{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:16:50Z","timestamp":1790889410397,"version":"4.1.0"},"reference-count":56,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Use of phosphodiesterase-5 inhibitors (PDE5i) for groups 2 and 3 pulmonary hypertension (PH) is rising nationally, despite guidelines recommending against this low-value practice. Although receiving care across healthcare systems is encouraged to increase veterans\u2019 access to specialists critical for PH management, receiving care in 2 systems may increase risk of guideline-discordant prescribing. We sought to identify factors associated with prescribing of PDE5i for group 2\/3 PH, particularly, to test the hypothesis that veterans prescribed PDE5i for PH in the community (through Medicare) will have increased risk of subsequently receiving potentially inappropriate treatment in Veterans Health Administration (VA).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>We constructed a retrospective cohort of 34\u2009775 Medicare-eligible veterans with group 2\/3 PH by linking national patient-level data from VA and Medicare from 2006 to 2015. We calculated adjusted odds ratios (ORs) of receiving daily PDE5i treatment for PH in VA using multivariable models with facility-specific random effects. In this cohort, 1556 veterans received VA prescriptions for PDE5i treatment for group 2\/3 PH. Supporting our primary hypothesis, the variable most strongly associated with PDE5i treatment in VA for group 2\/3 PH was prior treatment through Medicare (OR, 6.5 [95% CI, 4.9\u20138.7]). Other variables strongly associated with increased likelihood of VA treatment included more severe disease as indicated by recent right heart failure (OR, 3.3 [95% CI, 2.8\u20133.9]) or respiratory failure (OR, 3.7 [95% CI, 3.1\u20134.4]) and prior right heart catheterization (OR, 3.8 [95% CI, 3.4\u20134.3]).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Our data suggest a missed opportunity to reassess treatment appropriateness when pulmonary hypertension patients seek prescriptions from VA\u2014a relevant finding given policies promoting shared care across VA and community settings. Interventions are needed to reinforce awareness that pulmonary vasodilators are unlikely to benefit group 2\/3 pulmonary hypertension patients and may cause harm.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.119.005993","type":"journal-article","created":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T09:01:07Z","timestamp":1589274067000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Factors Associated With Potentially Inappropriate Phosphodiesterase-5 Inhibitor Use for Pulmonary Hypertension in the United States, 2006 to 2015"],"prefix":"10.1161","volume":"13","author":[{"given":"Kari R.","family":"Gillmeyer","sequence":"first","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Hospital, Bedford, MA (K.R.G., S.T.R., M.E.G., K.M.L., Q.S., S.X.Q., D.R.M., R.S.W.)."},{"name":"Department of Medicine, Pulmonary Center, Boston University School of Medicine, MA (K.R.G., S.T.R., E.S.K., R.S.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seppo T.","family":"Rinne","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Hospital, Bedford, MA (K.R.G., S.T.R., M.E.G., K.M.L., Q.S., S.X.Q., D.R.M., R.S.W.)."},{"name":"Department of Medicine, Pulmonary Center, Boston University School of Medicine, MA (K.R.G., S.T.R., E.S.K., R.S.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Glickman","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Hospital, Bedford, MA (K.R.G., S.T.R., M.E.G., K.M.L., Q.S., S.X.Q., D.R.M., R.S.W.)."},{"name":"Department of Statistics, Harvard University, Cambridge, MA (M.E.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Min","family":"Lee","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Hospital, Bedford, MA (K.R.G., S.T.R., M.E.G., K.M.L., Q.S., S.X.Q., D.R.M., R.S.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Shao","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Hospital, Bedford, MA (K.R.G., S.T.R., M.E.G., K.M.L., Q.S., S.X.Q., D.R.M., R.S.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley X.","family":"Qian","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans Hospital, Bedford, MA (K.R.G., S.T.R., M.E.G., K.M.L., Q.S., S.X.Q., D.R.M., R.S.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth S.","family":"Klings","sequence":"additional","affiliation":[{"name":"Department of Medicine, Pulmonary Center, Boston University School of Medicine, MA (K.R.G., S.T.R., E.S.K., R.S.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley A.","family":"Maron","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Veterans Affairs Boston Healthcare System, MA (B.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph T.","family":"Hanlon","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital, Boston, MA (B.A.M.)."},{"name":"Center for Health Equity Research and Promotion (J.T.H.), Veterans Affairs Pittsburgh Healthcare System, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald R.","family":"Miller","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Veterans 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