John Giacona, PhD, PA-C

ILD as a Cardiopulmonary Disease: Cardiology's Role in Management

 is frequently framed as a pulmonary problem, but the cardiovascular complications it generates — particularly pulmonary hypertension (PH)— can be as clinically consequential as the lung disease itself. At the 

Association of Pulmonary Advanced Practice Providers (APAPP) National Conference, held June 28-20 in Colorado Springs

, John Giacona, PhD, PA-C, CHC, Assistant Professor in the Department of Applied Clinical Research and the Division of Cardiology at UT Southwestern Medical Center, Dallas, and President-Elect of the Academy of Physician Associates in Cardiology, made the case that cardiology APPs have a defined and underutilized role in ILD care — and that systematic gaps in collaboration between specialties are costing patients.

"ILD — we view it as just a lung disease, but it really is a cardiopulmonary disease," Giacona said.

He identified 3 core contributions a cardiology APP brings to the ILD multidisciplinary team: screening for pulmonary hypertension, distinguishing cardiac from pulmonary causes of dyspnea, and longitudinal right ventricular surveillance via echocardiography. In his experience, ILD patients frequently present first to cardiology with symptoms initially attributed to heart failure or other cardiac causes — meaning the cardiology encounter may represent an unrecognized opportunity for earlier diagnosis and routing. He noted that collaboration quality varies substantially by institution and geography, with audience members at APAP highlighting significant deficiencies at their own institutions, and APPs in rural settings or without access to a pulmonary hypertension center facing the steepest barriers.

Once PH is suspected, distinguishing WHO group 2 (left heart disease) from group 3 (lung disease–related) pulmonary hypertension is clinically essential, since standard PAH therapies have demonstrated harm in the ILD setting, and management diverges meaningfully by type.

 Inhaled treprostinil, the only therapy currently approved for pulmonary hypertension associated with ILD (PH-ILD), has robust evidence from the INCREASE trial — a phase 3, randomized, placebo-controlled, 16-week study in 326 patients that demonstrated a 31-meter improvement in 6-minute walk distance, a 15% reduction in NT-proBNP levels with treprostinil versus a 46% increase with placebo, and a reduction in clinical worsening events.

 Giacona also flagged that amiodarone use in patients with atrial fibrillation confers elevated ILD risk — 1 of several medication-related ILD triggers that make cross-specialty vigilance important.

The persistent challenge is identifying which patients have PH-ILD in the first place. Standardized screening algorithms have historically been lacking, with clinical suspicion relying on signals such as symptoms disproportionate to the degree of fibrosis or desaturation on exertion. The recently completed PHINDER study (NCT05776225), a prospective multicenter observational study, published preliminary results in early 2026 suggesting that a combination of pulmonary function testing, lung imaging, and echocardiography may support earlier and more accurate PH detection in ILD — a potential step toward the systematic screening protocol the field has needed.

 Giacona expressed hope that the final PHINDER data will prompt development of an expert consensus document to guide institutional screening pathways.

His vision for a minimum viable MDT in ILD: pulmonology, cardiology, and radiology as the core, with rheumatology added when underlying autoimmune disease is driving the ILD — he cited scleroderma as a prime example — or when patients are on antifibrotics or immunosuppressive biologics. "The onus is on any one provider who gets a patient with ILD or pulmonary hypertension to ensure that patient is plugged in with all the appropriate specialists," he said.

Giacona has no relevant disclosures to report.

Giacona J, Glennie J, Mixon A, Smith D. Bridging Specialties in ILD: A Multidisciplinary Bootcamp Series for Early Recognition and Targeted Treatment. Presented at APAPP 2026 National Conference, June 18-20; Las Vegas, Nevada.

Cottin V, Martinez FJ, Smith V, Walsh SLF. Multidisciplinary teams in the clinical care of fibrotic interstitial lung disease: current perspectives. 

 2022;31(166):220003. doi:10.1183/16000617.0003-2022

Waxman A, Restrepo-Jaramillo R, Thenappan T, et al. Inhaled treprostinil in pulmonary hypertension due to interstitial lung disease. 

 2021;384(4):325–334. doi:10.1056/NEJMoa2008470

Zisman D, Sahay S, Bandyopadhyay D, et al. Screening for pulmonary hypertension in interstitial lung disease: preliminary results from the PHINDER study. 

 2026;43(5):2071–2089. doi:10.1007/s12325-026-03508-4

Videos

John Giacona, PhD, PA-C, says identifying pulmonary hypertension early, distinguishing its type, and engaging critically with clinical evidence are paramount.

The APAC Recap: AHA Hypertension Scientific Sessions 2024

Primary Aldosteronism: Screening and Diagnosis - 0:01:12

Renal Denervation: Efficacy and Implementation - 0:06:05

Identifying Appropriate Candidates for Renal Denervation - 0:08:14

Contraindications and Exclusions for Renal Denervation - 0:09:15

Audience and Tracks of the Conference - 0:09:32

, Erin Pardee, PA-C, a physician associate and board member of the 

Academy of Physician Associates in Cardiology (APAC)

, is joined by fellow board member and John Giacona, PhD, PA-C, an assistant professor in the Applied Clinical Research Department and the Department of Internal Medicine at UT Southwestern Medical Center, to discuss highlights from the American Heart Association’s (AHA) Hypertension Scientific Sessions 2024. Giacona, a hypertension specialist, describes the annual conference as a major event for hypertension researchers and clinicians, offering cutting-edge updates on research, clinical trials, and expert discussions on hypertension management.

This episode begins with Giacona discussing a session focused on primary aldosteronism, the most common endocrine form of secondary 

. He underscores the underscreening of this condition, with only 1 to 2% of eligible patients receiving proper evaluation. Giacona goes on to highlight key patient populations who should be screened, including those with resistant hypertension, hypertension with hypokalemia, or adrenal incidentalomas. He also shares practical advice on screening techniques, such as testing plasma aldosterone concentration, plasma renin activity, and potassium levels, even when patients are on medications like spironolactone.

The conversation then shifts to renal denervation, an emerging FDA-approved treatment for resistant hypertension. Giacona notes that while renal denervation yields a modest reduction in blood pressure—comparable to adding a new antihypertensive drug—it could benefit patients who cannot tolerate multiple medications. Giacona outlines ideal candidates for the procedure, such as patients with confirmed combined systolic and diastolic hypertension, but warns against its use in individuals with secondary causes of hypertension, kidney disease, or anatomical issues like renal artery stenosis.

Before closing Giacona encourages cardiologists, nephrologists, endocrinologists, and anybody who “has a patient with a blood pressure” to attend future AHA Hypertension sessions. The upcoming AHA Hypertension Scientific Sessions occurs September 4 to 7, 2025 in Baltimore, MD.

Editor’s Note: Around the 5:20 mark of this episode, Giacona says renal denervation provides an average blood pressure reduction of 5%. Giacona wants to clarify he misspoke and the proper figure is 5 mmHg. 

Pardee and Giacona have no relevant disclosures to report. 

All episodes of The APAC Recap will be available on HCPLive.com and on our 

Are you an APP interested in learning more about cardiology? Click the image below for more information on CAPP Live 2024!

In this episode, John Giacona, PhD, PA-C, shares insights from the 2024 AHA Hypertension Scientific Sessions, focusing on primary aldosteronism and renal denervation.

John Giacona, PhD, PA-C

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