Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Current Heart Failure Reports
Published in: Current Heart Failure Reports 2/2016

01-04-2016 | Management of Heart Failure (T Meyer, Section Editor)

Evolving Concepts of Pulmonary Hypertension Secondary to Left Heart Disease

Authors: Bhavadharini Ramu, Thenappan Thenappan

Published in: Current Heart Failure Reports | Issue 2/2016

Login to get access

Abstract

Pulmonary hypertension associated with left heart disease is the most common form of pulmonary hypertension. Although its pathophysiology remains incompletely understood, it is now well recognized that the presence of pulmonary hypertension is associated with a worse prognosis. Right ventricular failure has independent and additive prognostic value over pulmonary hypertension for adverse outcomes in left heart disease. Recently, several new terminologies have been introduced to better define and characterize the nature and severity of pulmonary hypertension. Several new treatment options including the use of pulmonary arterial hypertension specific therapies are being considered, but there is lack of evidence. Here, we review the recent advances in this field and summarize the diagnostic and therapeutic modalities of use in the management of pulmonary hypertension associated with left heart disease.
Literature
1.••
Vachiéry JL. Pulmonary hypertension due to left heart diseases. J Am Coll Cardiol. 2013;62(25 Suppl):D100-8. This paper discusses hemodynamic definitions, terminology and treatment options of pulmonary hypertension in left heart disease.PubMed
2.
Lam CS et al. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol. 2009;53(13):1119–26.PubMedPubMedCentralCrossRef
3.
Fang JC, World Health Organization, et al. Pulmonary Hypertension group 2: pulmonary hypertension due to left heart disease in the adult—a summary statement from the Pulmonary Hypertension Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2012;31(9):913–33.PubMedCrossRef
4.
Guazzi M, Borlaug BA. Pulmonary hypertension due to left heart disease. Circulation. 2012;126(8):975–90.PubMedCrossRef
5.
Cappola TP et al. Pulmonary hypertension and risk of death in cardiomyopathy: patients with myocarditis are at higher risk. Circulation. 2002;105(14):1663–8.PubMedCrossRef
6.
Ghio S et al. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol. 2001;37(1):183–8.PubMedCrossRef
7.
Galiè N et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009;30(20):2493–537.PubMedCrossRef
8.
Simonneau G et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2013;62(25 Suppl):D34–41.PubMedCrossRef
9.
Moraes DL, Colucci WS, Givertz MM. Secondary pulmonary hypertension in chronic heart failure: the role of the endothelium in pathophysiology and management. Circulation. 2000;102(14):1718–23.PubMedCrossRef
10.
Givertz MM et al. Acute endothelin A receptor blockade causes selective pulmonary vasodilation in patients with chronic heart failure. Circulation. 2000;101(25):2922–7.PubMedCrossRef
11.
Mehra MR et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates—2006. J Heart Lung Transplant. 2006;25(9):1024–42.PubMedCrossRef
12.
Naeije R et al. The transpulmonary pressure gradient for the diagnosis of pulmonary vascular disease. Eur Respir J. 2013;41(1):217–23.PubMedCrossRef
13.••
Gerges C et al. Diastolic pulmonary vascular pressure gradient: a predictor of prognosis in “out-of-proportion” pulmonary hypertension. Chest. 2013;143(3):758–66. This paper proposes a diagnostic algorithm using diastolic pulmonary gradient to better define pulmonary vascular disease superimposed on elevated left-sided pressures.PubMedCrossRef
14.
Rapp AH et al. Relation of pulmonary arterial diastolic and mean pulmonary arterial wedge pressures in patients with and without pulmonary hypertension. Am J Cardiol. 2001;88(7):823–4.PubMedCrossRef
15.
Tedford RJ et al. Prognostic value of the pre-transplant diastolic pulmonary artery pressure-to-pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension. J Heart Lung Transplant. 2014;33(3):289–97.PubMedPubMedCentralCrossRef
16.
