{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:27:51Z","timestamp":1789190871751,"version":"build-2803163510"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,1,17]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Diagnosis of pulmonary hypertension (PH) is often delayed or missed, leading to disease progression and missed treatment opportunities. In this study, we measured variation in care provided by board\u2010certified cardiologists and pulmonologists in simulated patients with potentially undiagnosed PH.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In a cross\u2010sectional study (\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              , NCT04693793), 219 US practicing cardiologists and pulmonologists cared for simulated patients presenting with symptoms of chronic dyspnea and associated signs of potential PH. We scored the clinical quality\u2010of\u2010care decisions made in a clinical encounter against predetermined evidence\u2010based criteria. Overall, quality\u2010of\u2010care scores ranged from 18% to 74%, averaging 43.2%\u00b111.5%. PH, when present, was correctly suspected 49.1% of the time. Conversely, physicians incorrectly identified PH in 53.7% of non\u2010PH cases. Physicians ordered 2\u2010dimensional echocardiography in just 64.3% of cases overall. Physicians who ordered 2\u2010dimensional echocardiography in the PH cases were significantly more likely to get the presumptive diagnosis (61.9% versus 30.7%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Ordering other diagnostic work\u2010up items showed similar results for ventilation\/perfusion scan (81.5% versus 51.4%;\n              <jats:italic>P<\/jats:italic>\n              =0.005) and high\u2010resolution computed tomography (60.4% versus 43.2%;\n              <jats:italic>P<\/jats:italic>\n              =0.001). Physicians who correctly identified PH were significantly more likely to order confirmatory right heart catheterization or refer to PH center (67.3% versus 15.8%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">A wide range of care in the clinical practice among simulated patients presenting with possible PH was found, specifically in the evaluation and plan for definitive diagnosis of patients with PH. The delay or misdiagnosis of PH is likely attributed to a low clinical suspicion, nonspecific symptoms, and underuse of key diagnostic tests.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT04693793.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.026413","type":"journal-article","created":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T10:07:29Z","timestamp":1673431649000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Gaps in the Care of Pulmonary Hypertension: A Cross\u2010Sectional Patient Simulation Study Among Practicing Cardiologists and Pulmonologists"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7702-3492","authenticated-orcid":false,"given":"Enrico","family":"de Belen","sequence":"first","affiliation":[{"name":"QURE Healthcare San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W.","family":"McConnell","sequence":"additional","affiliation":[{"name":"Norton Healthcare Louisville KY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean M.","family":"Elwing","sequence":"additional","affiliation":[{"name":"UC Health Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2184-4603","authenticated-orcid":false,"given":"David","family":"Paculdo","sequence":"additional","affiliation":[{"name":"QURE Healthcare San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6271-7301","authenticated-orcid":false,"given":"Ian","family":"Cabaluna","sequence":"additional","affiliation":[{"name":"QURE Healthcare San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1119-160X","authenticated-orcid":false,"given":"J\u00f6rg","family":"Linder","sequence":"additional","affiliation":[{"name":"Janssen\u2010Cilag GmbH Neuss Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0210-9232","authenticated-orcid":false,"given":"John W.","family":"Peabody","sequence":"additional","affiliation":[{"name":"QURE Healthcare San Francisco CA"},{"name":"University of California San Francisco CA"},{"name":"University of California Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv317"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-1166"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00005412"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200510-1668OC"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-019-0827-5"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1089\/pop.2018.0111"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjstel-2018-000370"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.13.1715"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-141-10-200411160-00008"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.12788\/jhm.3257"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.10.020418"},{"key":"e_1_3_2_13_2","first-page":"563","article-title":"Comparative effectiveness of two disparate policies on child health: experimental evidence from the Philippines","volume":"32","author":"Peabody JW","year":"2017","unstructured":"Peabody JW, Quimbo S, Florentino J, Shimkhada R, Javier X, Paculdo D, Jamison D, Solon O. 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Nagoya J Med Sci. 2019;81:19\u201330. doi: 10.18999\/nagjms.81.1.19","journal-title":"Nagoya J Med Sci"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.122.026413","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T12:39:28Z","timestamp":1715603968000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.122.026413"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,17]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,1,17]]}},"alternative-id":["10.1161\/JAHA.122.026413"],"URL":"https:\/\/doi.org\/10.1161\/jaha.122.026413","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,17]]},"assertion":[{"value":"2022-07-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e026413"}}