# A Real-World Study on Pulmonary Arterial Hypertension in Bulgaria: A Single-Center Retrospective Study From 2012 to 2022

## TL;DR

This study examines PAH patients in Bulgaria, finding that most are diagnosed late, use monotherapy, and have poor compliance, leading to worse survival.

## Contribution

The study provides real-world insights into PAH treatment patterns and outcomes in Bulgaria, emphasizing the need for early diagnosis and better treatment strategies.

## Key findings

- 69.5% of PAH patients were female with a mean age of 52 years.
- Monotherapy was used by 61.4% of patients despite advanced disease stages.
- Adherent patients had significantly longer survival (78.9 months) compared to non-adherent patients (50.8 months).

## Abstract

Purpose: This study aimed to analyze the epidemiological, clinical, and therapeutic characteristics of patients with pulmonary arterial hypertension (PAH) treated at a major reference center in Bulgaria and to assess treatment patterns, patient compliance, and overall survival.

Principal Results: The epidemiological data revealed that 69.5% of the patients were female, with a mean age of 52 years. The majority of patients were diagnosed at advanced stages of PAH, with 92.1% classified as World Health Organization Functional Class III. Monotherapy was the most common treatment regimen, used by 61.4% of patients, despite advanced disease. Patients who adhered to treatment demonstrated significantly longer overall survival (78.9 months) compared to those lost to follow-up (50.8 months). The study also identified a 31% rate of noncompliance, with patients missing follow-up visits and becoming ineligible for further therapy.

Major Conclusions: The findings highlight the need for earlier diagnosis and more aggressive treatment strategies, as monotherapy appears insufficient for optimal outcomes in advanced PAH. Establishing a national PAH registry and increasing disease awareness could facilitate earlier interventions and improve patient outcomes in Bulgaria.