National Pulmonary Hypertension Audit,16th Annual Report

I am honoured to have been asked to write the foreword for the NAPH 16th Report. Reflecting on the journey - from my earliest data collection using simple Excel spreadsheets to today’s sophisticated databases and interactive dashboards—highlights the remarkable progress we have made. Since 2009, NHS England has published this data annually with open access, reflecting our enduring commitment to transparency and to improving patient care.

The strength of the national audit lies in the collaboration of the entire pulmonary hypertension (PH) community, especially our patients and carers. Together, we have defined standards, monitored pathways and outcomes, and deepened our understanding of PH treatment—an achievement that is increasingly important in this era of combination therapies and emerging disease-modifying drugs.

Over the years, the audit has been both a friend and a demanding taskmaster. It has driven improvements in care while requiring unwavering attention to data accuracy. Despite the occasional frustrations, I take great satisfaction in data input, interpretation, and analysis. Accurate, complete data offers confidence that we are delivering high-quality care; in contrast, missing information or suboptimal care can quickly lead to sleepless nights.

Although PH services across the UK differ in patient populations, geography, and staffing, all meet the international specifications required of expert centres. We work together with a shared goal: to optimise patient experience, survival, and quality of life. The national audit identifies areas for improvement and continues to drive high-quality, specialist care.

The audit has also captured the evolving demographics of our patient population. Patients are, on average, older and often have more coexisting medical conditions. This can make accurate diagnosis more challenging, but by collecting detailed real-world data—beyond the confines of clinical trial populations—we gain invaluable insights that increasingly inform and refine our practice.

Looking ahead, as our understanding of current and emerging treatments grows, we will be better equipped to deliver personalised medicine, offering tailored therapies with fewer side effects, longer life expectancy, and an improved quality of life for people living with PH.

Wendy Gin-Sing
Pulmonary Hypertension Nurse Consultant
Hammersmith Hospital, Imperial College Healthcare NHS Trust

The NAPH sets out to measure the quality of care provided to people referred to PH services in Great Britain (England, Scotland, Wales) by answering a number of questions:

The Audit answers these questions through the measurement of a number of professionally-agreed National Standards reported at a national and centre level.

This report is of particular interest to commissioners and healthcare providers to monitor the quality and effectiveness of PH services. It may also be of interest to researchers and charities working on this subject and to members of the public, including those with PH.

• Data is collected and submitted by hospital staff at PH services in Great Britain. 
• The Audit is delivered by NHS England in collaboration with NHS Scotland, NHS Wales (GIG Cymru), the Pulmonary Hypertension Association UK (PHA UK) and the National Pulmonary Hypertension Centres of United Kingdom and Ireland Physicians' Committee.
• Please see the Data quality statement for information on data quality.

In the 16^th Annual Report our key facts summary highlights that the UK pulmonary hypertension service is busier than ever. In 2024-2025 the UK network commenced more people on treatment and managed more patients than at any time since its inception. The most marked increase in activity has been in patients being referred with suspected pulmonary hypertension, with activity up over 20% compared to the previous year. Despite these increases in activity, performance against the national standards remain strong overall.

The pulmonary hypertension dashboard continues to evolve providing valuable information on forms of pulmonary hypertension evaluated and changes in demographics, approaches to treatment and outcomes. For the first time we provide additional data on outcomes for most major sub-groups of pulmonary hypertension. Not only does this highlight the challenge we face managing pulmonary hypertension in various forms of lung disease, but it also demonstrates the considerable progress that we have made treating people with pulmonary hypertension. In particular, for those with CTEPH and younger patients with idiopathic pulmonary arterial hypertension there have been very significant improvements in survival with new treatment approaches. Another change in the dashboard includes a more detailed breakdown on the use of drug therapies and how these drugs are increasingly used in combination. Whilst the national audit demonstrates increasing diagnostic rates, more aggressive approaches to treatment and improvements in outcomes, it highlights that there is still much work to be done.

I would like to thank the many dedicated professionals throughout the NHS, people living with pulmonary hypertension and the UK patients’ association, the PHA UK, for all the hard work that they have done to ensure that the audit remains relevant. This year I would particularly like to thank my colleagues at NHSE, Pam Freeman, Jo Wapshott, Olivia Dennis and Sally Jones who have worked tirelessly behind the scenes to ensure that the audit continues to evolve and that data is handled and analysed with a rigour that inspires confidence.

Whilst the audit helps identify areas of unmet need and where we need to focus our efforts, we should take comfort from a UK pulmonary hypertension service that continues to perform well against national standards despite the challenges we face in the NHS.

Professor David G Kiely

NAPH Clinical Lead