Photo Credit: Pitchayanan Kongkaew

In a study published in JACC: Advances, researchers evaluated the effectiveness of the Quality Enhancement Research Initiative in improving PAH detection in adults with congenital heart disease (CHD) who underwent repair of systemic-to-pulmonary arterial shunt lesions. The study included 217 patients aged at least 18 years with additional PAH risk factors. Clinicians assessed patients annually for three years using history, physical exams, electrocardiograms, transthoracic echocardiograms (TTE), WHO functional class, and 6-minute walk tests. Pop-up reminders provided evidence-based recommendations during data entry. Over time, capture of required TTE measures improved, as did alignment between study and core-center interpretations. Despite 40% of patients having two or more high-risk features for PAH on TTE, only 7% underwent right heart catheterization, confirming PAH in just two patients. The researchers concluded that a structured screening protocol could enhance PAH detection in at-risk patients with CHD, though right heart catheterization remains underutilized despite suggestive TTE findings.