Location of Care Delivery for Pulmonary Arterial Hypertension in the United States

<b>Rationale:</b> Guidelines recommend patients with pulmonary arterial hypertension (PAH) be referred to pulmonary hypertension (PH) centers, but little is known about where care is actually delivered in the United States. <b>Objectives:</b> We used prescription patterns to estimate the proportion of PAH care delivered at U.S. PH centers and explore factors associated with location of care. <b>Methods:</b> This retrospective study analyzed claims from the Komodo database in adults who received at least one prescription for PAH between March 2021 and February 2022. A PH center was defined as accredited (Pulmonary Hypertension Association accreditation), high-volume (with ⩾10 patients receiving parenteral prostacyclin), or a composite including either definition. <b>Measurements and Main Results:</b> Analyses included 12,137 patients. Only 37.1% of patients received PAH-specific prescriptions from PH centers. A minority of patients on monotherapy (31.8%) received prescriptions from PH centers. A greater fraction of patients on triple therapy (61.8%) received prescriptions from PH centers. Patients on monotherapy were less likely to receive prescriptions from a PH center if they were older, were male, had a higher comorbidity burden, had Medicaid, resided in the South or West, or lived in a three-digit ZIP code without a PH center. Fewer characteristics were associated with PH center-based care for patients on dual or triple therapy; however, ZIP code and insurance status were associated with center-based care for these patients. <b>Conclusions:</b> A minority of U.S. patients received PAH-specific prescriptions from a PH center. This potential guideline discordance warrants further exploration and may require guidelines to be revisited or the health system to adapt.