· Executive Brief
Pulmonary Hypertension Awareness Month 2026
Use the observance to review how people find information, enter the right route, and remain connected through follow-through.
Leadership signal
Recognition becomes useful when leaders inspect the real route.
The strongest use of the observance is operational. Map where questions enter, how requests move, when ownership changes, and how unresolved work becomes visible. The goal is not to make a clinical claim. It is to make the organization’s response easier to understand and manage.
Start by distinguishing what is known from what the organization still needs to learn. A campaign plan, communication volume, or meeting count does not establish that a route is usable. Leaders need direct listening, clear ownership, locally defined measures, and a method for keeping exceptions visible.
Executive opening
Pulmonary hypertension is a routing problem before it is a diagnosis
Pulmonary hypertension rarely arrives at a health system with its name attached. It appears as breathlessness in primary care, an abnormal echocardiogram in cardiology, a complication in a rheumatology clinic, a problem in neonatal intensive care or an emergency department visit. That dispersion is the core operating risk for executives. No single service line naturally owns the route from first suspicion to an expert team. Each of those services can do its own work well and still leave a patient waiting between them.
The cost of an unowned route shows up in hospital use. Among 2,712 U.S. adults with treated pulmonary arterial hypertension, 44.9% had at least one disease-related hospitalization over a mean of 2.2 years of follow-up.[1] In the same claims analysis, 57.2% of those hospitalizations required an intensive care stay.[1] Among newly treated patients, 25.2% died within three years of starting treatment.[1]
Delay is a pathway signal that leaders can measure. In a prospective cohort of patients with Takayasu arteritis and pulmonary artery involvement, those with pulmonary hypertension had a median diagnostic delay of 20.5 months, compared with 6.0 months for those without it.[3] Patients with methamphetamine-associated disease described diagnoses that often began in emergency departments and treatment delays tied to lack of insurance or negative experiences with physicians.[2] Access to specialized care is also uneven: in a national claims study in Japan, 30.7% of 13,228 patients reached registry-affiliated specialized facilities.[8]
Pulmonary Hypertension Awareness Month is a useful moment to examine those routes. The sections below summarize peer-reviewed evidence on burden, screening, referral, hospitalization, equity, workforce design and communication. They sit beside the executive guidance already on this page and give leaders a shared factual base for choosing which handoff to strengthen first. The emphasis is on operations: where recognition happens, how referral moves, who owns each transition and how leaders know whether the route works.
Current evidence
What the research says about burden, cost and hospital use
Global estimates describe a condition whose death and disability rates are falling while its footprint grows. From 1990 to 2021, the global age-standardized prevalence rate of pulmonary arterial hypertension rose by 22.8% and the incidence rate by 4.0%.[14] Over the same period, the age-standardized mortality rate fell by 22.9% and the disability-adjusted life-year rate fell by 37.6%.[14] The authors also reported health improvements alongside widening disparities.[14] Falling death rates alongside rising prevalence suggest more people living longer with the condition and needing coordinated care over time.
The burden is not confined to older adults. Among people aged 15 to 49, global incidence reached 15,980 cases in 2021, and 53.40% of them were female.[15] Incidence in that age group increased by 63.64% from 1990 to 2021, and the study projected a 1.30-fold rise in total cases from 2022 to 2045.[15] For employers and health systems, this is a working-age condition as well as a condition of later life.
Financial exposure is concentrated in hospital care. In the U.S. claims analysis, mean per-patient-per-year all-cause costs were $302,014 for commercially insured patients and $200,581 for Medicare patients.[1] The mean cost per disease-related hospitalization was $89,799 for commercially insured patients and $37,288 for Medicare patients.[1] Over half of patients, 56.2%, had at least one all-cause hospitalization during follow-up.[1] Nearly a third, 31.0%, were hospitalized for at least one complication such as thrombosis, hemorrhage or sepsis.[1]
Much of the inpatient burden sits outside the specialty clinic. In a national sample of 2019 U.S. hospital admissions, 648,190 female admissions carried a coded diagnosis of secondary pulmonary hypertension, or 3.8% of all female admissions.[13] These patients had higher rates of COPD (43.4% versus 20.2%) and chronic kidney disease (43.3% versus 14.0%) than other female admissions.[13] Their all-cause mortality was also higher, at 4.5% versus 1.8%.[13]
Associated conditions widen the population that needs a reliable route. A systematic review of 47 studies in systemic sclerosis found pulmonary arterial hypertension in 6–12% of patients and called for early detection and standardized care in expert centers.[10] Taken together, the evidence places pulmonary hypertension risk across cardiology, pulmonology, rheumatology, neonatology and hospital medicine. Measurement has to follow patients across those services rather than stop at the specialty clinic door. For a board, a pulmonary hypertension dashboard drawn only from specialty clinic data will understate the problem.
Figure 1
Pulmonary hypertension pathways leak at recognition, access and the hospital bed
Percent of patients or hospitalizations, as reported in each study. Values are copied from the cited studies [1], [4], [5], [8]; none is estimated.
