Background/Purpose: Annual screening for pulmonary hypertension (PH) in patients with Systemic Sclerosis (SSc) has been shown to decrease mortality. The American College of Radiology, European Society of Cardiology/European Respiratory Society, and 6^th World Symposium of PH all recommend yearly screening with 1) Pulmonary Function Testing (PFT) with diffusing capacity for carbon monoxide (DLCO), 2) Transthoracic Echocardiogram (TTE), and 3) B-natriuretic peptide (BNP). Clinician adherence to these screening guidelines is not well established, with one study showing rates as low as 34% (Pauling JD et al.). In our retrospective study, we aim to assess adherence to screening guidelines in our medical center to develop a quality improvement intervention for enhanced timely screening.

Methods: Patient charts were reviewed from Loyola University Medical Center, a quartenary care health system in the Chicagoland area. Patients were selected by meeting the following criteria: 1) patients received a diagnosis of SSc by a rheumatologist (using ICD-10 diagnostic codes), 2) were at least 18 years old at diagnosis, 3) were seen by a rheumatologist in our outpatient clinics from January 1, 2018 to December 31, 2022, and 4) did not have a diagnosis of pulmonary hypertension before January 1, 2018.

Charts were reviewed for demographic data, outpatient rheumatology appointments, PFTs, TTEs, and BNPs. Full compliance was defined as an appointment with a completed PFT, TTE, and BNP in the 12 months prior or 6 months after said visit. Ever compliant was defined as a patient having just one of these tests completed. Using these definitions allowed us to not underestimate compliance in situations where a patient did not follow with a rheumatologist all 5 years of the study period (e.g. changed care to an outside provider, established care late, had inconsistent follow-ups).

Results: Seventy-nine patients were identified to have met all criteria as above. Demographically, 87% of patients were female, 54% White, 14% Black, 25% Latino, 1% Asian, and 5% other. Over five years, these patients had a total of 484 appointments. Seventy-five percent (363) of all appointments had at least one screening test (PFT, TTE, BNP) completed 12 months prior or 6 months after the visit. However, only 10.7% of all appointments had all three tests completed, as recommended by international guidelines. Analyzing each test separately, only 58.1% (281), 61.2% (296), and 15.7% (76) of appointments had a corresponding PFT, TTE, and BNP, respectively (Figure 1).

Conclusion: Our results show that our medical center is not immune to the internationally reported low rates of guideline-directed screening for PH in SSc patients. These results are the impetus for our quality improvement project currently in progress at our institution. Interventions include an educational session by a PH expert and an order set on our EMR for seamless point-of-care ordering. We hope to share post-intervention results soon, as we all tackle this specialty-wide gap in guideline-care delivery.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluating-improving-adherence-to-pulmonary-hypertension-screening-in-systemic-sclerosis-patients/