Multidisciplinary Care, Evidence-Based Practice in ILD: John Giacona, PhD

Cardiac disease occurs in up to 60% of patients with idiopathic pulmonary fibrosis, and pulmonary hypertension (PH) prevalence in this population ranges from 32% to 85% depending on the cohort studied.1 These figures place cardiovascular risk assessment squarely inside routine interstitial lung disease (ILD) care rather than as an occasional referral.

Multidisciplinary discussion has been endorsed in international consensus guidelines as the gold standard method for diagnosing ILD, a framework increasingly extended to ongoing management as well as initial workup.2 Medication choices can compound cardiopulmonary risk directly, since amiodarone use for atrial fibrillation carries a known risk of drug-induced ILD requiring closer pulmonology involvement. Repeat pulmonary function testing, echocardiography, and imaging for staging help track progression across specialties over time.

Catching PH before right ventricular failure becomes irreversible depends on distinguishing left heart disease from pulmonary vascular disease early, a distinction cardiology input can sharpen. Rheumatology involvement becomes important when patients are on antifibrotic or immunosuppressant therapy tied to an underlying autoimmune condition. Advanced practice providers see the highest volume of these patients day to day, and staying current with primary literature is a growing expectation rather than an optional pursuit.

John Giacona, PhD, PA-C, CHC, an assistant professor in the Applied Clinical Research Department with a secondary appointment in the Division of Cardiology at UT Southwestern Medical Center, holds PhD training specifically in applied clinical research methodology. In the following interview, Giacona spoke with HCPLive at the APAPP 2026 National Conference in Las Vegas about building a comprehensive ILD care team and applying clinical evidence in daily practice.

HCPLive: Given the cardiovascular comorbidities associated with ILD, how should risk assessment and cardiology involvement be incorporated into patient follow-up?

John Giacona, PhD, PA-C: It comes back to needing a multidisciplinary evaluation, which really should be the standard in interstitial lung disease. There are several overlaps in terms of comorbidities, symptoms, and even potential side effects from medications. For example, if a patient has atrial fibrillation and is on amiodarone, they're at high risk for ILD, so they should be screened. Multidisciplinary discussions between providers for a patient having repeat evaluation like PFTs, echoes, and imaging for staging are important for identifying ILD progression. From a cardiology standpoint, the key for us is to catch pulmonary hypertension early, before right ventricular failure becomes irreversible, and distinguishing group 2 versus group 3 is very important. If any one provider gets a patient with ILD or pulmonary hypertension, the onus is on them to ensure the patient is plugged in with all the appropriate specialists.

What does a truly comprehensive multidisciplinary team for ILD look like, particularly integrating cardiology with pulmonology?

Giacona: The main thing for my personal view of a multidisciplinary team is remembering we're often taught ILD is a lung disease or a pulmonology problem, but really it's a cardiopulmonary disease. Depending on the comorbidities or etiology of the interstitial lung disease, we should include other specialists. If patients are on anti-fibrotics, immunosuppressant agents, or biologics, rheumatology should be involved, and radiology should always be looped in for longitudinal imaging of the patient. That's the bare minimum team in my mind for patients with ILD.

From your research background, how should APPs be engaging with and applying clinical evidence in practice?

Giacona: I'm very biased on this since I have PhD training in Applied Clinical Research, which is focused on research design, methodology, and statistics. I think APPs should be, at bare minimum, abreast of the newest evidence for their field. We should all be practicing evidence-based medicine. APPs are at the forefront of patient care. I know some APPs who are seeing 30 patients a day, and they're the ones implementing guidelines written by institutional bodies. PAs and NPs are the ones prescribing medications and interacting with patients longitudinally. Getting involved in research might be a big ask for APPs, because a lot of them don't have protected time to do so. But understanding how to appraise primary literature, like a clinical trial, and how to determine whether the patient population applies to and would benefit the patients you see, is important. I think it's the bare minimum for practicing evidence-based medicine. I will add, it is very challenging. It's a big ask. Many PAs and NPs aren't given protected time, so a lot of them have to spend time on weekends or after work to read these articles. But if there's a big trial or landmark study in their field, I think it's important to read through it and at least have a basic understanding of the findings.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools.

References

1. Althobiani MA, Russell AM, Jacob J, et al. Interstitial lung disease: a review of classification, etiology, epidemiology, clinical diagnosis, pharmacological and non-pharmacological treatment. Front Med (Lausanne). 2024;11:1296890. doi:10.3389/fmed.2024.1296890

2. Glenn LM, Troy LK, Corte TJ. Diagnosing interstitial lung disease by multidisciplinary discussion: a review. Front Med (Lausanne). 2022;9:1017501. doi:10.3389/fmed.2022.1017501