Data note. These values come from different studies, countries, populations and denominators, so this is an indirect comparison; the bars show where pathways leak, not how one step compares with another.
Limitation. Each value reflects its own setting; the infant and screening-threshold figures are single-setting studies, and the hospitalization figures apply only to treated patients in U.S. claims.
Figure data (5 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| Screening echocardiography detected pulmonary hypertension in premature infants | 15% | Single-center program for premature infants with at least moderate bronchopulmonary dysplasia, 2017 to 2022 | [5] |
| Patients who accessed registry-affiliated specialized facilities | 30.7% | 13,228 patients with pulmonary arterial hypertension in national claims data from Japan, 2012 to 2023 | [8] |
| Treated patients with at least one disease-related hospitalization | 44.9% | 2,712 U.S. adults with treated pulmonary arterial hypertension, mean follow-up 2.2 years | [1] |
| Disease-related hospitalizations requiring an intensive care stay | 57.2% | Same U.S. commercial and Medicare claims cohort | [1] |
| Sensitivity of echocardiographic screening at a 2.7 m/s cutoff | 72% | 755 patients at two general hospitals with both echocardiography and right heart catheterization | [4] |
Continuum of care
Where the route breaks between suspicion, referral and follow-up
The continuum begins with deciding who is screened and how a screening result is read. In 755 patients at two general hospitals who had both echocardiography and right heart catheterization, a peak tricuspid regurgitation velocity cutoff of 2.7 m/s gave 72% sensitivity.[4] The conventional 2.9 m/s threshold gave 60% sensitivity, while specificity at the lower cutoff stayed at 82%.[4] The authors noted that the conventional threshold was derived largely from referral centers under an older hemodynamic definition.[4]
For executives, the lesson is not which cutoff to choose, because that belongs to clinical governance. The lesson is that a screening rule built in referral centers may perform differently in a general hospital. That makes the echocardiography laboratory’s reporting standard a control point in the pathway, with a named clinical owner and periodic review.
Protocol-based screening can find disease before it becomes obvious. In one center’s program for premature infants with at least moderate bronchopulmonary dysplasia, screening echocardiography at 36 weeks postmenstrual age detected pulmonary hypertension in 15%.[5] The paired blood biomarker had a sensitivity of 57% and a specificity of 45%, and the authors judged it unreliable as a screening tool in that group.[5] In a predominantly Black and Hispanic lupus cohort of 140 adults in the Bronx, pulmonary hypertension independently predicted lupus flare-related hospitalization.[11]
Transitions after diagnosis carry their own risk. Among 1,079 patients hospitalized for the disease in the U.S. claims analysis, median time to rehospitalization was 1.2 years.[1] Discharge planning, therapy continuity and specialist follow-up therefore belong in the same pathway as the first referral, with one owner who can see all three. Among newly treated patients in the same analysis, 9.7% died within one year and 18.6% within two years of starting treatment.[1] Those figures make the first year after diagnosis a priority period for coordinated follow-up.
At the far end of the continuum, referral for transplantation tests coordination across organizations. In France, 241 patients with pulmonary arterial hypertension underwent lung or heart-lung transplantation from 2008 to 2023, and the share aged 50 or older rose from 30% to 44%.[7] Pre-operative extracorporeal membrane oxygenation as a bridge rose from 6% to 14%, while three-month survival was 85% and 91% in the two periods.[7] Among patients aged 65 or younger, deaths without transplantation outnumbered transplantations by more than five to one.[7] The authors concluded that advances in severe disease management enabled transplantation in older and more intensively treated patients without compromising short-term outcomes.[7]
Figure 3
Why the pathway breaks
People
- Referring clinicians unsure where to send an abnormal echocardiogram
- Limited collaboration with substance use specialists
- Critical care and specialist consultation stretched by complex admissions
Process
- No agreed screening route for high-risk groups such as lupus, systemic sclerosis or premature infants
- Emergency department diagnosis without a defined handoff to a specialty clinic
- Late referral for transplantation evaluation
Technology
- Echocardiography thresholds derived in referral centers applied in general hospitals
- Biomarkers with weak screening performance in some groups
- Coded diagnoses that miss or misclassify secondary disease
Environment
- Regional variation in access to specialized facilities
- Distance to tertiary referral centers
- Research sites concentrated in high-resource regions
Policy
- Lack of insurance delaying treatment
- High per-hospitalization costs that differ by payer
- Unequal access to transplantation across etiologies
Measurement
- Diagnostic delay not measured
- Outcomes not stratified by race, sex, payer or geography
- Rehospitalization and intensive care use not linked to referral status
Unranked qualitative cause-and-effect diagram for the outcome in the box: People with pulmonary hypertension are recognized late, reach expert teams unevenly and are hospitalized before the pathway is in place Causes are assembled from the cited literature [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [13]; categories are not weighted and their order carries no meaning.
Data note. Qualitative; no frequencies are implied.
Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.
