Diagnosing and Managing Pulmonary Arterial Hypertension in Primary Care

Pulmonary Disease
Diagnosing and Managing PAH
1 AAFP Prescribed Credit(s) 1 AANP Contact Hours 1 AMA PRA Category 1 Credit(s)
Launch Date:
January 01, 2016
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Primary Care MD/DO; and NPs/PAs and other clinicians managing patients with PAH

Relevant Terms:

Pulmonary arterial hypertension; pulmonary hypertension

Franck Rahaghi, MD, MHS, FCCP

Franck Rahaghi, MD, MHS, FCCP
Director, Pulmonary Hypertension Clinic
Director, Pulmonary Education and Rehabilitation
Cleveland Clinic Florida
Weston, FL

Dr. Franck Rahaghi graduated from the University of California San Diego cum laude with a degree in biomedical engineering. He subsequently attended the University of California San Francisco where he obtained his doctorate in medicine. He also attended University of California Berkeley at the same time to obtain a degree in public health and health administration. Dr. Rahaghi completed his internship at the University of Minnesota and in his medical residency at the University of Illinois in Chicago. He completed his pulmonary and critical care fellowship at the Weil-Cornell campus of New York Presbyterian Hospital. He has since been serving as staff attending and clinical researcher at the Cleveland Clinic Florida. He holds the positions of Chair of Quality, Head of the Pulmonary Education department, and Director of the Pulmonary Hypertension Clinic at the Cleveland Clinic in Florida.
1. Explain the pathophysiology of pulmonary arterial hypertension (PAH)
2. Determine when PAH should be suspected and how to determine the specific etiology
3. Define parameters that determine the severity of PAH
4. Review treatments and appropriately refer and follow patients receiving treatment for PAH

Planning Committee
Gregg Sherman, MD
Family Practice
Northwest Heart and Heath
Margate, FL
Harvey C. Parker, PhD, CCMEP
National Association for Continuing Education
Plantation, FL
Joshua Kilbridge, President
Kilbridge Associates
San Francisco, CA
Pulmonary arterial hypertension (PAH) is a subgroup of pulmonary hypertension (PH) - a chronic and progressive condition characterized by abnormally high pressure in the pulmonary vasculature. PAH has previously been considered a rare disease, but evidence suggests a prevalence of about 15-50 cases per million. In the United States, about 1,000 new cases of PAH are diagnosed each year and mortality and hospitalization rates for PH have been increasing.
The pathophysiology of PAH is complex, with abnormalities occurring at the genetic and molecular levels, and involving pulmonary arterial smooth muscle, endothelial cells, and the adventitia. PAH may be associated with disturbances in the balance of endogenous vasoconstrictors and vasodilators (including endothelin, prostacyclin and nitric oxide) in response to endothelial dysfunction or injury, and has led to the development of specific therapies targeting the prostacyclin-, nitric oxide- and endothelin-mediated pathways.
Dramatic advances in the treatment of PAH have occurred over the past two decades, but despite these advances, education and training of clinicians has lagged behind advances in the management of PAH. It is important for clinicians to know when additional or more aggressive treatment is needed, and timely referral to a specialty PH center for a more detailed evaluation and/or more aggressive therapy should be carefully considered. Unfortunately, PAH patients are commonly referred too late in the disease process, at a time when hemodynamic abnormalities are at an advanced stage.
This program will help to bridge the knowledge and performance gaps related to identification, and management of PAH. This educational initiative offers a two-phased curriculum. Phase 1 will offer a Self Assessment Program (SAP) to allow learners to assess their knowledge and skills in this area, compare their selections and scores with all other learners to date, and review commentary from the faculty. The goal of the SAP is to make learners aware of their strengths and weaknesses in this subject area.
A second activity utilizing a case-based interactive structure will be developed in Phase 2 focused on these drivers. This two-phased approach incorporating these statistical techniques will not only provide the stakeholders of this curriculum with the guidance to create an activity that will have optimal impact on clinical behavior, but will significantly impact the development of future curricula as well.
It is the policy of NACE to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. NACE assesses conflict of interest with its faculty, planners and managers of CME activities. Conflicts of interest that are identified are resolved by reviewing that presenter's content for fair balance and absence of bias, scientific objectivity of studies utilized in this activity, and patient care recommendations.
While NACE endeavors to review faculty content, it remains the obligation of each physician or other healthcare practitioner to determine the applicability or relevance of the information provided from this course in his or her own practice.
Franck Rahaghi, MD, has the following disclosures: Speaker - United Therapeutics, Actelion, Lung Biotech; Consultant - Bayer, Lung Biotech; Researcher - Gilead, Lung Biotech
Planning Committee
Gregg Sherman, MD, has no real or apparent conflicts of interest to report. 
Harvey Parker, PhD, has no real or apparent conflicts of interest to report. 
Joshua Kilbridge has no real or apparent conflicts of interest to report. 
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The opinions expressed during the educational activity are those of the faculty and do not necessarily represent the views of NACE. The information is presented for the purpose of advancing the attendees' professional development.
The National Association for Continuing Education is accredited by the ACCME to provide continuing medical education for physicians.
NACE designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
National Association for Continuing Education is approved as a provider of nurse practitioner continuing education by the American Academy of Nurse Practitioners. AANP Provider Number 121222. This program has been approved for 1.0 contact hour of continuing education (which includes 0.25 hours of pharmacology).
This enduring activity, Diagnosing and Managing Pulmonary Arterial Hypertension in Primary Care, has been reviewed and is acceptable for up to 1.0 prescribed credit by the American Academy of Family Physicians. Term of approval begins 01/01/2016. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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This activity is sponsored by National Association for Continuing Education.
This educational activity is supported by an educational grant from Actelion.
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