Risk Stratification in Pulmonary Hypertension in the UAE

Risk stratification in pulmonary arterial hypertension is critical in determining therapeutic strategies for patients. Patients are stratified into low-,
intermediate-, and high-risk groups based on determinants of prognosis like clinical assessment, exercise tests, biochemical markers,
echocardiography, and haemodynamic tests. The primary objective of treatment is to shift each of the component tests into a low-risk zone either
by treatment escalation alone, as in the case of intermediate-risk patients, or by a combination of treatment escalation and repeat evaluation by right
heart catheterisation in high-risk patients. Low-risk patients should be clinically assessed at least every 3 months, but follow-up is more frequent
for intermediate- and high-risk patients. Apart from improving survival rates, health-related quality of life is also assessed at baseline and followup
visits, which may predict the prognosis. Additionally, therapeutic drug monitoring is also essential during visits due to the risk of major side
effects during treatment initiation or dose escalation. Initial and follow-up risk stratification can prevent delays in the intensification of therapy, but
insurance denials act as a barrier to this approach. Therefore, a dedicated insurance team is required for approval of testing and therapies and a fasttrack
process to communicate with the pulmonary hypertension expert centre. It can be concluded that risk stratification improves the treatment
approach and helps make individualised treatment decisions. It also helps healthcare professionals better allocate treatment resources in cases of
scarcity.