Figure data (6 rows)
| Category | Causes drawn from the cited literature |
|---|---|
| People | Referring clinicians unsure where to send an abnormal echocardiogram; Limited collaboration with substance use specialists; Critical care and specialist consultation stretched by complex admissions |
| Process | No agreed screening route for high-risk groups such as lupus, systemic sclerosis or premature infants; Emergency department diagnosis without a defined handoff to a specialty clinic; Late referral for transplantation evaluation |
| Technology | Echocardiography thresholds derived in referral centers applied in general hospitals; Biomarkers with weak screening performance in some groups; Coded diagnoses that miss or misclassify secondary disease |
| Environment | Regional variation in access to specialized facilities; Distance to tertiary referral centers; Research sites concentrated in high-resource regions |
| Policy | Lack of insurance delaying treatment; High per-hospitalization costs that differ by payer; Unequal access to transplantation across etiologies |
| Measurement | Diagnostic delay not measured; Outcomes not stratified by race, sex, payer or geography; Rehospitalization and intensive care use not linked to referral status |
Access
Reaching expert teams, advanced therapy and the right front door
Expert centers are central to pulmonary hypertension care, which makes reaching them an executive question as well as a clinical one. In national claims data from Japan covering 2012 to 2023, 30.7% of 13,228 patients with pulmonary arterial hypertension accessed registry-affiliated specialized facilities.[8] In the same study, 23.7% began disease-specific combination therapy, and both figures varied across regions.[8] The authors concluded that regional disparities in access to specialized treatment need to be addressed.[8] For U.S. leaders, the comparable local measure is the share of diagnosed patients who are seen by an expert team at all.
Distance alone may not determine outcomes once patients are connected to a referral center. Across three tertiary referral centers, 504 patients were analyzed: 51 (10.1%) lived in rural areas and 324 (64.3%) in large urban centers.[9] Another 69 (13.7%) lived in small population centers and 60 (11.9%) in medium ones.[9] The study found no robust or consistent associations between community size or commute time and severity at diagnosis or follow-up.[9] A reasonable management reading is that the harder access problem may lie upstream, in getting suspected patients referred at all.
The front door shapes the route in. In interviews with 20 U.S. patients with methamphetamine-associated pulmonary arterial hypertension, initial diagnosis commonly occurred in emergency departments.[2] Treatment delays were frequent and were often related to lack of insurance or negative experiences with physicians.[2] When the emergency department is the first point of contact, the handoff from acute recognition to a specialty clinic becomes the access step that matters most.
Payer status also shapes what the route costs and who carries it. In the U.S. claims analysis, 57.9% of patients were commercially insured, and the mean cost of a disease-related hospitalization was more than twice as high for commercially insured patients as for Medicare patients.[1] Leaders reviewing access should look at payer mix alongside referral volume, because coverage gaps and authorization delays can slow the same patients the pathway is meant to reach.
Access to advanced therapy is uneven as well. The French transplant study reported that major disparities in access to transplantation persist across disease etiologies.[7] Time from diagnosis to transplantation tended to increase, from 39 to 46 months, although that change was not statistically significant.[7] Each of these findings points to referral timing and cross-organization coordination as levers within leadership reach. For a health system without its own expert program, the practical question is whether a written referral agreement exists with one, and whether its response times are tracked.
Executive guidance · System route
Map the path from first contact to verified follow-through.
Use this route as a discussion framework. Replace each stage with the organization’s approved process, qualified roles, current service capacity, and applicable requirements. Do not infer a clinical protocol from the observance title.
The route at a glance
- Listen
- Clarify entry
- Coordinate the partner route
- Protect transitions
- Verify and learn
Reliability rule: Every stage needs a named owner, an observable status, an approved escalation path, and a defined signal that shows whether responsibility moved or remained unresolved.
Listen
Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions.
Clarify entry
Publish a plain-language first step and identify who receives requests through each approved channel.
Coordinate the partner route
Align internal teams and external partners around one current message, real entry point, receiving owner, escalation path, and follow-through signal.
Protect transitions
Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations.
Verify and learn
Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals.
Figure 2
The system route as one flow
The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.
Data note. Shows sequence and handoffs only; it carries no counts or rates.
Limitation. Local processes may add, merge or reorder stages under organizational policy.
