Ali W, Ur Rab A, Shaikh A, Anil G, Surani S, Sharma M. Palliative care in pulmonary hypertension: A systematic review and meta-analysis. World J Crit Care Med 2025; 14(4): 110597 [DOI: 10.5492/wjccm.v14.i4.110597]
Corresponding Author of This Article
Salim Surani, FACP, FCCP, Professor, Department of Medicine and Pharmacology, Texas A&M University, 40 Bizzell Street, College Station, TX 77843, United States. srsurani@hotmail.com
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Meta-Analysis
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Dec 7, 2025
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Journal Information of This Article
Publication Name
World Journal of Critical Care Medicine
ISSN
2220-3141
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Ali W, Ur Rab A, Shaikh A, Anil G, Surani S, Sharma M. Palliative care in pulmonary hypertension: A systematic review and meta-analysis. World J Crit Care Med 2025; 14(4): 110597 [DOI: 10.5492/wjccm.v14.i4.110597]
Wajid Ali, Department of Medicine, Harlem Hospital Center, New York, NY 10037, United States
Asad Ur Rab, Department of Medicine, Foundation University Medical College, Islamabad 44000, Pakistan
Asim Shaikh, Department of Research, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, United States
Gokhan Anil, Department of Obstetrics and Gynecology, Mayo Clinic Health System, Mankato, MN 56001, United States
Salim Surani, Department of Medicine and Pharmacology, Texas A&M University, College Station, TX 77843, United States
Munish Sharma, Department of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White, Temple, TX 76508, United States
Author contributions: Ali W, Rab AU, Shaikh A, Surani S, and Shrama M contribute to manuscript writing and revision; Ali W, Rab AU, and Shaikh A contribute to data collection, analysis; Anil G, Surani S, and Shrama M contribute to editing and supervision; Surani S and Shrama M contribute to conceptualization.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FACP, FCCP, Professor, Department of Medicine and Pharmacology, Texas A&M University, 40 Bizzell Street, College Station, TX 77843, United States. srsurani@hotmail.com
Received: June 11, 2025 Revised: July 23, 2025 Accepted: October 21, 2025 Published online: December 9, 2025 Processing time: 172 Days and 0.9 Hours
Abstract
BACKGROUND
Pulmonary arterial hypertension (PAH) is a debilitating and progressive pulmonary pathology that often leads to death. Guidelines recommend the use of palliative care (PC) early in the treatment course to ease the burden of symptoms; however, uptake remains low.
AIM
To evaluate barriers to PC uptake and determine its association with mortality in patients with PAH.
METHODS
All studies discussing PC in PAH were selected in our review and analysis. Clinical and cross-sectional studies were included. Barriers were described in a qualitative fashion. A random-effects meta-analysis was also conducted, in which the odds ratio for mortality was pooled and reported, along with 95% confidence intervals.
RESULTS
A total of 19 studies were included in the review. The most common barriers identified included feeling like the patients were “not sick enough”, belief that PC is only appropriate for end-of-life care, belief that it would burden family members, and general feelings of hopelessness. Physicians identified structural causes, such as a lack of funding and low levels of PC-related knowledge, as barriers to recommending PC. The meta-analysis showed no statistically significant difference in mortality across four included studies (Log odds ratio = 0.89, 95% confidence intervals: -3.06-1.28). Heterogeneity was high (I2 = 80.32%).
CONCLUSION
Uptake of PC in PAH is low due to patient and physician-level barriers, which can be overcome with systematic PC integration. Long-term studies are also needed to investigate the impact of PC on outcomes in PAH, as the current limited data show no significant difference.
Core Tip: There are significant patient and physician-level barriers hindering the uptake of palliative care in pulmonary arterial hypertension, including feelings of hopelessness, depression, sadness, lack of funding, and lack of knowledge. These psychological and systemic challenges collectively limit timely referral and integration of palliative services within routine pulmonary arterial hypertension management. A meta-analysis of four studies reveals no statistically significant difference in mortality with palliative care (Log odds ratio = 0.89, 95% confidence intervals: -3.06-1.28).
