Under the Tent of the New ACCP Guidelines in PAH: Room for Debate, Comment, Analysis

Abstract

Publication of the new American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines for pulmonary arterial hypertension (PAH) represents a major advance in understanding the diagnosis and management of the disease. For the target audience of cardiologists, pulmonologists, rheumatologists, internists, and other healthcare providers involved in such care, the guidelines are the first revision of an earlier document created 10 years ago. Lewis J. Rubin, MD, who chaired the consensus panel, and the international panel of 19 experts from five medical specialties, deserve our appreciation and praise for the extraordinary work they have done during the last 3 years. We applaud their efforts and commitment to the highest standards of medical care.If the guidelines cast a long shadow over our practice because of how large they loom in clinical decision-making, they also shed tremendous light on areas where we need more evidence-based information. Under the tent of the guidelines, however, there is plenty of room for debate and comment over how the new criteria should be applied in the myriad decisions we make every day. As clinicians, we must often make decisions in areas in which the evidence base is inadequate because of the need for more data. As our Editorial Board reviewed the guidelines, we wanted to explore various approaches taken by clinicians involved with PAH, especially in areas where the guidelines cannot (of necessity) make strong recommendations.The experts we have assembled for this issue are not debating the relative merits of the guidelines. Beginning on page 3, they are offering fresh and varied perspectives, whether it is on the use of echocardiography or the benefits of new agents still in phase 3 clinical trials. Gleaned from their own knowledge and practice-based experience, these comments, queries, and insights will, it is hoped, broaden our base of knowledge.