Figure data (5 rows)
| Stage | What the stage requires |
|---|---|
| Listen | Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions. |
| Clarify entry | Publish a plain-language first step and identify who receives requests through each approved channel. |
| Coordinate the partner route | Align internal teams and external partners around one current message, real entry point, receiving owner, escalation path, and follow-through signal. |
| Protect transitions | Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations. |
| Verify and learn | Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals. |
Equity and trust
Who reaches the route, and who reaches it last
Disparities in pulmonary hypertension appear in who is diagnosed, where and with which associated conditions. In the Bronx lupus cohort, drawn from an underserved urban setting, interstitial lung disease was more common in patients with pulmonary hypertension than in those without it (22.9% versus 8.7%).[11] Raynaud phenomenon was also more common (66.7% versus 39.1%).[11] The authors framed vigilant screening and timely intervention as ways to reduce morbidity in high-risk, underserved populations.[11] The cohort included 140 adults treated from 2017 to 2021 at a large academic center.[11]
Race and comorbidity patterns appear in national hospital data too. Females hospitalized with secondary pulmonary hypertension were more often identified as Black than other female admissions (20.5% versus 15.5%).[13] Their median age was 75 years, compared with 58 years.[13] The authors intended the model built on those admissions to support sex-specific risk stratification once it is externally validated.[13] In systemic sclerosis, African-descent, Indigenous American and some South Asian populations had more frequent diffuse disease, interstitial lung disease and reduced survival.[10]
Sex differences are consistent across global estimates. Among people aged 15 to 49, women had higher incidence, mortality and disability-adjusted life years across most regions, and low Socio-demographic Index regions showed higher rates and faster growth.[15] A separate global trend analysis also found notable gender and age disparities, especially among women and older adults.[14]
Access to new therapies through research is unequal. Of 97 randomized trials of pulmonary arterial hypertension drugs identified in a public trial registry, most trials and recruiting sites were in North America and Europe.[6] Many countries in Africa, Central Asia and parts of South America had little or no representation.[6] Each one-unit increase in a country’s Healthcare Access and Quality Index was associated with a 5.2% increase in the expected number of phase II trials.[6] Health systems that host trials can ask the same question locally about which communities and referral sources reach the research clinic.
Trust is part of equity. Patients with methamphetamine-associated disease described compassionate care as lacking, particularly when they were treated outside pulmonary hypertension specialty centers.[2] Stratified pathway data, reviewed alongside protected patient feedback, is how leaders can tell whether the route works for the people who reach it last. Leaders can begin with a small set of measures, such as referral completion and time to expert review, reported by race, sex, payer and geography.
Human infrastructure
The people and workflows that keep the pathway moving
Pulmonary hypertension pathways depend on a small number of specialized people. They include sonographers and echocardiographers, right heart catheterization teams, specialty nurses, pharmacists who manage complex therapies and referring clinicians in rheumatology, cardiology, pulmonology and neonatology. When those roles are not connected, the result is delay rather than a visible failure. Many of these roles are scarce, and in smaller hospitals a single reader or coordinator may carry the whole local pathway.
Structured workflows can change how a team practices. In a single-center retrospective study of 77 neonates with early acute pulmonary hypertension receiving inhaled nitric oxide, 36 (46.7%) received care guided by a neonatal intensive care ultrasound workflow.[12] That group had significantly shorter durations of inhaled nitric oxide and mechanical ventilation and lower hospitalization costs, with no observed differences in mortality.[12] The finding is observational, but it shows how a defined bedside imaging routine can become a shared operating standard.[12]
Expertise outside the pulmonary hypertension team also matters. Patients with methamphetamine-associated disease described inadequate education and limited collaboration with substance use specialists.[2] The authors called for integrating substance use support into pulmonary hypertension management.[2] At diagnosis, 60% of interviewed patients were still actively using methamphetamine, and half of them stopped within one year.[2] That pattern makes diagnosis a moment when coordinated substance use support can be offered. That is a staffing and referral design question as much as a clinical one, and it requires agreements between services that may sit in different departments or organizations.
General hospital teams carry much of the early recognition work. The echocardiography study was designed for general hospitals precisely because existing screening thresholds came largely from referral centers.[4] Executives can ask whether sonographers, readers and referring clinicians in community settings share one reporting language and one route to expert review, and whether anyone is accountable for that alignment.
Inpatient capacity is part of the workforce picture. With 57.2% of disease-related hospitalizations in the U.S. claims analysis requiring an intensive care stay, critical care staffing and specialist consultation are part of the pathway rather than an add-on.[1] Systemic sclerosis evidence points to expert centers as the place for standardized care, which raises a practical question for every community hospital.[10] If a patient is recognized at night or on a weekend, who makes the call to the expert team, and how is the response tracked?
Executive guidance · Operating dashboard
Measure whether the operating route works as intended.
Do not publish a number until the organization defines its numerator, denominator where relevant, owner, source system, exclusions, review cadence, and limits. The candidates below are management prompts, not benchmarks or reported results.
Four operating signals
Each signal pairs an executive question with one candidate local measure, set out below.
Executive guidance · Signal
Entry-point clarity
Can people and staff identify the approved first step without searching across conflicting instructions?
- Candidate local measure
- Locally defined contact, routing, and repeat-contact signals by channel and service.
Executive guidance · Signal
Ownership reliability
Does a specific team accept each request and make its status visible?
- Candidate local measure
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
Executive guidance · Signal
Partner-route reliability
Do participating teams share one current route and understand who owns each dependency?
- Candidate local measure
- Locally defined conflicting instructions, unaccepted handoffs, unresolved dependencies, repeat contacts, and partner feedback.
Executive guidance · Signal
Improvement closure
Does the organization correct recurring friction and report what changed?
- Candidate local measure
- Selected barriers, assigned actions, completion status, and post-change review.
Figure 4
The operating system behind the dashboard
The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.
Data note. Structural diagram; no measured values.
Limitation. Owners are candidates to be confirmed locally.
