Presenting symptom patterns of pulmonary arterial hypertension across adult age groups and etiologies: Implications for early recognition.

BACKGROUND

Diagnosis of pulmonary arterial hypertension (PAH) is often delayed 2-4 years after symptom onset. Early recognition is hindered by the nonspecific nature of presenting symptoms and by overlapping symptoms of comorbidities and underlying etiologies. Few studies have examined patterns of presenting symptoms in PAH.

OBJECTIVES

Characterize presenting symptoms of PAH by adult age group and etiology, and examine changes in symptom prevalence following diagnosis.

METHODS

We analyzed cross-sectional data from adults with self-reported World Health Organization Group I PAH. Descriptive statistics summarized presenting symptoms across younger (18-40 years), middle-aged (41-64 years), and older adults (≥ 65 years) and PAH etiology. Changes in symptom prevalence after diagnosis (1-3, 4-6, and ≥ 7 years) were assessed using a binomial sign test.

RESULTS

The sample included 151 participants (mean age at diagnosis 47 ± 14.6 years); mostly female (86.1%) and Caucasian (86.8%). Dyspnea was the most prevalent presenting symptom across all age groups and etiologies. Presyncope/syncope was more prevalent among younger adults (p < .001), whereas fatigue predominated among middle-aged and older adults. Adults with idiopathic PAH had the greatest symptom variability. Aside from dyspnea in the 4-6 years from diagnosis group, symptom prevalence increased significantly after diagnosis (p < .05).

CONCLUSIONS

Presenting symptom patterns of PAH vary by age group and etiology and persist after diagnosis. Increased awareness of these patterns may support earlier recognition, referral to specialists, and symptom management. Presyncope/syncopal symptoms may reflect disease severity, emphasizing the need for early diagnostic evaluation and specialist referral among younger adults.