Abstract 12512: Predictive Factors of Right Heart Catheterization to Diagnose Pulmonary Arterial Hypertension Using Least Absolute Shrinkage Selection Operator (LASSO) Regression

Abstract

Introduction: Right Heart Catheterization (RHC) is the gold standard diagnostic test to confirm Pulmonary Arterial Hypertension (PAH). However, not all patients receive a RHC to confirm diagnosis. Hypothesis: This study analyzed a real-world PAH dataset to understand factors predictive of RHC being used to confirm diagnosis. Methods: Data were analyzed from the 2022 Adelphi PAH Disease Specific Programme™ containing physician-provided patient information for PAH patients in the US, France, Germany, Italy, Spain, UK and Japan. As our outcome (RHC at diagnosis) is binary, logistic regression was used behind LASSO for 113 covariates (predictors). LASSO regression inputs many covariates, only those associated with the outcome are presented. Each covariate is tested individually and against all others. In LASSO an odds ratio (OR) is generated. An OR > 1 or more indicates a predictor is associated with a higher likelihood of RHC at diagnosis, an OR < 1 indicates a lower likelihood. RHC at diagnosis was physician-confirmed from patient records. Results: A total of 529 PAH patients with complete data for all covariates were analyzed. Mean age was 55 and 51% were female. Overall, 75% received a RHC at diagnosis. Patient refusal (34%) and deemed unnecessary by managing physician due to other testing (29%) were the most frequently cited reasons for lack of RHC. Of the 113 initial predictors, 24 were considered important in predicting RHC ( Figure 1 ). The leading predictors for RHC at diagnosis were patients classified as functional class (FC) III, those experiencing symptoms of dyspnea, palpitations and cyanosis, and those diagnosed at an accredited expert pulmonary hypertension (PH) center. Conclusions: Results indicate that RHC is more likely to be used for patients presenting with a higher FC, key PAH symptoms and diagnosed at PH expert centers. Further emphasis should be placed on RHC at diagnosis particularly within non-specialist settings to help achieve accurate diagnosis.