Figure data (4 rows)
| Operating signal | Candidate owner |
|---|---|
| Entry-point clarity | Executive sponsor and operational lead |
| Ownership reliability | Operational owner and participating teams |
| Partner-route reliability | Sending and receiving owners |
| Improvement closure | Improvement owner and executive sponsor |
Executive guidance · Handoff workflow
Keep work owned when it crosses a boundary.
A handoff is reliable only when the sending party knows who is expected to receive the work, the receiving party acknowledges responsibility, and any unresolved exception remains visible. Local policy and qualified judgment control the actual process.
How responsibility moves
Lane A
From message to accepted ownership
- Confirm the approved message and intended audience.
- Publish the actual entry point and receiving role.
- Acknowledge receipt using the locally approved method.
- Escalate when ownership or response remains unclear.
Lane B
From accepted ownership to verified follow-through
- Record the next accountable owner and visible status.
- Name the sending and receiving owners, shared information, current status, and unresolved dependency.
- Keep unresolved work visible across boundaries.
- Confirm closure or document the continuing exception.
Executive guidance · Executive scorecard
Ask questions that connect intent, ownership, and results.
The scorecard keeps review focused on decisions. Leaders should set definitions locally, examine variation without overclaiming cause, and pair quantitative signals with the experience of people who use and operate the route.
Who reviews what
- Executive sponsor and operational lead
- Operational owner and participating teams
- Sending and receiving owners
- Improvement owner and executive sponsor
Candidate owners named in the scorecard, confirmed locally.
| Operating signal | Executive question | Candidate owner | Suggested review point |
|---|---|---|---|
| Entry-point clarity | Can people and staff identify the approved first step without searching across conflicting instructions? | Executive sponsor and operational lead | At campaign launch and close |
| Ownership reliability | Does a specific team accept each request and make its status visible? | Operational owner and participating teams | At a locally defined cadence |
| Partner-route reliability | Do participating teams share one current route and understand who owns each dependency? | Sending and receiving owners | At a locally defined cadence |
| Improvement closure | Does the organization correct recurring friction and report what changed? | Improvement owner and executive sponsor | Until action is verified |
Figure 5
Control points for a reliable pulmonary hypertension pathway
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Echocardiography reporting standard for possible pulmonary hypertension | Thresholds and wording vary, and abnormal results are not acted on | Echocardiography laboratory medical director with cardiology quality lead | Periodic audit of reports that flag possible disease and the share with a documented referral |
| Defined screening route for high-risk groups | Patients with lupus, systemic sclerosis or bronchopulmonary dysplasia are recognized late | Rheumatology, neonatology and cardiology service chiefs | Agreed screening protocol with completion tracked by service |
| Handoff from emergency or inpatient recognition to an expert team | Diagnosis in the emergency department without specialty follow-up | Hospital medicine lead and pulmonary hypertension program director | Share of new diagnoses with an accepted specialty appointment before discharge |
| Diagnostic interval measurement | Delay remains invisible and cannot be improved | Chief quality officer | Median time from first suspicion to confirmed diagnosis, reviewed each quarter |
| Post-discharge follow-through | Rehospitalization and intensive care use without therapy continuity | Care transitions lead with specialty pharmacy | Follow-up visit and therapy continuity after each disease-related admission |
| Timely transplant referral pathway | Patients die before evaluation or reach transplantation on emergency support | Pulmonary hypertension program director with transplant center liaison | Referral timing and outcomes reviewed with the partner transplant center |
| Stratified access and outcome review | Disparities by race, sex, payer, geography or substance use history go unseen | Chief medical officer and board quality committee | Pathway measures reported by population group with protected patient feedback |
Control points derived from the cited evidence [1], [2], [3], [4], [5], [7], [8], [10], [11], [13] and this brief’s executive guidance.
Data note. Each row is a control to verify, not a measured result.
Limitation. Owners and evidence of control must follow local policy and applicable requirements.
Public communication
Communicating so that awareness leads to a real next step
Awareness messages for this observance should lead to a clear route, because the evidence describes delay more often than absence of care. Patients in the methamphetamine-associated cohort described inadequate education, and the authors called for strengthening education for both patients and providers.[2] In the Takayasu arteritis cohort, delayed diagnosis was an independent risk factor for pulmonary hypertension.[3] The authors concluded that early recognition and timely intervention may improve outcomes.[3]
Communication between clinicians matters as much as public messaging. An echocardiogram report that raises the possibility of pulmonary hypertension helps only if the ordering clinician understands it and knows where to send the patient. In the general hospital study, adding estimated right atrial pressure to tricuspid regurgitation velocity improved discrimination among 681 patients, with a c-statistic of 0.83 versus 0.80.[4] Leaders can ask clinical governance groups how findings like this become consistent reporting language for referring teams.
Families need clear explanations when screening is protocol-driven. In the infant screening program, echocardiography detected unrecognized pulmonary hypertension before significant decline in right ventricular performance.[5] The same program found no difference in right ventricular systolic function metrics between infants with and without pulmonary hypertension.[5] Parents told that their child will receive a screening test deserve to know why it is done, what a result means and who will follow up with them.
