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The global impacts of pulmonary hypertension (PH) were formally recognised in 1973 at the 1st World Health Organization meeting dedicated to primary pulmonary hypertension, held in Geneva. Investigations into disease pathogenesis and classification led to the development of numerous therapies over the ensuing decades. While the impacts of the disease have been lessened due to treatments, the symptoms and adverse effects of PH and its therapies on patients' wellbeing and mental health remain significant. As such, there is a critical need to enhance understanding of the challenges patients face on a global scale with respect to care access, multidimensional patient support and advocacy. In addition, thoughtful analysis of the potential benefits and utilisation of mechanisms for the incorporation of patient-reported outcomes into diagnosis and treatment plans is needed. A summary of these areas is included here. We present a report of global surveys of patient and provider experiences and challenges regarding care access and discuss possible solutions. Also addressed is the current state of PH patient associations around the world. Potential ways to enhance patient associations and enable them to provide the utmost support are discussed. A summary of relevant patient-reported outcome measures to assess health-related quality of life in PH is presented, with suggestions regarding incorporation of these tools in patient care and research. Finally, information on how current global threats such as pandemics, climate change and armed conflict may impact PH patients is offered, along with insights as to how they may be mitigated with advanced contingency planning., Competing Interests: Conflict of interest: H.J. Ford reports grants from United Therapeutics, Merck, Gossamer Bio, Janssen, Cereno and Enzyvant, consultancy fees from United Therapeutics, Merck, Enzyvant, Liquidia, Janssen and Gossamer Bio, and a leadership role with the Pulmonary Hypertension Association. C. Brunetti reports support for the present work from Pulmonary Hypertension Association (USA), consultancy fees from Bayer and Aerovate, support for attending meetings from Pulmonary Hypertension Association, and a leadership role with Pulmonary Hypertension Association. P. Ferrari has no potential conflicts of interest to disclose. G. Meszaros reports consultancy fees from PHA Europe, EU-PFF and ERN-Lung, payment or honoraria for lectures, presentations, manuscript writing or educational events from Patient Expert Center vzw, and support for attending meetings from ERS. V.M. Moles reports grants from Janssen, Acceleron Pharma, Axon Therapies, Keros Therapeutics and Sumitomo Pharma America/Parexel International LLC, support for attending meetings from Foresee Pharmaceutical, participation on a data safety monitoring board or advisory board with United Therapeutics and Gossamer Bio, and is Assistant Editor at ACC.org Section of Pulmonary Hypertension and Venous Thromboembolism. H. Skara reports participation on a data safety monitoring board or advisory board with Aerovate. A. Torbicki reports consultancy fees from Bayer, Gossamer, Janssen and MSD, payment or honoraria for lectures, presentations, manuscript writing or educational events from AOP, Bayer, Janssen, Pfizer, MSD and Ferrer, support for attending meetings from Pfizer, AOP and Ferrer, and participation on a data safety monitoring board or advisory board with Boston and Janssen. J.S.R. Gibbs reports consultancy fees from Acceleron, Aerovate, Actelion/Janssen, Gossamer Bio, LG Chem, Keros, Merck, Bial Labcorp and United Therapeutics, and participation on a data safety monitoring board or advisory board with Merck, Gossamer Bio, Bial Labcorp, Keros and Actelion., (Copyright ©The authors 2024.)

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism, either symptomatic or not. The occlusion of proximal pulmonary arteries by fibrotic intravascular material, in combination with a secondary microvasculopathy of vessels <500 µm, leads to increased pulmonary vascular resistance and progressive right heart failure. The mechanism responsible for the transformation of red clots into fibrotic material remnants has not yet been elucidated. In patients with pulmonary hypertension, the diagnosis is suspected when a ventilation/perfusion lung scan shows mismatched perfusion defects, and confirmed by right heart catheterisation and vascular imaging. Today, in addition to lifelong anticoagulation, treatment modalities include surgery, angioplasty and medical treatment according to the localisation and characteristics of the lesions.This statement outlines a review of the literature and current practice concerning diagnosis and management of CTEPH. It covers the definitions, diagnosis, epidemiology, follow-up after acute pulmonary embolism, pathophysiology, treatment by pulmonary endarterectomy, balloon pulmonary angioplasty, drugs and their combination, rehabilitation and new lines of research in CTEPH.It represents the first collaboration of the European Respiratory Society, the International CTEPH Association and the European Reference Network-Lung in the pulmonary hypertension domain. The statement summarises current knowledge, but does not make formal recommendations for clinical practice., Competing Interests: Conflict of interest: M. Delcroix