OBJECTIVES: In Brazil, despite the existence of policies to access free treatment for pulmonary arterial hypertension (PAH), few studies have analyzed the disease treatment patterns in the Brazilian public health system (SUS). This study aimed to evaluate treatment patterns and survival outcomes in patients with PAH monitored at a Public Reference Outpatient Clinic in Bahia, Brazil.

METHODS: Retrospective observational study involving patients with PAH group 1 (WHO classification) diagnosed between January 2010 and December 2019. Diagnosis was confirmed by right heart catheterisation. Sociodemographic and clinical data were collected from medical and pharmaceutical care charts. The treatment pattern was identified as monotherapy when using only one class of medication for PAH, or combination therapy when using two or more therapeutic classes simultaneously. Mortality was ascertained by active follow-up or through the Brazilian Ministry of Health’s Mortality Information System.

RESULTS: 373 patients were included (49.2 ± 17.8 years, 67.3% female), of whom 63.5% received monotherapy, with sildenafil (95.0%) being the most common. Only 36.5% patients received combination therapy, of which sildenafil-bosentan combination (92.7%) was the most frequently. The shortest distance covered in 6-minute walk test (p=0.02) and use of a greater number of medications for comorbidities treatment (p=0.01) were associated with the combination therapy use. Overall, the treatment discontinuation rate was 13.1% and was higher in monotherapy than combination therapy (16.9% vs. 6.6%). During the mean follow-up of 2.7 years, survival rates at 1-, 2-, 3- and 5-years were 89.5%, 82.3%, 79.1% and 76.3%, respectively.

CONCLUSION: Combination therapy is frequently underused for the treatment of PAH in the reference center in Bahia, Brazil. These findings suggest important gaps between the guideline recommendations and clinical practice, pointing to the need to review the current policies of treatment for this disease in the SUS.