Public data should be described with care. The inpatient model for secondary pulmonary hypertension showed good discrimination, with an area under the curve of 0.823, but it classified an existing coded diagnosis and was validated only internally.[13] Global projections, such as an expected reduction of about 31.8% in the disability-adjusted life-year rate by 2035, are model estimates and should be presented that way.[14] Describing each figure with its setting and year helps audiences avoid treating a global estimate as a local benchmark.
Trust grows when awareness campaigns are honest about access. The Japanese claims study showed that reaching specialized facilities varied by region, which is a reminder that a message is only as good as the route behind it.[8] Public materials that name a real first step, a reachable expert team and a follow-up owner give people more to act on than a general call to seek care. During the observance, a short internal message to referring clinicians about where to send a suspected case may be as valuable as any public campaign.
Executive guidance · 90-day plan
Move from listening to a verified improvement in 90 days.
The time boxes below are a management framework, not a clinical timeline. Adjust them to risk, scope, governance, resources, stakeholder participation, and applicable review requirements.
Ninety days, three moves
- Days 1–30See the current route
- Days 31–60Build the reliable path
- Days 61–90Make the change visible
Days 1–30 · Listen and map
See the current route
- Name an executive sponsor and an operational owner.
- Listen to people using the route and representative frontline teams.
- Map how Pulmonary Hypertension Awareness Month communications connect to real entry points, owners, transitions, and escalation.
- Select one recurring barrier that the organization can responsibly address.
Days 31–60 · Design and test
Build the reliable path
- Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal.
- Validate the design with every sending and receiving team involved.
- Test one internal or partner handoff and correct a verified communication, dependency, or ownership gap.
- Test the route in more than one representative setting or operating period where practical.
Days 61–90 · Implement and verify
Make the change visible
- Launch the redesigned route with a small set of locally defined measures.
- Review unresolved work and recurring friction using a learning approach.
- Correct implementation barriers and record who owns each remaining dependency.
- Report what changed, what evidence was reviewed, and what still requires live oversight.
Figure 6
The 90-day plan on one timeline
The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.
Data note. Time boxes are a management framework, not a clinical timeline.
Limitation. Durations are uniform 30-day windows; real tasks may span windows.
Figure data (12 rows)
| Window | Action |
|---|---|
| Days 1–30 · Listen and map | Name an executive sponsor and an operational owner. |
| Days 1–30 · Listen and map | Listen to people using the route and representative frontline teams. |
| Days 1–30 · Listen and map | Map how Pulmonary Hypertension Awareness Month communications connect to real entry points, owners, transitions, and escalation. |
| Days 1–30 · Listen and map | Select one recurring barrier that the organization can responsibly address. |
| Days 31–60 · Design and test | Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal. |
| Days 31–60 · Design and test | Validate the design with every sending and receiving team involved. |
| Days 31–60 · Design and test | Test one internal or partner handoff and correct a verified communication, dependency, or ownership gap. |
| Days 31–60 · Design and test | Test the route in more than one representative setting or operating period where practical. |
| Days 61–90 · Implement and verify | Launch the redesigned route with a small set of locally defined measures. |
| Days 61–90 · Implement and verify | Review unresolved work and recurring friction using a learning approach. |
| Days 61–90 · Implement and verify | Correct implementation barriers and record who owns each remaining dependency. |
| Days 61–90 · Implement and verify | Report what changed, what evidence was reviewed, and what still requires live oversight. |
Executive guidance · Leadership close
Carry one accountable improvement beyond the campaign window.
Recognition matters. It becomes durable when leaders also listen, clarify the route, support the people operating it, close an identified gap, and report the result without claiming more than the evidence supports.
Leadership commitment
Listen to the people closest to the route, assign one barrier, and verify the change.
Executive action kit · Month observance
Turn Pulmonary Hypertension Awareness Month into accountable action.
Use the observance to review how people find information, enter the right route, and remain connected through follow-through.
Leadership focus
Use this observance to examine trustworthy information, prevention access, and community connection. Select one verified barrier, assign an accountable owner, and carry the improvement beyond the campaign window.
Workforce lens
Ask whether staffing, role clarity, training, tools, workload, and escalation support the people operating the information, access, coordination, and follow-through pathway.
Patient and community lens
Make the approved first step clear. Test whether a person can move from information to an acknowledged next action without navigating conflicting instructions.
Equity and access lens
Review language, disability, transportation, digital access, geography, trust, and other barriers using protected feedback and locally appropriate data.
Five-minute briefing
Inspect the operating sequence
Listen with people using the pathway, frontline teams, operational leaders, and community partners. Find one a message, request, referral, or handoff that does not reach an accountable owner, then test the locally approved route from entry through acknowledged follow-through.
- Listen
- Clarify entry
- Coordinate the partner route
- Protect transitions
- Verify and learn
Leadership actions for this week
- Name an executive sponsor and frontline operating owner.
- Ask people using and operating the pathway where ownership becomes unclear.
- Test one representative route from first question to acknowledged next step.
- Select one barrier that can be corrected without overstating the evidence.
- Set a review date and define how completion will be verified.
Candidate measures
Define every numerator, denominator where relevant, owner, data source, exclusions, cadence, and limitation locally. These are management prompts, not external benchmarks.
