Memos

Deborah Jo Levine, MD

Professor of Medicine, Pulmonary and Critical Care, Medical Director Lung Transplantation, Director of Pulmonary Hypertension, University of Texas Health Science Center San Antonio, San Antonio, TX

As we move into 2021, the editorial board, guest editors, and staff of the PHA Advances in Pulmonary Hypertension wish you a safe, happy and peaceful new year. The unpredictable challenges that shaped 2020 have transformed much of the way we all care for our patients, promote medical education, and continue important clinical research. We have learned new strategies that have enabled us to continue and even improve our practices in ways that will be important for years to come.

We dedicate this issue of Advances, the first of 2021, to all who have been affected in any way by the pandemic. Thank you to Dr. John Ryan, who has graciously created an issue with manuscripts devoted to what we have learned over the last year. Thank you to all who have contributed.

One of the most important issues that has troubled our patients is disparity in our health care systems. Although this topic has been stressed over the last few years, it has been even more apparent in 2020. Dr Jeanna Ryan and her co–authors describe the impact that these obstacles have had on our patients, of which, most important is the impediment to care. The group stresses the call for collaboration with all disciplines in health care to approach this barrier for PH and other patients.

Dr Roham Zamanian and Dr John Ryan discuss how COVID–19 has affected research in PH over the last year and how it will affect us moving forward. They discuss the challenges that have arisen in both clinical trials in basic research. Overcoming barriers with tools like ZOOM meetings, electronic consents, and site initiations helped move the field forward. We are still working on other barriers like onsite visits for patients and monitors.

Drs John Ryan, Mark Avdalovic and Jennalyn Mayeux, discussed the trials and tribulations of telehealth and how the creation of these programs began and flourished at their centers.

Elizabeth Colglazier and Anna Brown continued the work on telehealth by describing their experience with the pediatric PH population. Both of these manuscripts help build a road map for any center to start or continue with this process.

Thank you to all of the authors and contributors for this special edition of Advances.

I would also like to give a special thank you and farewell to our Managing Editor, Clarissa Nemeth, for all of her hard work and dedication to getting us through this year. We will miss you but wish you all of the very best in your new adventure. We would also like to welcome Kara Kopchinski, who is now transitioning into this position and we will look forward to working with you!

Building Bridges During a Time of Crisis

John J. Ryan, MD, MB, BCh, BAO

Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT

It has been a hard year. With the ongoing pandemic, a long overdue social justice movement, continuing political conflict, and economic instability, it has been challenging for health care providers to remain focused on providing the highest quality care possible. As societal norms evaporated, health care professionals innovated and adapted, creating new processes for delivering care, and taking on roles and responsibilities far removed from what they were hired or expected to do. In doing so, we had to build bridges, joining the world of technology and health care like never before, integrating assembly line concepts into care models, and involving community members more directly than ever into the practice of medicine. In this issue of Advances in Pulmonary Hypertension, we are fortunate to have publications which capture the challenges that were faced in health care during this past year and which demonstrate the agility of health care heroes in responding to crisis.

The article from Jeanna Ryan and colleagues highlights health disparities that play a significant role in quality and outcomes in pulmonary arterial hypertension (PAH). The authors describe social determinants of health and detail the historical and current impact that racism and discrimination have on patients with PAH, as well as the barriers to equitable care. The manner in which the COVID-19 pandemic has exacerbated health inequity is explored, as is the path forward, whereby we can all provide more equitable care by building bridges, creating transdisciplinary collaborations, and addressing the intersectionality of societal risk factors. The message is clear—we need to act and we cannot do this alone.

In the Pulmonary Hypertension (PH) Roundtable, Mark Avdalovic, at the University of California Davis, and Jennalyn Mayeux, of the University of Utah, discuss how their programs have evolved during 2020. Both centers faced challenges which will be familiar to many PH programs around the country, and they share how their approaches changed to evaluating patients, adapting diagnostic protocols, and reaching out to the most vulnerable patients in their respective communities. Dr Avdalovic shares best practices on how to identify patients who are most at risk during the pandemic, and Dr Mayeux shares her team’s efforts to partner with hospitals and providers in the patients’ home communities in order to optimize outcomes and keep patients safe. Again, the theme of building bridges during this time of crisis persists.

So much of the care delivered this year could not have been done without the rapid adoption of telehealth. In this issue of Advances, Elizabeth Colglazier and Anna Brown provide an in-depth discussion of the benefits and challenges in providing care to pediatric patients with PH. The paper offers an excellent template on how to structure and deliver telehealth. The authors emphasize the transformative power of technology, stating that “the barriers that might restrict support group attendance, such as time and distance, may be overcome when telehealth modalities are used.”

Research operations were also dramatically affected by the COVID-19 pandemic. Dr Roham Zamanian describes the broad impact the virus had on basic science and clinical research, as well as the potential long term consequences the pandemic will have on scientific discovery due to barriers to data collection. The need to overcome the challenges presented to us is clear as Dr Zamanian states, “I feel like since the pandemic…probably because of all the barriers identified, [I] haven’t had a chance to make unique conversations with colleagues that I would otherwise have met just out of the blue.”

As I reviewed the themes of the articles in this issue of Advances in Pulmonary Hypertension, it was clear that our writers, all clinicians, are imminently concerned about the impact of the COVID-19 pandemic on their patients and their programs. What was missing, however, was a roadmap for how we can take care of ourselves during the pandemic. We must lean on each other and find the best way to practice self-care. The Pulmonary Hypertension Association (PHA) is a unique organization, with the integral role played by patients and community caregivers. The multidisciplinary nature of the PHA can help build the bridges necessary to connect our PH providers with each other, as well as with the resources that they need, so that they too can find healing during this time of crisis.