A novel nurse-led, multidisciplinary, and guideline-directed disease intensive management program improves long-term survival of pulmonary hypertension patients

Abstract Background Although the overall survival of pulmonary hypertension (PH) patients improved in the current era, better management strategy for PH patients still needs further exploration. Here, we proposed a novel nurse-led, multidisciplinary, and guideline-directed disease intensive management program and hypothesized this strategy would improve the overall survival of PH patients. Methods Patients were prospectively enrolled and divided into the intensive management group (IDM) and the conventional disease care (CDC) group voluntarily. Intensive management was nurse-led and delivered by multidisciplinary teams, including patient education, symptoms monitoring, and patient adherence improvement with careful outpatient or inpatient assessment every 3 months and medicine prescription whenever needed. Patients with conventional care were treated by primary cardiologists’ consultants and telephone follow-ups every year. Results Overall, 413 PH patients were finally included. Both total survival (p<0.001) and event-free survival (p=0.008) of the IDM group were significantly higher than the CDC group. After adjustment of age and sex, intensive management was also an independent protective predictor for both primary [all-cause mortality, HR 0.378, 95% CI (0.214-0.668), p<0.001] and composite endpoints [all-cause mortality and re-hospitalization, HR 0.648, 95% CI (0.454-0.927), p=0.017]. In subgroup analysis, IDM was beneficial in prolonging the overall survival of patients in high-risk situations (HR 0.283, 95% CI 0.125-0.641, p=0.002) and with advanced RV dysfunction (HR 0.250, 95% CI 0.123-0.510, p<0.001). Conclusion Nurse-led, multidisciplinary, and guideline-directed disease intensive management program represented an ideal method to strengthen the overall and event-free survival of PH patients, especially for those in advanced stages of PH.Novel management program