- Locally defined contact, routing, and repeat-contact signals by channel and service.
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
- Locally defined conflicting instructions, unaccepted handoffs, unresolved dependencies, repeat contacts, and partner feedback.
Department readiness checklist
- The public and staff entry points match the actual approved process.
- A specific role accepts each request, referral, or escalation.
- Handoffs include acknowledgment and a visible unresolved state.
- Language, disability, digital, transportation, and trust barriers receive explicit review.
- Communications do not introduce unsupported themes, statistics, or clinical advice.
- A named leader will review what changed after the observance.
Intended audiences
- Executive and Operational Leaders
- Public Health and Community Partners
Staff communication template
During Pulmonary Hypertension Awareness Month, our organization will connect awareness with a practical review of the information, access, coordination, and follow-through pathway. Use approved information, identify the correct entry point, confirm ownership when work moves, protect privacy, and escalate unresolved barriers through local channels.
Community communication template
Pulmonary Hypertension Awareness Month is an opportunity to share trustworthy information and make the next step easier to find. Use our approved channels for information and support. If a request changes hands, our goal is to keep ownership and follow-through visible.
Measurement worksheet
- Signal
- What observable condition will show whether the route works?
- Definition
- What is included, excluded, and counted?
- Owner
- Who reviews the signal and acts on exceptions?
- Cadence
- When will leaders review it?
- Equity check
- Which differences require protected, locally appropriate review?
- Closure
- What evidence will confirm the improvement was completed?
- Editorial review
- Completed
- Source records
- 2 listed under Authoritative resources
- Review standard
- Sourced facts remain separated from original executive guidance
- Clinical boundary
- No new statistical or clinical claim was added by this action kit
Sources and content boundary
Authoritative resources
Use note: All operating models, measures, scorecard questions, and action steps are original executive guidance. This article supports leadership planning and education. It does not replace clinical judgment, emergency procedures, legal advice, professional standards, organizational policy, or applicable federal, state, and local requirements.
Peer-reviewed references
References
Fifteen peer-reviewed sources, newest first. Each was individually verified through authenticated academic research databases. Bracketed numbers in the text link here; the original executive guidance on this page carries no citations because it is guidance, not a sourced claim. Sources last checked in those databases on .
- 1.Ravichandran A, Beaudet A, Lopez D, Lew CR, Varker H, Jerry M, et al. Contemporary Economic, Hospitalization, and Mortality Burden Among Pulmonary Arterial Hypertension Patients: A Real‐World US Claims Data Analysis. Pulmonary Circulation. 2026;16(4):e70414. https://doi.org/10.1002/pul2.70414
- 2.Melendres-Groves L, Perez VDJ, Vaidya A, Lee HG, Sandros M, Lopez D, et al. Qualitative interviews of patients with methamphetamine-associated pulmonary hypertension: Understanding the unmet medical need from the patient lens. JHLT Open. 2026;13:100549. https://doi.org/10.1016/j.jhlto.2026.100549
- 3.Zheng S, Li Y, Liu Z, Chen Y, Song Y, Zhang S, et al. Pulmonary hypertension in Takayasu arteritis with pulmonary artery involvement: risk factors and impact on mortality. BMJ Open Respiratory Research. 2026;13(1):e003854. https://doi.org/10.1136/bmjresp-2025-003854
- 4.Fukuda Y, Akagi S, Taya S, Ejiri K, Takaya Y, Dohi Y, et al. Predictive value of simple echocardiographic parameters for screening pulmonary hypertension under the revised definition: a study for general hospitals. Open Heart. 2026;13(1):e004185. https://doi.org/10.1136/openhrt-2026-004185
- 5.Ramachandra R, Arunamata A, Moy A, Tracy MC, Ji Y, Boothroyd D, et al. Results of a pulmonary hypertension screening program for premature infants with bronchopulmonary dysplasia. Journal of Perinatology. 2026. https://doi.org/10.1038/s41372-026-02580-6
- 6.Khan D, Matusov Y. Global disparities in access to randomized controlled trials for pulmonary arterial hypertension. Respiratory Medicine. 2026;263:109165. https://doi.org/10.1016/j.rmed.2026.109165
- 7.Pradère P, Luong MC, Le Pavec J, Issard J, Coiffard B, Renard S, et al. Evolving profile and outcomes of patients with pulmonary arterial hypertension undergoing lung transplantation. JHLT Open. 2026;14:100675. https://doi.org/10.1016/j.jhlto.2026.100675
- 8.Iwahori T, Hayashi Y, Tsuchiya H, Hirata T. Regional Disparities in Access to Specialized Facilities and Prescription Preference for Initial Pulmonary Arterial Hypertension Treatment ― A Nationwide Study Using the National Database of Health Insurance Claims ―. Circulation Journal. 2026;90(6):736-738. https://doi.org/10.1253/circj.cj-25-0873
