Clinicians use risk assessment tools to evaluate the severity of disease at diagnosis. This is an ongoing process repeated at routine follow-up visits every 3 to 6 months to re-evaluate whether the patient’s condition has changed or remains the same. It is important to be monitored regularly to help guide treatments and other important decisions in one’s care plan. Overall, risk scores guide a patient’s treatment plan.
Goals of risk assessment
- Quantify disease severity
- Determine a treatment plan
- Project health outcomes
- Improve patient care
- Monitor disease progression
How disease severity is determined
Risk assessment uses various clinical, functional, exercise and hemodynamic parameters that may include the recent results of:
- A 6-minute walk test
- Natriuretic peptides (NT-proBNP/BNP) test
- Right heart catheterization
- Echocardiogram or cardiac magnetic resonance
Other considerations that may affect an individual’s risk score:
- Functional class or exercise tolerance/ability
- Signs of right heart failure
- How quickly symptoms worsen
- History of fainting/passing out
- Significant changes in 6-minute walk test results from previous visits
- Cardiopulmonary exercise test results
Video: Assessing Risk in Pulmonary Arterial Hypertension: Is Your Treatment Plan Working?
Functional classes
Doctors rate the severity of PH symptoms through four functional classes. A functional class refers to the ability of a person to perform certain activities with or without symptoms also thought of as someone’s exercise ability or tolerance. The classes can help doctors map out treatment plans.
Many patients at the time of diagnosis are significantly affected by symptoms during minimal exertion because they are diagnosed in the later stages of PH. One goal of treatment is to improve a patient’s exercise tolerance and decrease they symptoms they experience.
These functional classes descriptions are modified from World Health Organization functional assessments for pulmonary hypertension.
You have no symptoms during ordinary physical activity.
You are comfortable at rest, but your ordinary physical activity is somewhat limited because of breathlessness, chest pain, fatigue or dizziness.
You usually have no symptoms at rest, but breathlessness, chest pain, fatigue or dizziness greatly limits routine activity.
You are often breathless and tired even while resting. You can’t do any physical activity without symptoms. You show signs of right heart failure. Anyone prone to fainting would be in this class.
You have no symptoms during ordinary physical activity.
You are comfortable at rest, but your ordinary physical activity is somewhat limited because of breathlessness, chest pain, fatigue or dizziness.
You usually have no symptoms at rest, but breathlessness, chest pain, fatigue or dizziness greatly limits routine activity.
You are often breathless and tired even while resting. You can’t do any physical activity without symptoms. You show signs of right heart failure. Anyone prone to fainting would be in this class.
Risk score categories
Your doctor will determine your risk score based on clinical observations along with risk score assessment.
Low risk
Often indicates a favorable prognosis and may suggest a less aggressive treatment approach.
Intermediate risk
Requires ongoing monitoring and careful consideration of treatment options.
High risk
Suggests a more severe condition and may warrant more aggressive treatment, including potential for lung transplant.
Your risk score can improve
As your functional class or risk status changes, your doctor might change your medication type, amount and/or delivery method. Although PH is a progressive condition, appropriate treatment and therapy can improve your risk score.