Tampakakis E et al. The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease. JACC Heart Fail. 2015;3(1):9–16.PubMedPubMedCentralCrossRef
17.
Champion HC, Michelakis ED, Hassoun PM. Comprehensive invasive and noninvasive approach to the right ventricle-pulmonary circulation unit: state of the art and clinical and research implications. Circulation. 2009;120(11):992–1007.PubMedCrossRef
18.
Enson Y et al. The influence of heart rate on pulmonary arterial-left ventricular pressure relationships at end-diastole. Circulation. 1977;56(4 Pt 1):533–9.PubMedCrossRef
19.
West JB, Mathieu-Costello O. Vulnerability of pulmonary capillaries in heart disease. Circulation. 1995;92(3):622–31.PubMedCrossRef
20.
Georgiopoulou VV et al. Left ventricular dysfunction with pulmonary hypertension: Part 1: epidemiology, pathophysiology, and definitions. Circ Heart Fail. 2013;6(2):344–54.PubMedCrossRef
21.
Azarbar S, Dupuis J. Lung capillary injury and repair in left heart disease: a new target for therapy? Clin Sci (Lond). 2014;127(2):65–76.CrossRef
22.
Dupuis J, Guazzi M. Pathophysiology and clinical relevance of pulmonary remodelling in pulmonary hypertension due to left heart diseases. Can J Cardiol. 2015;31(4):416–29.PubMedCrossRef
23.
Chen Y et al. Left ventricular failure produces profound lung remodeling and pulmonary hypertension in mice: heart failure causes severe lung disease. Hypertension. 2012;59(6):1170–8.PubMedPubMedCentralCrossRef
24.
Damy T et al. Determinants and prognostic value of pulmonary arterial pressure in patients with chronic heart failure. Eur Heart J. 2010;31(18):2280–90.PubMedCrossRef
25.
Capomolla S et al. Invasive and non-invasive determinants of pulmonary hypertension in patients with chronic heart failure. J Heart Lung Transplant. 2000;19(5):426–38.PubMedCrossRef
26.
Patel JB et al. Mitral regurgitation in patients with advanced systolic heart failure. J Card Fail. 2004;10(4):285–91.PubMedCrossRef
27.
Bouchard JL et al. Usefulness of the pulmonary arterial systolic pressure to predict pulmonary arterial wedge pressure in patients with normal left ventricular systolic function. Am J Cardiol. 2008;101(11):1673–6.PubMedCrossRef
28.
Maréchaux S et al. Functional mitral regurgitation: a link to pulmonary hypertension in heart failure with preserved ejection fraction. J Card Fail. 2011;17(10):806–12.PubMedCrossRef
29.
Miller WL, Grill DE, Borlaug BA. Clinical features, hemodynamics, and outcomes of pulmonary hypertension due to chronic heart failure with reduced ejection fraction: pulmonary hypertension and heart failure. JACC Heart Fail. 2013;1(4):290–9.PubMedCrossRef
30.
Redfield MM et al. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation. 2005;112(15):2254–62.PubMedCrossRef
31.
Leung CC et al. Prevalence and risk factors of pulmonary hypertension in patients with elevated pulmonary venous pressure and preserved ejection fraction. Am J Cardiol. 2010;106(2):284–6.PubMedCrossRef
32.
Saouti N et al. The arterial load in pulmonary hypertension. Eur Respir Rev. 2010;19(117):197–203.PubMedCrossRef
33.
34.
Pellegrini P et al. Prognostic relevance of pulmonary arterial compliance in patients with chronic heart failure. Chest. 2014;145(5):1064–70.PubMedCrossRef
35.
Al-Naamani N et al. Pulmonary arterial capacitance is an important predictor of mortality in heart failure with a preserved ejection fraction. JACC Heart Fail. 2015;3(6):467–74.PubMedPubMedCentralCrossRef
36.••
Dragu R et al. Pulmonary arterial capacitance in patients with heart failure and reactive pulmonary hypertension. Eur J Heart Fail. 2015;17(1):74–80. This paper demonstrates pulmonary arterial compliance as an independent marker of mortality in heart failure.PubMedCrossRef
37.
Lankhaar JW et al. Quantification of right ventricular afterload in patients with and without pulmonary hypertension. Am J Physiol Heart Circ Physiol. 2006;291(4):H1731–7.PubMedCrossRef
38.
Lankhaar JW et al. Pulmonary vascular resistance and compliance stay inversely related during treatment of pulmonary hypertension. Eur Heart J. 2008;29(13):1688–95.PubMedCrossRef
39.
40.
