Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) improves outcome. The DETECT screening algorithm (DETECT-algorithm) is recommended in a high-risk SSc subgroup. The aim of this study is to compare the positive predictive value (PPV) of screening using the 2009 European Society of Cardiology/European Respiratory Society guidelines (ESC/ERS-guidelines) and the DETECT-algorithm and comparing their cost-effectiveness in an unselected day-to-day SSc population.
Methods: 195 consecutive SSc patients, included in the Ghent University hospital systemic sclerosis unit, having their yearly SSc-specific visit between February 2015 and February 2016 were prospectively screened using both algorithms and the cost-effectiveness was calculated.
Results: In 63 (32%) of the 195 included patients (11%/71%/18% limited/limited cutaneous/diffuse cutaneous SSc), a right heart catheterization (RHC) was recommended (46/4/13 using DETECT-algorithm alone/ESC/ERS-guidelines alone/both algorithms). A RHC was performed in 53 patients: (36 [78%]/4 [100%]/13 [100%] where recommended by DETECT-algorithm alone/ESC/ERS-guidelines alone/both). PAH was diagnosed in 3 patients (incidence 1.5%/year, 95%CI:0.5-4.4%), in whom both algorithms recommended a RHC. The PPV was 23%,95%CI:8-50% (3/13) for both algorithms, 18%,95%CI:6-41% (3/17) for the ESC/ERS-guidelines and 6%,95%CI:2-17% (3/49) for the DETECT-algorithm. The average cost for screening was 80 and 227 euro using the ESC/ERS-guidelines and the DETECT-algorithm respectively.
Conclusion: In an unselected SSc population, the PPV is 23% when both algorithms recommend RHC. Interestingly, with only one algorithm used, the PPV drops to 18% for the ESC/ERS-guidelines and 6% for the DETECT-algorithm. Based upon this comparison and on cost-effectiveness, echocardiography may remain an important first step screening tool for PAH in SSc.
To cite this abstract in AMA style:Vandecasteele E, Drieghe B, Melsens K, Thevissen K, De Pauw M, Deschepper E, Decuman S, Bonroy K, Piette Y, De Keyser F, Brusselle G, Smith V. Screening for Pulmonary Arterial Hypertension in an Unselected Prospective Systemic Sclerosis Cohort [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/screening-for-pulmonary-arterial-hypertension-in-an-unselected-prospective-systemic-sclerosis-cohort/. Accessed December 3, 2020.
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