Comparing Pulmonary Arterial Hypertension Care in Urban and Rural Settings: Treatment Patterns and Risk Trajectories

Pulmonary arterial hypertension (PAH) significantly impacts mortality and quality of life. Access to specialized care may differ between urban and rural patients, potentially influencing outcomes. This study compared the clinical course and treatment patterns of PAH patients from urban and rural settings treated at a single comprehensive care center. Adult patients with WHO Group I PAH evaluated between August 2020 and August 2024 at the University of Utah Pulmonary Hypertension Comprehensive Care Center were prospectively enrolled in a program-specific registry. A total of 263 patients were categorized as urban or rural based on residential address. Baseline characteristics, diagnostics, treatments, and outcomes were compared. No significant differences were observed in baseline characteristics, 6-min walk distance (6MWD), right ventricular function, hemodynamics, or NT-proBNP levels. In-person and virtual clinic utilization were also similar. However, among patients receiving triple therapy, rural patients were significantly more likely to receive inhaled treprostinil as the prostacyclin component (p = 0.03). In a subset of patients (n = 146), REVEAL Lite 2 scores were available at baseline and follow-up. Risk distributions and mean scores were similar at each time point. However, urban patients showed significant improvement in REVEAL risk category over time (p = 0.007), while no significant change occurred in rural patients. These findings suggest that although care delivery appeared comparable across settings, differences in treatment selection and risk trajectories emerged over time. Further investigation is needed to understand the drivers of these differences and their implications for disease management and progression.