Vonk-Noordegraaf A et al. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. J Am Coll Cardiol. 2013;62(25 Suppl):D22–33.PubMedCrossRef
41.
Gulati A et al. The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy. Circulation. 2013;128(15):1623–33.PubMedCrossRef
42.
La Vecchia L et al. Reduced right ventricular ejection fraction as a marker for idiopathic dilated cardiomyopathy compared with ischemic left ventricular dysfunction. Am Heart J. 2001;142(1):181–9.PubMedCrossRef
43.
Puwanant S et al. Right ventricular function in patients with preserved and reduced ejection fraction heart failure. Eur J Echocardiogr. 2009;10(6):733–7.PubMedCrossRef
44.
Damy T et al. Prevalence of, associations with, and prognostic value of tricuspid annular plane systolic excursion (TAPSE) among out-patients referred for the evaluation of heart failure. J Card Fail. 2012;18(3):216–25.PubMedCrossRef
45.
Shah AM et al. Cardiac structure and function in heart failure with preserved ejection fraction: baseline findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial. Circ Heart Fail. 2014;7(1):104–15.PubMedPubMedCentralCrossRef
46.
Burke MA et al. Prognostic importance of pathophysiologic markers in patients with heart failure and preserved ejection fraction. Circ Heart Fail. 2014;7(2):288–99.PubMedCrossRef
47.•
Melenovsky V et al. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014;35(48):3452–62. This paper characterizes the prognostic value of right ventricular dysfunction in patients with heart failure with preserved ejection fraction.PubMedPubMedCentralCrossRef
48.
Gavazzi A et al. Value of right ventricular ejection fraction in predicting short-term prognosis of patients with severe chronic heart failure. J Heart Lung Transplant. 1997;16(7):774–85.PubMed
49.
Meluzin J et al. Prognostic importance of various echocardiographic right ventricular functional parameters in patients with symptomatic heart failure. J Am Soc Echocardiogr. 2005;18(5):435–44.PubMedCrossRef
50.
51.
Di Salvo TG et al. Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol. 1995;25(5):1143–53.PubMedCrossRef
52.
53.
Kalogeropoulos AP et al. Echocardiographic assessment of pulmonary artery systolic pressure and outcomes in ambulatory heart failure patients. J Am Heart Assoc. 2014;3(1):e000363.PubMedPubMedCentralCrossRef
54.
van de Veerdonk MC et al. Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol. 2011;58(24):2511–9.PubMedCrossRef
55.
Kusunose K et al. Prognostic significance of exercise-induced right ventricular dysfunction in asymptomatic degenerative mitral regurgitation. Circ Cardiovasc Imaging. 2013;6(2):167–76.PubMedCrossRef
56.
57.
Thenappan T et al. Clinical characteristics of pulmonary hypertension in patients with heart failure and preserved ejection fraction. Circ Heart Fail. 2011;4(3):257–65.PubMedCrossRef
58.
59.
Borlaug BA. Discerning pulmonary venous from pulmonary arterial hypertension without the help of a catheter. Circ Heart Fail. 2011;4(3):235–7.PubMedCrossRef
60.
61.
Hoeper MM et al. Diagnosis, assessment, and treatment of non-pulmonary arterial hypertension pulmonary hypertension. J Am Coll Cardiol. 2009;54(1 Suppl):S85–96.PubMedCrossRef
62.
Enriquez-Sarano M et al. Determinants of pulmonary hypertension in left ventricular dysfunction. J Am Coll Cardiol. 1997;29(1):153–9.PubMedCrossRef
63.
Tumminello G et al. Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure. Eur Heart J. 2007;28(5):569–74.PubMedCrossRef
64.
Arkles JS et al. Shape of the right ventricular Doppler envelope predicts hemodynamics and right heart function in pulmonary hypertension. Am J Respir Crit Care Med. 2011;183(2):268–76.PubMedCrossRef
65.
Ha JW et al. Determinants of exercise-induced pulmonary hypertension in patients with normal left ventricular ejection fraction. Heart. 2009;95(6):490–4.PubMedCrossRef
66.
Willens HJ et al. Noninvasive differentiation of pulmonary arterial and venous hypertension using conventional and Doppler tissue imaging echocardiography. J Am Soc Echocardiogr. 2008;21(6):715–9.PubMedCrossRef
67.
McLaughlin VV et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association. J Am Coll Cardiol. 2009;53(17):1573–619.PubMedCrossRef
