Susanne McDevitt, DNP, ACNP-BC, Acute Care Nurse Practitioner in the Pulmonary Hypertension Program at Michigan Medicine, University of Michigan, Ann Arbor

Susanne McDevitt, DNP

Decoding PH Monitoring, Testing, and Referral, With Susanne McDevitt, DNP

Right heart catheterization is not just a diagnostic entry point in 

 (PH) — it is a longitudinal management tool, and using it well requires understanding not only the basics of hemodynamic assessment but the nuances of provocative testing, patient phenotyping, and treatment goal monitoring. At the 

Association of Pulmonary Advanced Practice Providers (APAPP) National Conference, held June 28-20 in Las Vegas, Nevada

, Susanne McDevitt, DNP, ACNP-BC, Acute Care Nurse Practitioner in the Pulmonary Hypertension Program at Michigan Medicine, University of Michigan, Ann Arbor, co-presented a session titled Decoding Pulmonary Hypertension with Mindy Rivera, MSN, APRN, CNS-BC, covering the evolving role of hemodynamics in PH diagnosis and management.

The session reviewed right heart catheterization fundamentals alongside its current place in the diagnostic algorithm — which has shifted meaningfully with updated hemodynamic definitions lowering the mean pulmonary arterial pressure threshold to >20 mmHg — and dedicated substantial time to provocative testing in the catheterization laboratory.

 Comprehensive provocative testing is central to accurate patient phenotyping: distinguishing WHO group classifications, identifying exercise-induced PH, and uncovering left heart disease as a contributor to hemodynamic abnormalities are all critical to treatment selection, and none of these can be reliably accomplished without a thorough catheterization.

"Doing a comprehensive right heart cath is imperative to getting the correct diagnosis for the patient, and that impacts the entire treatment plan," McDevitt said.

On monitoring strategy, McDevitt described her center's standard approach: a thorough index right heart catheterization at diagnosis, followed by repeat catheterization within 6–12 months of initiating therapy to evaluate hemodynamic response against treatment goals — including normalization of cardiac output and pulmonary vascular resistance — alongside echocardiography, 6-minute hall walk, functional class assessment, and biomarkers including BNP or NT-proBNP. Once low-risk status and treatment goals are achieved, echocardiography-based surveillance may suffice, but any clinical change, unexplained biomarker rise, or concern for new comorbidity — including diastolic dysfunction or heart failure with preserved ejection fraction, which can develop over decades of therapy in long-surviving patients — warrants repeat hemodynamic evaluation. "When in doubt, we repeat a right heart cath for sure," she said.

Despite advances in awareness and screening in higher-risk populations such as those with scleroderma, interstitial Lung Disease, or chronic thromboembolic disease, late referral to PH specialty centers remains a persistent problem for WHO group 1 pulmonary arterial hypertension.

 McDevitt expressed cautious optimism that artificial intelligence and machine learning tools applied to echocardiographic screening may help identify patients with unexplained dyspnea earlier — before hemodynamic compromise and right ventricular remodeling are advanced — though she acknowledged the field is still working toward that reality.

McDevitt had no relevant disclosures to report.

McDevitt S, Rivera M. Hemodynamic deep dive: decoding pulmonary hypertension. Presented at: Association of Pulmonary Advanced Practice Providers Annual Meeting (APAPP 2026); Las Vegas, NV.

Humbert M, Kovacs G, Hoeper MM, et al; ESC/ERS Scientific Document Group. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. 

 2022;43(38):3618–3731. doi:10.1093/eurheartj/ehac237

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Beyond hemodynamics and treatment targets, McDevitt says the most important conversations APPs have with patients are often the ones that don't appear in guidelines.

Caring for the Whole Person With Pulmonary Hypertension, With Susanne McDevitt, DNP

 (PH) care is built around measurable endpoints — hemodynamics, functional class, biomarkers, echocardiographic findings, exercise capacity. But for patients living with the chronic, progressive, life-limiting disease that disproportionately affects young women, the clinical picture extends well beyond those numbers. At the 

, Susanne McDevitt, DNP, ACNP-BC, Acute Care Nurse Practitioner in the Pulmonary Hypertension Program at Michigan Medicine, University of Michigan, Ann Arbor, participated in a PH fireside chat session that centered on the extra-clinical dimensions of PH care that need more attention.

The session, led by Melisa Wilson, DNP, APRN, BC, brought together 4 expert APPs for a dialogue on whole-person care in PH — including conversations about intimacy concerns, pregnancy and contraception counseling, the timing and framing of palliative care discussions, and APP well-being and resilience in a high-demand specialty. 

