A Supplement to CareManagement CE FOR CCM & CDMS APPROVED FOR 2 HOURS OF CCM, CDMS AND NURSING EDUCATION CREDIT
Cardiol Rev. 2018;26(2):62-72.
Patients with an acute PE or VTE should be monitored for the subsequent development of CTEPH. High-risk factors in these patients have been identified. The group of patients at highest risk includes patients with major central thromboembolic events, those presenting with significant hemodynamic disturbance or evidence of right ventricular dysfunction, patients with documented thrombophilia, and patients with persistent abnormalities of lung perfusion on follow-up testing.14 These patients should probably be followed regularly for up to 2 years.
6. Gall H, Hoeper MM, Richter MJ, et al. An epidemiological analysis of the burden of chronic thromboembolic pulmonary hypertension in the USA, Europe and Japan. Eur Respir Rev. 2017;26(143).
10. Korkmaz A, Ozlu T, Lzsu S, Kazaz Z, Bulbul Y. Long-term outcomes in acute pulmonary thromboembolism: the incidence of CTEPH and associated risk factors. Clin Appl Thromb Hemost. 2012;18(3):281-288.
Nurses must provide supportive care for those patients who are compromised because of sickness and fear who must now undergo a series of tests they do not understand. Moreover, they certainly may fear the results. If a diagnosis of CTEPH is proven, the nurse can provide support during decision making about appropriate treatment. Additionally, the nurse is in an ideal position to assist the patients through referrals to other providers (eg, social workers) or programs (eg, financial) that may be able to assist with the patient’s needs. The nurse also can support the patient through the cumbersome titration process if medical therapy is required. Education
A primary role of the nurse is as an educator. The nurse is an interpreter—translating medical terminology into language that a patient can understand, keeping in mind that adult learners learn best in the context of problem solving. Put differently, the nurse can help the patient relate what is being taught to how it may help them to breathe and function better now and in the future. Once the diagnosis has been provided the nurse can become a valued partner throughout the process of making treatment decisions and manging their disease. n
References 1. Mullin C, Klinger J. Chronic thromboembolic pulmonary hypertension. Heart Fail Clin. 2018;14:339-351. 2. Lang I. Is CTEPH a distinct disease entity. Eur Respir Rev. 2015;24:246-252. 3. Lang IM, Simonneau G, Pepke-Zaba JW, et al. Factors associated with diagnosis and operability of chronic thromboembolic pulmonary hypertension. A case-control study. Thromb Haemost. 2013;110:83-91. 4. Ende-Verhaar Y, Cannegieter S, Vonk Noordegraaf A, et al. Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of published literature. Eur Respir J. 2017;49(2). 5. Yandrapalli S, Tariq S, Kumar J, et. al. Chronic thromboembolic pulmonary hypertension: epidemiology, diagnosis, and management. Made possible by an educational grant from Actelion Pharmeceuticals
7. Kim NH, Delcroix M, Jais W, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2019;53(1). 8. Kirson N, Birnbaum H, Ivanova J, et al. Prevalence of pulmonary artery hypertension and chronic thromboembolic pulmonary hypertension in the United States. Curr Med Res Opin. 2011;27(9):1763-1768. 9. Delcroix M, Lang I, Pepke-Zaba J, et. al. Long-term outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. Circulation. 2016;133(9):859-871.
11. Mahmud E, Madani M, Kim N, et al. Chronic thromboembolic pulmonary hypertension: evolving therapeutic approaches for operable and inoperable disease. J Am Coll Cardiol. 2018;71(21):2468-2486. 12. Elwing J, Vaidya A, Auger W. Chronic thromboembolic pulmonary hypertension: an update. Clin Chest Med. 2018;39(3):605-620. 13. Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. New Engl J Med. 2004;350(22):2257-2264. 14. McNeil K, Dunning J. Chronic thromboembolic pulmonary hypertension (CTEPH). Heart. 2007;93:1152-1158. 15. Orem C. Epidemiology of pulmonary hypertension in the elderly. J Geriatr Cardiol. 2017;14(1):11-16. 16. Madani M, Ogo T, Simonneau G. The changing landscape of chronic thromboembolic pulmonary hypertension management. Eur Respir Rev. 2017;26(146). 17. Galie N, Humbert M, Vachiery JL, et al; The Joint Task Force for the Diagnosis and Treatment of pulmonary hypertension of the ESC/ ERS. 2015 ESC/ERS guidelines for diagnosis and treatment pulmonary hypertension. Eur Heart J. 2015;37:67-119. 18. Jenkins D, Madani M, Fadel E, D’Armini AM, Mayer E. Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension. Eur Respir Rev. 2017;26(143). 19. Ghofrani HA, D’Armini AM, Grimminger F, et al. Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med. 2013;369(4):319-329. 20. Ghofrani HA, Simmonneau G, D’Armini AM, et al. Macitentan for the treatment of inoperable chronic thromboembolic pulmonary hypertension (MERIT-1): results from the multicenter, phase 2, randomized, double-blind, placebo-controlled study. Lancet Respir Med. 2017;5(10):785-794. 21. Jais X, D’Armini AM, Jansa P, et. al. Bosentan for treatment of inoperable chronic thromboembolic pulmonary hypertension: BENEFiT (Bosentan Effects in iNopErable Forms of chronic Thromboembolic pulmonary hypertension: a randomized placebo-controlled trial. J Am Coll Cardiol. 2008;52(25):2127-2134. 22. Ambrisentan for inoperable chronic thromboembolic pulmonary hypertension (AMBER I). ClinicalTrials.gov Identifier: NCT01884675. APRIL 2019 | 4
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