68.
Jacobs W et al. Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension. Eur Respir J. 2015;46(2):422–30.PubMedCrossRef
69.
Crawley SF et al. LA volume by CMR distinguishes idiopathic from pulmonary hypertension due to HFpEF. JACC Cardiovasc Imaging. 2013;6(10):1120–1.PubMedCrossRef
70.
Ryan JJ et al. Current practice for determining pulmonary capillary wedge pressure predisposes to serious errors in the classification of patients with pulmonary hypertension. Am Heart J. 2012;163(4):589–94.PubMedCrossRef
71.
Hoeper MM et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013;62(25 Suppl):D42–50.PubMedCrossRef
72.
Robbins IM et al. High prevalence of occult pulmonary venous hypertension revealed by fluid challenge in pulmonary hypertension. Circ Heart Fail. 2014;7(1):116–22.PubMedPubMedCentralCrossRef
73.
Fox BD et al. High prevalence of occult left heart disease in scleroderma-pulmonary hypertension. Eur Respir J. 2013;42(4):1083–91.PubMedCrossRef
74.
75.
Borlaug BA et al. Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Heart Fail. 2010;3(5):588–95.PubMedPubMedCentralCrossRef
76.
Andersen MJ et al. Differential hemodynamic effects of exercise and volume expansion in people with and without heart failure. Circ Heart Fail. 2015;8(1):41–8.PubMedCrossRef
77.
Nishimura RA et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):e521–643.PubMedCrossRef
78.
Yancy CW et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240–327.PubMedCrossRef
79.
Spieker LE et al. Acute hemodynamic and neurohumoral effects of selective ET(A) receptor blockade in patients with congestive heart failure. ET 003 Investigators. J Am Coll Cardiol. 2000;35(7):1745–52.PubMedCrossRef
80.
Porter TR et al. Endothelium-dependent pulmonary artery responses in chronic heart failure: influence of pulmonary hypertension. J Am Coll Cardiol. 1993;22(5):1418–24.PubMedCrossRef
81.
Nagasaka T et al. Positive inotropic effect of endothelin-1 in the neonatal mouse right ventricle. Eur J Pharmacol. 2003;472(3):197–204.PubMedCrossRef
82.
Borlaug BA et al. Effects of sildenafil on ventricular and vascular function in heart failure with preserved ejection fraction. Circ Heart Fail. 2015;8(3):533–41.PubMedCrossRef
83.
Preston IR et al. Pulmonary edema caused by inhaled nitric oxide therapy in two patients with pulmonary hypertension associated with the CREST syndrome. Chest. 2002;121(2):656–9.PubMedCrossRef
84.
Humbert M et al. Pulmonary edema complicating continuous intravenous prostacyclin in pulmonary capillary hemangiomatosis. Am J Respir Crit Care Med. 1998;157(5 Pt 1):1681–5.PubMedCrossRef
85.
Califf RM et al. A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: The Flolan International Randomized Survival Trial (FIRST). Am Heart J. 1997;134(1):44–54.PubMedCrossRef
86.
Packer M et al. Clinical effects of endothelin receptor antagonism with bosentan in patients with severe chronic heart failure: results of a pilot study. J Card Fail. 2005;11(1):12–20.PubMedCrossRef
87.
Kalra PR, Moon JC, Coats AJ. Do results of the ENABLE (Endothelin Antagonist Bosentan for Lowering Cardiac Events in Heart Failure) study spell the end for non-selective endothelin antagonism in heart failure? Int J Cardiol. 2002;85(2-3):195–7.PubMedCrossRef
88.
Lüscher TF et al. Hemodynamic and neurohumoral effects of selective endothelin A (ET(A)) receptor blockade in chronic heart failure: the Heart Failure ET(A) Receptor Blockade Trial (HEAT). Circulation. 2002;106(21):2666–72.PubMedCrossRef
89.
Anand I et al. Long-term effects of darusentan on left-ventricular remodelling and clinical outcomes in the EndothelinA Receptor Antagonist Trial in Heart Failure (EARTH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364(9431):347–54.PubMedCrossRef
90.
Katz SD et al. Acute type 5 phosphodiesterase inhibition with sildenafil enhances flow-mediated vasodilation in patients with chronic heart failure. J Am Coll Cardiol. 2000;36(3):845–51.PubMedCrossRef
91.
Lepore JJ et al. Effect of sildenafil on the acute pulmonary vasodilator response to inhaled nitric oxide in adults with primary pulmonary hypertension. Am J Cardiol. 2002;90(6):677–80.PubMedCrossRef