High Anxiety and Depression Comorbidity  Rates With PH

The psychosocial burden of PH is substantial and well documented. Anxiety and depression are highly prevalent in this population, compounded by losses that extend across functional ability, occupational capacity, and social and family participation. McDevitt was direct about the role of APPs in addressing this dimension: it is not optional, and it is not purely a referral function. 

"Discussions about mental wellness along with physical wellness should be part of every patient visit for pulmonary hypertension, no doubt," she said. APPs, she argued, are well positioned to hold these conversations — evaluating for fear, anxiety, uncertainty, and depression as a routine part of the clinical encounter — while also knowing when to engage social work and community resources.

She also raised the sustainability challenge for APPs themselves. Working in a therapeutically intensive, emotionally demanding specialty like PH or PH-ILD carries real risk of burnout, and McDevitt described the fireside chat's closing focus on APP community-building, resilience, and self-care as a dimension of professional life the field needs to address more openly and more often.

McDevitt S, Reed L, Rivera M, Wilson M, Young C. PAH fireside. Presented at: Association of Pulmonary Advanced Practice Providers Annual Meeting (APAP 2026); Las Vegas, NV.

Lowe B, Grafe K, Ufer C, et al. Anxiety and depression in patients with pulmonary hypertension. 

 2004;66(6):831–836. doi:10.1097/01.psy.0000145593.37594.39

Beyond hemodynamics and treatment targets, McDevitt says the most important conversations APPs have with patients are often the ones that don't appear in guidelines.


Navigating a New Era of PH Management as an APP, With Susanne McDevitt, DNP

Pulmonary hypertension (PH) management has undergone a profound transformation in the past several years, driven by updated hemodynamic definitions, more rigorous treatment targets, and the arrival of a mechanistically novel therapy that is producing hemodynamic improvements the field has not seen before. 

sat down with Susanne McDevitt, DNP, ACNP-BC, Acute Care Nurse Practitioner in the Pulmonary Hypertension Program at Michigan Medicine, University of Michigan, Ann Arbor, who joined a panel of PH-specialized APPs to discuss the evolving landscape of PAH care — and what it demands from the clinicians managing these patients, at the 

"We now have a therapy that actually impacts the pulmonary artery pressure more than anything we've ever seen in all the decades we've been working in this," McDevitt said, referring to sotatercept (Winrevair), the first-in-class activin signaling inhibitor approved by the FDA for PAH in March 2024.

 By restoring balance between pro- and anti-proliferative vascular signaling — a mechanism distinct from all prior PAH drug classes — sotatercept targets right ventricular afterload in a way that vasodilator-based therapies do not, producing hemodynamic improvements on right heart catheterization that McDevitt described as clinically remarkable.

Updated hemodynamic definitions, which now use a mean pulmonary arterial pressure threshold of >20 mmHg — down from the previous >25 mmHg — have raised the bar for earlier diagnosis, and McDevitt expressed hope that this change is translating into earlier identification of patients who can benefit from treatment before significant RV dysfunction develops. Treatment targets have become correspondingly more rigorous: risk stratification tools are now expected to incorporate not just composite clinical scores but direct RV functional assessment via echocardiography or cardiac MRI. 

She also touched on the evolving practical complexity of PAH management in the sotatercept era. The addition of a third pathway — activin signaling inhibition — alongside phosphodiesterase-5 inhibitors, endothelin receptor antagonists, and prostacyclin agents has created both new therapeutic opportunities and new decision-making demands: when to add sotatercept, whether to de-escalate existing therapies when doing so, and how to manage the pharmacologic and monitoring burden on patients who are already carrying a significant symptom and treatment load. 

"In some ways it's become more complex, but it's so much more hopeful that it's worth all of the time and effort we put into this to see these amazing outcomes," McDevitt said.

McDevitt S, Reed L, Rivera M, Wilson M, Young C. PAH fireside. Presented at: Association of Pulmonary Advanced Practice Providers Annual Meeting (APAPP 2026); Las Vegas, NV.

Hoeper MM, Badesch DB, Ghofrani HA, et al. Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension. 

 2023;388(16):1478–1490. doi:10.1056/NEJMoa2213556

From tighter hemodynamic definitions to a first-in-class activin signaling inhibitor, a nearly 30-year PH veteran says the field has never had more to offer patients — or more complexity to manage.

Susanne McDevitt, DNP

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