Abstract
Limited guidance exists for the management of methamphetamine-associated PAH (Meth-APAH) and the experiences of physicians treating this population are not well documented. This study explored how physicians approach diagnosis and treatment and identified unmet needs in clinical care through structured interviews with 30 U.S. pulmonologists and cardiologists who manage patients with Meth-APAH. Physicians relied heavily on patient self-report to establish methamphetamine use; only 20% performed routine toxicology testing. Compared with patients with other forms of pulmonary arterial hypertension, those with methamphetamine-associated disease were younger, more likely to present in the emergency department, and more often diagnosed at advanced functional class based on physician perspectives. Physicians reported caution with initiating triple therapy and often preferred oral or subcutaneous prostacyclin agents due to concerns about adherence and risks of intravenous therapy. Socioeconomic instability and stigma were identified as major contributors to delayed diagnosis, nonadherence, and poor outcomes. Unmet needs included earlier recognition by frontline providers and greater access to addiction support resources. This study highlights critical challenges in diagnosing and managing Meth-APAH. Improving provider education, standardizing screening practices, and integrating addiction treatment into care pathways are essential to address unmet needs.