Challenges and Strategies in Managing Pulmonary Arterial Hypertension Within the Indian Healthcare System: A...

Pulmonary arterial hypertension (PAH) in India is a substantial yet under-recognized contributor to cardiovascular morbidity and mortality. Its progressive course, nonspecific early manifestations, and heterogeneous aetiologies often lead to delayed diagnosis and fragmented care. The unique epidemiological profile of India, characterized by a higher prevalence of PAH due to factors such as uncorrected congenital heart disease, environmental exposure, and chronic infections, underscores the need for a management approach tailored to Indian settings. These realities intersect with systemic challenges, including late presentation, resource constraints, a lack of local guidelines, and the costs of diagnostic workups and therapies, which hinder the delivery of standardized care. Variabilty in clinical practice in PAH management underscores the need for guidelines that account for local context and resources. Despite robust international recommendations, including those from the European Society of Cardiology and the European Respiratory Society, implementation of standardized risk stratification and treatment algorithms remains inconsistent across Indian centers. This variability reflects disparities in infrastructure, expertise, and affordability rather than differences in disease biology. This consensus document reviews current guidelines and advances in the management of PAH, consolidating evidence with potential for adoption in India and other low- and middle-income countries (LMICs). This document also highlights the need to establish centers of excellence, develop specialized care protocols, and increase awareness to improve patient outcomes.