92.
Forfia PR et al. Acute phosphodiesterase 5 inhibition mimics hemodynamic effects of B-type natriuretic peptide and potentiates B-type natriuretic peptide effects in failing but not normal canine heart. J Am Coll Cardiol. 2007;49(10):1079–88.PubMedCrossRef
93.
Angel Gómez-Sánchez M et al. Pilot assessment of the response of several pulmonary hemodynamic variables to sublingual sildenafil in candidates for heart transplantation. Eur J Heart Fail. 2004;6(5):615–7.PubMedCrossRef
94.
Jabbour A et al. Chronic sildenafil lowers transpulmonary gradient and improves cardiac output allowing successful heart transplantation. Eur J Heart Fail. 2007;9(6-7):674–7.PubMedCrossRef
95.
Lewis GD et al. Sildenafil improves exercise hemodynamics and oxygen uptake in patients with systolic heart failure. Circulation. 2007;115(1):59–66.PubMedCrossRef
96.
Lewis GD et al. Sildenafil improves exercise capacity and quality of life in patients with systolic heart failure and secondary pulmonary hypertension. Circulation. 2007;116(14):1555–62.PubMedCrossRef
97.
Guazzi M et al. The effects of phosphodiesterase-5 inhibition with sildenafil on pulmonary hemodynamics and diffusion capacity, exercise ventilatory efficiency, and oxygen uptake kinetics in chronic heart failure. J Am Coll Cardiol. 2004;44(12):2339–48.PubMedCrossRef
98.
Stasch JP, Pacher P, Evgenov OV. Soluble guanylate cyclase as an emerging therapeutic target in cardiopulmonary disease. Circulation. 2011;123(20):2263–73.PubMedPubMedCentralCrossRef
99.
Bonderman D et al. Riociguat for patients with pulmonary hypertension caused by systolic left ventricular dysfunction: a phase IIb double-blind, randomized, placebo-controlled, dose-ranging hemodynamic study. Circulation. 2013;128(5):502–11.PubMedCrossRef
100.
Guazzi M et al. Pulmonary hypertension in heart failure with preserved ejection fraction: a target of phosphodiesterase-5 inhibition in a 1-year study. Circulation. 2011;124(2):164–74.PubMedCrossRef
101.
Hoendermis ES et al. Effects of sildenafil on invasive haemodynamics and exercise capacity in heart failure patients with preserved ejection fraction and pulmonary hypertension: a randomized controlled trial. Eur Heart J. 2015;36(38):2565–73.
102.
Zile MR et al. Randomized, double-blind, placebo-controlled study of sitaxsentan to improve impaired exercise tolerance in patients with heart failure and a preserved ejection fraction. JACC Heart Fail. 2014;2(2):123–30.PubMedCrossRef
103.
Bonderman D et al. Acute hemodynamic effects of riociguat in patients with pulmonary hypertension associated with diastolic heart failure (DILATE-1): a randomized, double-blind, placebo-controlled, single-dose study. Chest. 2014;146(5):1274–85.PubMedPubMedCentralCrossRef
104.
Pieske B et al. Rationale and design of the SOluble guanylate Cyclase stimulatoR in heArT failurE Studies (SOCRATES). Eur J Heart Fail. 2014;16(9):1026–38.PubMedCrossRef
Metadata
Title
Evolving Concepts of Pulmonary Hypertension Secondary to Left Heart Disease
Authors
Bhavadharini Ramu
Thenappan Thenappan
Publication date
01-04-2016
Publisher
Springer US
Published in
Current Heart Failure Reports / Issue 2/2016
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI
https://doi.org/10.1007/s11897-016-0284-x

Other articles of this Issue 2/2016

Current Heart Failure Reports 2/2016 Go to the issue

Biomarkers of Heart Failure (W H W Tang, Section Editor)

Exploring the Microbiome in Heart Failure

Management of Heart Failure (T Meyer, Section Editor)

Baroreflex Activation Therapy in Heart Failure With Reduced Ejection Fraction: Available Data and Future Perspective

Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (A Hasan, Section Editor)

Nonadherence in the Advanced Heart Failure Population

Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (A Hasan, Section Editor)

How to Approach the Assessment of Cardiac Allograft Vasculopathy in the Modern Era: Review of Invasive Imaging Modalities
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits