ISHLT Consensus Statement on Risk Stratification in Pulmonary Arterial Hypertension

Published 5 September 2025

Sandeep Sahay, MD, MSc; Scott Visovatti, MD; Adriano Tonelli; Nelson Villasmil Hernandez, MD; Eric Austin, MD, MSCI; Roberto Badagliacca, MD, PhD; Rolf Berger, MD, PhD; Athénaïs Boucly, MD; Yucheng Chen, MD; Colin Church, BSC(Hons), PhD, FRCP; Marion Delcroix, MD, PhD; Allen Everett, MD; Harrison Farber, MD; Charles Fauvel, MD; Mardi Gomberg-Maitland, MD, MSc; Megan Griffiths, MD; Francois Haddad, MD; Yuchi Han, MD; Anna Hemnes, MD; Marius Hoeper, MD; Manreet Kanwar, MD; Daniel Lachant, DO; Sandhya Murthy, MD; Karen Olsson, MD; Ioana Preston, MD; Göran Rådegran, MD; Olivier Sitbon, MD; Maria Trivieri, MD, PhD; Jean-Luc Vachiery, MD; Rebecca Vanderpool, PhD; Jason Weatherald, MD, MSc, FRCPC; R. James White, MD; Helen Whitford, MBBS, FRACP; Melisa Wilson, DNP, MSN, APRN; and Raymond Benza, MD.

J Heart Lung Transplant. September 2025.

• Consensus Document
• Publications & Journals
• Pulmonary Vascular Disease (PAH & CTEPH)
• Standards & Guidelines

Pulmonary arterial hypertension (PAH) is a rare, progressive disorder characterized by vascular remodeling and increased pulmonary vascular resistance, ultimately leading to right heart failure and premature death. Given the serious and life-limiting nature of the disease, accurate risk stratification is essential to guide therapeutic decision-making, identify patients at increased risk for clinical deterioration or mortality, and inform prognostic discussions.

In order to improve the understanding and utilization of risk stratification tools in the real world practice, experts worked for several years to develop a document to provide clinicians with a practical framework for the application of risk stratification systems in routine clinical practice along with future directions, thereby promoting evidence-based management and supporting efforts to improve patient outcomes.

This consensus statement on risk stratification in PAH integrates emerging evidence, contemporary clinical practice, and advancements since prior frameworks were established, and emphasizes that risk assessment should complement, rather than replace, clinical judgment. Additionally, it highlights the importance of multidisciplinary collaboration, patient-centered care models, and systematic efforts to refine and expand the evidence base.

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