WHO Functional Class and Four-Strata Risk in PAH (ESC/ERS 2022)
Follow-up risk assessment in pulmonary arterial hypertension with the ESC/ERS 2022 four-strata tool (COMPERA 2.0): WHO functional class, 6-minute walk distance and BNP or NT-proBNP, each graded 1–4.
Score interpretation
Four-strata grade 1 (mean of grades below 1.5).
→ Continue current therapy; reassess every 3–6 months. Low risk is the treatment goal.
Four-strata grade 2 (mean 1.5–2.4).
→ ESC/ERS 2022: consider adding a prostacyclin receptor agonist or switching PDE5 inhibitor to riociguat; PAH centre review.
Four-strata grade 3 (mean 2.5–3.4).
→ ESC/ERS 2022: consider adding an i.v./s.c. prostacyclin analogue and referral for lung transplant evaluation.
Four-strata grade 4 (mean 3.5 or more).
→ ESC/ERS 2022: add an i.v./s.c. prostacyclin analogue and refer for lung transplant evaluation; urgent PAH centre review.
Interpretation bands for the PH WHO Class. Apply clinical judgement and local guidance.
References
- Humbert M et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618–3731.
- Hoeper MM et al. COMPERA 2.0: a refined four-stratum risk assessment model for pulmonary arterial hypertension. Eur Respir J. 2022;60(1):2102311.
Related
Curated clinical cross-links plus same-class fallbacks.
- Epoprostenol · Prostacyclin (PGI2) — Severe Pulmonary Arterial Hypertension
- Treprostinil · Prostacyclin Analogue — Pulmonary Arterial Hypertension / Digital Ulcers
- Selexipag · Prostacyclin Receptor (IP Receptor) Agonist — Pulmonary Arterial Hypertension
- Selexipag · Pulmonary Arterial Hypertension
- Macitentan · Pulmonary Arterial Hypertension
- Sildenafil (Paediatric — PPHN / PAH) · PDE5 Inhibitor (Paediatric Pulmonary Hypertension)
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.