{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T15:43:37Z","timestamp":1793029417179,"version":"4.5.0"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pulm. circ."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Pulmonary arterial hypertension (PAH) is a rare and progressive disease characterized by remodeling of the pulmonary vasculature, which leads to increased pulmonary artery pressure and ultimately right ventricular failure. Although Japanese guidelines recommend combination therapy, real\u2010world data show inconsistencies in its implementation. We thus conducted a cross\u2010sectional, web\u2010based questionnaire survey to understand the recent real\u2010world clinical practices in Japan and identify factors associated with treatment decisions, with a particular focus on the use of combination therapies. The findings indicated that oral PAH medications were widely available and commonly prescribed, whereas inhaled and parenteral infusion therapy were less accessible and used less frequently. Moreover, physicians working in PAH\u2010specialized centers were significantly more likely to prescribe parenteral infusion therapies (adjusted odds ratio [aOR]\u2009=\u20092.6, 95% confidence interval [CI]: 1.5\u20134.3,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and adopt dual (aOR\u2009=\u20093.0, 95% CI: 1.4\u20136.5,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.01) or triple combination regimens (aOR\u2009=\u20092.7, 95% CI: 1.5\u20132.7,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Physicians with experience treating high risk patients at PAH\u2010specialized centers were also significantly more likely to prescribe parenteral infusion therapies (aOR\u2009=\u20093.5, 95% CI: 1.8\u20136.6,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and adopt dual (aOR\u2009=\u20095.9, 95% CI: 2.5\u201314.2,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) or triple combination regimens (aOR\u2009=\u20093.4, 95% CI: 1.7\u20136.7,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). This study revealed differences in clinical practice between PAH\u2010specialized and non\u2010specialized centers in real\u2010world settings. Management of PAH at PAH\u2010specialized centers was associated with increased treatment intensification, indicating the need for enhanced collaboration between PAH\u2010specialized and non\u2010specialized centers to ensure optimal care for patients with PAH.\n                  <\/jats:p>","DOI":"10.1002\/pul2.70351","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:47:55Z","timestamp":1785239275000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Practice of Pulmonary Arterial Hypertension (PAH) and Potential Barriers to Intensive Treatment Among PAH\u2010Specialized and Non\u2010PAH\u2010Specialized Centers in Japan"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4012-8849","authenticated-orcid":false,"given":"Yoko","family":"Arai","sequence":"first","affiliation":[{"name":"MSD K.K Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1540-5529","authenticated-orcid":false,"given":"Wen","family":"Zhang","sequence":"additional","affiliation":[{"name":"IQVIA Solutions G.K. Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shohei","family":"Yamauchi","sequence":"additional","affiliation":[{"name":"IQVIA Solutions G.K. Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0916-2199","authenticated-orcid":false,"given":"Shigeru","family":"Tokita","sequence":"additional","affiliation":[{"name":"MSD K.K Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1959-6102","authenticated-orcid":false,"given":"Shunta","family":"Akutsu","sequence":"additional","affiliation":[{"name":"MSD K.K Tokyo 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