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Navigating a New Era of PH Management as an APP, With Susanne McDevitt, DNP
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.
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.
HCPLive 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 Association of Pulmonary Advanced Practice Providers (APAPP) National Conference, held June 28-20 in Las Vegas, Nevada.1
"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 2024.2 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 had no relevant disclosures to report.
References
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. N Engl J Med. 2023;388(16):1478–1490. doi:10.1056/NEJMoa2213556