reports grants and other (investigator, speaker and consultant fees received by the institution) from Actelion/J&J, other (investigator, speaker and consultant fees received by the institution) from Bayer, other (speaker and consultant fees received by the institution) from MSD, other (investigator fees received by the institution) from Reata, other (investigator and consultant fees received by the institution) from Bellarophon, other (consultant fees received by the institution) from Acceleron, outside the submitted work. Conflict of interest: A. Torbicki reports grants and personal fees for lectures and consultancy from Actelion/Janssen, Bayer and MSD, personal fees for lectures from AOP, personal fees for lectures and consultancy from Pfizer, outside the submitted work. Conflict of interest: D. Gopalan reports other (speaker fees) from Actelion/J&J, other (consultancy work and speaker fees) from Bayer, outside the submitted work. Conflict of interest: O. Sitbon reports grants, personal fees and non-financial support from Actelion Pharmaceuticals and MSD, grants from GlaxoSmithKline, personal fees from Bayer, Acceleron Pharmaceuticals, Gossamer Bio and Ferrer, outside the submitted work. Conflict of interest: F.A. Klok reports research grants from Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi-Sankyo, MSD and Actelion, the Dutch Heart Foundation and the Dutch Thrombosis association, outside the submitted work. Conflict of interest: I. Lang reports grants and personal fees from Actelion-Janssen and AOP Orphan Pharma, personal fees from Medtronic, Ferrer and United Therapeutics, outside the submitted work. Conflict of interest: D. Jenkins reports grants from Bayer, personal fees for advisory board work from Actelion, outside the submitted work. Conflict of interest: N.H. Kim reports personal fees for consultancy from Actelion, Bayer and Merck, outside the submitted work. Conflict of interest: M. Humbert reports grants and personal fees from Actelion and Bayer, personal fees from Acceleron, GSK, Merck, Novartis, AstraZeneca and Sanofi, outside the submitted work. Conflict of interest: X. Jais reports personal fees and non-financial support from Actelion and MSD, grants from Bayer, outside the submitted work. Conflict of interest: A. Vonk Noordegraaf is supported by the Netherlands CardioVascular Research Initiative (CVON-2012-08 PHAEDRA, CVON-2017-10 DOLPHIN-GENESIS) and the Netherlands Organization for Scientific Research (NWO-VICI: 918.16.610), has received speakers’ money from Johnson & Johnson and Ferrer in the past 3 years, and served as a member of the scientific advisory board of Morphogen-XI. Conflict of interest: J. Pepke-Zaba has received speaker fees and honoraria for consultations from Actelion, Merck and Bayer, and her institution received research and educational grants from Actelion and Merck. Conflict of interest: P. Brénot has nothing to disclose. Conflict of interest: P. Dorfmuller has nothing to disclose. Conflict of interest: E. Fadel has nothing to disclose. Conflict of interest: H-A. Ghofrani reports personal fees and other (consultancy fees) from Actelion, Bayer AG, GlaxoSmithKline, Novartis and Pfizer, other (consultancy fees) from Bellerophon Pulse Technologies and MSD, grants from Deutsche Forschungsgemeinschaft (DFG), during the conduct of the study. Conflict of interest: M.M. Hoeper reports personal fees for consultancy and lectures from Bayer AG, MSD, Actelion, Jansen, Acceleron and Pfizer, during the conduct of the study. Conflict of interest: P. Jansa reports other (investigator) from Actelion, personal fees and other (investigator) from Bayer Pharma AG and Reata Pharmaceuticals, personal fees from AOP and MSD, outside the submitted work. Conflict of interest: M. Madani reports personal fees for consultancy from Actelion and Wexler Surgical, outside the submitted work. Conflict of interest: H. Matsubara reports personal fees from Actelion Pharmaceuticals Japan, Ltd, AOP Orphan Pharmaceuticals AG, Bayer Yakuhin, Ltd, Pfizer Japan, Inc., Nippon Shinyaku, Co., Ltd, Kaneka Medix Corporation, GlaxoSmithKline Pharmaceuticals, Ltd and United Therapeutics Corporation, outside the submitted work. Conflict of interest: T. Ogo has nothing to disclose. Conflict of interest: E. Grünig reports fees for lectures and/or consultations from Actelion, Bayer AG, GSK, MSD, United Therapeutics and Pfizer, outside the submitted work. Conflict of interest: A. D'Armini reports personal fees from Actelion Phamaceuticals, Bayer AG and Merck Sharp & Dohme, outside the submitted work. Conflict of interest: N. Galie reports grants and personal fees from Actelion and Janssen, personal fees from Pfizer and Ferrer, outside the submitted work. Conflict of interest: B. Meyer reports personal fees for lectures from Bayer AG, outside the submitted work. Conflict of interest: P. Corkery has nothing to disclose. Conflict of interest: G. Meszaros reports personal fees from Actelion Pharmaceuticals, outside the submitted work. Conflict of interest: E. Mayer reports personal fees for lectures and consultancy from Actelion, Bayer and MSD, during the conduct of the study. Conflict of interest: G. Simonneau reports personal fees and non-financial support from Actelion, Bayer and MSD, outside the submitted work., (Copyright ©ERS 2021. For reproduction rights and permissions contact permissions@ersnet.org.)