Barriers to Early Diagnosis
Diagnosis of pulmonary hypertension often takes years, during which patients are commonly misdiagnosed one or more times. In the end, a majority of patients have reached the advanced stages of the disease by the time they are finally diagnosed by right heart catheterization.
What can cause a delay in the diagnosis of PH?
A small delay in diagnosis has a dramatic impact on prognosis.
Preconception: Tendency to diagnose more common diseases and conditions
- When patients tell their doctors about nonspecific symptoms such as shortness of breath, a more common disorder such as asthma may be suspected.
Comorbidities: Development of PH may be masked due to other coexisting disease(s) with similar symptoms
- A patient may have a poor walk distance attributed to an orthopedic impairment, thus masking a cardiopulmonary limitation.
- With older age, and perhaps a lower activity level, a loss of exercise tolerance may not be identified until more noticeable signs of right heart failure occur.
- Common respiratory disorders such as obstructive lung disease and sleep apnea may lead to misdiagnosis.
Progression of Disease: Milder hemodynamic impairment in patients may make PH more difficult to recognize
- Without overt signs of right ventricular failure, a diagnostic catheterization is less likely to occur promptly at symptom onset, denying the opportunity for earlier initiation of therapy.
Age Disparities: Patients younger than 36 years have the highest likelihood of delayed recognition of PAH
- In younger patients, breathlessness is less likely to raise concern for cardiovascular disease. A more common disorder, such as asthma, may be suspected.
- Younger patients with a higher level of activity are more likely to notice symptoms earlier in the course of the disease when the PH is milder.
- Young patients are one of the largest groups of uninsured Americans.
Socioeconomic Disparities: Uneven access to healthcare in the United States