National Audit of Pulmonary Hypertension, 13th Annual Report

The management of pulmonary hypertension (PH) continues to evolve at a rate with which audits and registries have difficulty keeping pace.  In the next few years we are likely to see several major developments coming though.  There will be an increase in the drug classes used to treat the condition, wider capture of the patients’ genetic background and greater understanding of how to incorporate information on patient comorbidities into diagnosis, treatment and prognostication.  This year has also seen the release of the much heralded European Society of Cardiology (ESC)/European Respiratory Society (ERS) 2022 Guidelines on PH (1).  Not only have they changed the treatment algorithm and made significant statements on optimal follow-up and risk stratification of patients but they have even changed the definition of PH. 

The Great Britain National Audit of Pulmonary Hypertension has several strengths which help it stay relevant in this rapidly changing arena.  It is the only PH audit with complete, country-wide capture of information on pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH) patients.  Over 8,000 patients in the audit are currently active and over 5,000 are on PH treatment.  There have been a number of constant features in the annual report over the last few years, particularly the National Standards, and these have been key to drive up the quality of PH management in the UK. 

In addition, the data collected are systematically revised each year and the analysis performed and presented in the annual report is used to illustrate new and developing themes.  Of particular interest this year were the CTEPH survival curves which illustrate in a stark way the clear group benefit for patients who undergo surgery.  The COVID-19 mortality data are reassuring as they illustrate the minimal excess mortality experienced by our patients during the pandemic.  The information on which therapies are used for PAH and CTEPH and whether in mono, dual or triple combination is useful for peer comparison of prescribing practices.

The National Audit of Pulmonary Hypertension is a vital tool in driving quality PH management in the UK – long may it continue.

Dr Martin Johnson, Director, Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital

Dr Craig Wheelans, National Medical Advisor for Specialist Healthcare Commissioning, National Networks & National Planning

Notes:

1. https://erj.ersjournals.com/content/erj/early/2022/08/25/13993003.00879-2022.full.pdf 

• The National Audit of Pulmonary Hypertension (NAPH) sets out to measure the quality of care provided to people referred to PH services in Great Britain.
• Data is collected and submitted by hospital staff at PH services in Great Britain. Efforts continue to be made to incorporate Northern Ireland into the Audit again.
• The Audit is delivered by NHS Digital and commissioned by NHS England and supported by NHS Scotland, NHS Wales (GIG Cymru), the Pulmonary Hypertension Association (PHA UK) and the National Pulmonary Hypertension Centres of United Kingdom and Ireland Physicians’ Committee.
• Please see the Explanatory Notes and accompanying Data Quality Statement for information on data quality.

Notes:

For further information, see Glossary.