allied health professionals will find benefit from this program, which examines the current thinking around diagnosis and treatment. A focus is placed in echocardiographic examination of the right heart. The utilization of right heart catheterization as the Gold standard of diagnosis is emphasized. Included in this program is a review of the current diagnosis and treatment guidelines as well as a consideration of the currently available medications, treatment strategies and treatment goals for patients with PAH.

Learning Objectives

• Describe the process for the differential diagnoses of pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH)
• List key echocardiographic features that may indicate PAH
• Explain the role for right heart catheterization in the diagnosis of PAH
• Discuss the current definition of PAH
• Review the classification of pulmonary hypertension according to the 2013 Nice Guidelines
• Utilize currently available medical treatments, strategies and goals for PAH treatment

Justifying PAH Care in 2017:The Value of Preventing PAH Hospitalizations

Program Summary

Pulmonologists, nurses, pharmacists and health economists will find benefit from this program that examines the value proposition of effectively treating PAH aggressively to avoid patient hospitalization. Quality of life impact of PAH is reviewed as is the evolution of current therapeutic goals and the strategic approaches to patient care. The negative impact of patient hospitalization on patient outcomes is reviewed. The cost-effectiveness of an aggressive PAH strategy is considered in light of reducing hospitalizations related to disease.

Learning Objectives

• Review the impact that PAH has on life expectancy and quality of life
• Discuss the current evolution of the goals of PAH therapy and the strategic approaches to care
• Consider the negative impact of hospitalization on outcomes in PAH patients
• Interpret the major results supporting aggressive PAH treatment in preventing hospitalizations
• Consider the cost-effectiveness of modern PAH therapy in light of hospitalizations for the disease

Managing Connective Tissue Disease (CTD)-Associated Pulmonary Arterial Hypertension (PAH): Advanced Screening and New Treatment Strategies

Program Summary

This CME program is intended for physicians and nurses dealing with the diagnosis and treatment of patients with pulmonary hypertension resulting from connective tissue disease (CTD). Specific attention is paid to the prevalence, morbidity and predictors of mortality associated with CTD-PH. The signs and symptoms of CTD-PH are reviewed as is the importance of screening for PH in the CTD patient. Treatment approaches for CTD-PH are reviewed with emphasis on combination strategies. Finally, the role of lung transplantation in the treatment algorithm is considered along with transplantation associated survival.

Learning Objectives

• Identify the incidence, morbidity, and predictors of mortality of pulmonary arterial hypertension (PAH) in persons with connective tissue disease (CTD)
• Recognize the signs and symptoms of PAH in patients with CTD
• Discuss the importance of screening for pulmonary hypertension (PH) in CTD and its impact on mortality
• Explain the need for early diagnosis and treatment of CTD-associated PAH
• Employ current treatment strategies for CTD-associated PAH including combination therapies
• Describe the role of lung transplantation in the therapeutic algorithm and its effect on survival

Developing a PH Center- The Nursing Perspective

Program Summary

This program is designed for nurses and other allied health professionals, who encounter newly diagnosed PAH patients with some regularity. The program focuses on the importance of early and accurate diagnosis of PAH and the need to establish coordinated diagnostic and treatment strategies. To effect this, the need to develop a specialized, multidisciplinary PH center team is discussed. The roles and responsibilities of the various members of a PH center team are reviewed leading to a brief consideration of current definitions, treatment and diagnostic algorithms for PAH. The program concludes with a summary of the PAH patient education needs to insure best chances for treatment success.

Learning Objectives

• Review the morbidity and mortality risks associated with pulmonary hypertension
• Discuss the goals of treatment for pulmonary hypertension and the importance of developing a team-oriented approach to patient diagnosis and care
• Define the role of the specialty PH center and its key members’ roles in the diagnosis and treatment of pulmonary hypertension
• Review the development of PH center policies and procedures to improve PH patient diagnosis and care
• Understand the current consensus guidelines for diagnosis and treatment of pulmonary hypertension as they relate to the operation of a PH specialty center
• Discuss the issues of access to treatment and how the specialty pulmonary hypertension center can facilitate patient access to care and education

Managing Pulmonary Hypertension Medication Side Effects

Program Summary

This educational program is designed to aid nurses and allied health professionals in the treatment of patients with PAH. The learning module begins with a brief review of currently approved PAH medications, treatment algorithms and the goals of treatment. However, the bulk of the program focuses on the side effects of these medications with a specific focus on the use of prostacyclins, prostacyclin analogs and receptor agonists. Subtopics such as injection site management are specifically addressed.

Learning Objectives

• Review the therapeutic pathways targeted to treat PAH
• Discuss goals of PH therapy and how goals are evaluated
• Discuss common adverse events from PH medications
• Describe various ways to manage side effects of PH medications in order to keep patients on therapy
• Review the specific complexities of prostacyclin side effects and strategies for managing them

Continuing Education Credit 

Physician Continuing Medical Education

Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Postgraduate Institute for Medicine and Total CME. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
The Postgraduate Institute for Medicine designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

Postgraduate Institute for Medicine is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This educational activity for 1.0 contact hours is provided by Postgraduate Institute for Medicine. 

California Board of Registered Nursing 
Provider approved by the California Board of Registered Nursing, Provider Number 13485, for 1.0 contact hours.

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy.  The existence or absence of COI for everyone in a position to control content will be disclosed to participants prior to the start of each activity.

Fee Information

There is no fee for this educational activity 

A statement of credit will be issued only upon receipt of a completed activity evaluation form and will be emailed to you within three weeks.  

This initiative is supported by independent educational grants from Actelion Pharmaceuticals US, Inc. and Bayer HealthCare Pharmaceuticals, Inc.

Available Formats

Grand Rounds
Your institution will select a faculty presenter and topic, and provide the in-hospital venue. Mentor Meetings and Events with work with an on-site representative to assist with logistical planning as needed.

Dinner Meeting
Held at a restaurant, this program will include the selection of a speaker and topic for a one hour lecture with question-and- answer session (1.0 credit hour). Site selection will comply with ACCME and PhRMA guidelines, and will include a modest meal selection. These are generally private programs for an individual practice group.

Lunch (or breakfast) Meeting
Held at your practice, this program includes a one hour lecture with question-and-answer session (1.0 credit hour). This format will include a modest meal selection, compliant with ACCME and PhRMA guidelines. This program may be for a single practice, or multiple practice groups.

Symposium
This format may include multiple speakers and lecture topics. Please speak to a representative at Mentor Meetings and Events to plan this event.

Compliance with Sunshine Act
The National Physician Payment Transparency Program (Sunshine Act) is a section of the Patient Protection and Affordable Care Act of 2010 that requires pharmaceutical and medical device companies to report to the Federal government certain payments (e.g. meals and other meeting expenses) they make to physicians and teaching hospitals. IMPACT PH programs fully comply with the Sunshine Act and, as a result, payments may be reportable based upon these requirements. For detailed information, please visit www.cms.gov.