- 9.Reimer R, Swiston JR, McInnis C, Tom F, Thakrar MV, Hirani N, et al. Effect of Community Size and Commute Time on Severity of Pulmonary Arterial Hypertension at Diagnosis and Follow-up in Patients Across 3 Sites. CJC Open. 2026;8(8):1052-1059. https://doi.org/10.1016/j.cjco.2026.04.014
- 10.Toro-Gutierrez CE, Quintana-Lopez G, Pope J. Systemic sclerosis: A comprehensive systematic review of global epidemiology, sex and ethnic disparities, disease burden, and organ-specific involvement. Best Practice & Research Clinical Rheumatology. 2026;40(2):102156. https://doi.org/10.1016/j.berh.2026.102156
- 11.King M, Martinez A, Abbruzzese S, Fazzari M, Ameer A, Cheema MA, et al. Pulmonary Hypertension in Systemic Lupus Erythematosus Among Black and Hispanic Patients: An Observational Cohort Study. JCR: Journal of Clinical Rheumatology. 2026. https://doi.org/10.1097/rhu.0000000000002381
- 12.Zheng M, Ling W, Zhang J, Ju R, Xiao T, Fu Y, et al. Impact of the neonatal intensive critical ultrasound workflow for managing neonatal acute pulmonary hypertension. Frontiers in Pediatrics. 2026;14:1896889. https://doi.org/10.3389/fped.2026.1896889
- 13.Mohammed AS, Mellacheruvu SP, Gandhi Z, Lekkala SP, Manne S, Yasmeen U, et al. Factors Associated with Secondary Pulmonary Hypertension Among Hospitalized Females: An Artificial Neural Network Analysis of a National US Cohort. Journal of Personalized Medicine. 2026;16(8):421. https://doi.org/10.3390/jpm16080421
- 14.Guan A, Dai Z, Lin J, Chen Q, Jiang C. Global disease burden of pulmonary arterial hypertension: patterns and inequality in 1990–2021, with projections to 2035. BMC Public Health. 2026;26(1):4. https://doi.org/10.1186/s12889-025-24972-7
- 15.Wang L, Zhang K, Kan C, Ma Y, Tian Z, Zhang Y, et al. Global, Regional and National Burden of Pulmonary Arterial Hypertension in Young and Middle-Aged Adults, 1990–2021, with Projections to 2045. Heart, Lung and Circulation. 2026. https://doi.org/10.1016/j.hlc.2026.03.058
Claim-to-source matrix
What each source supports
Every sourced claim in the new sections maps to the references that support it, the section where it is used, and the limitation a reader should keep in mind. Original executive guidance carries no sources because it is guidance, not a finding.
| Claim group | Sources | Years | Used in | Limitation |
|---|---|---|---|---|
| Hospitalization, intensive care, cost and mortality burden of treated pulmonary arterial hypertension | [1] | 2026 | Current evidence | U.S. commercial and Medicare claims, 2017 to 2024; claims-based case definition; treated patients only. |
| Global prevalence, incidence, mortality and disability trends and inequality | [14] [15] | 2026 | Current evidence | Modeled global burden estimates; projections are model outputs and not local forecasts. |
| Secondary pulmonary hypertension among hospitalized females | [13] | 2026 | Current evidence | Coded diagnoses in 2019 U.S. admissions; model classifies an existing diagnosis and was validated only internally. |
| Pulmonary arterial hypertension in systemic sclerosis and the role of expert centers | [10] | 2026 | Current evidence | Qualitative systematic review of 47 heterogeneous studies; no pooled estimates. |
| Echocardiographic screening thresholds in general hospitals | [4] | 2026 | Continuum of care | Retrospective analysis at two general hospitals of patients who underwent both tests, which may introduce selection effects. |
| Protocol-based screening in premature infants with bronchopulmonary dysplasia | [5] | 2026 | Continuum of care | Single-center retrospective cohort; findings specific to infants with at least moderate disease. |
| Pulmonary hypertension and hospitalization in a Black and Hispanic lupus cohort | [11] | 2026 | Equity and trust | Single academic center in the Bronx; 140 adults; echocardiographic definition of pulmonary hypertension. |
| Transplantation referral, timing and access across etiologies | [7] | 2026 | Continuum of care | French national experience; retrospective period comparison; some changes not statistically significant. |
| Regional access to specialized facilities and initial combination therapy | [8] | 2026 | Access | Japanese claims data; access defined by registry-affiliated facilities; short report. |
| Community size, commute time and disease severity | [9] | 2026 | Access | Three tertiary referral centers; patients already referred; commute data in the abstract were not reported consistently and were not used. |
| Diagnostic delay as a risk factor | [3] | 2026 | Public communication | Takayasu arteritis cohort with pulmonary artery involvement; may not generalize to other forms of pulmonary hypertension. |
| Patient experience, insurance barriers and substance use collaboration | [2] | 2026 | Access | Qualitative interviews with 20 patients; mostly female and White participants. |
| Geographic disparities in access to clinical trials | [6] | 2026 | Equity and trust | Cross-sectional analysis of registered trials; recruiting locations as reported; country-level associations. |
| Structured bedside ultrasound workflow in neonatal acute pulmonary hypertension | [12] | 2026 | Human infrastructure | Single-center retrospective study of 77 neonates; observational association only. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
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