Talks, studies spotlight patient-centered research, emerging therapies in pulmonary hypertension

For Franz Rischard, DO, MSc, the global and national stage is an extension of the work he leads every day in Tucson — advancing research and care for patients with pulmonary hypertension.

About 1% of the world’s population suffers from pulmonary hypertension, or PH, translating to 50-70 million people. A subset of the disease, pulmonary arterial hypertension, or PAH, affects about 40,000 people in the U.S. and 192,000 people globally. It’s characterized by narrowing, thickening and stiffening of lung arteries that can significantly affect the heart, forcing it to work harder and leading to cardiomyopathy and heart failure.

Dr. Rischard, director of the Pulmonary Hypertension Program in the Division of Pulmonary, Allergy, Critical Care & Sleep Medicine (PACCS) at the University of Arizona College of Medicine – Tucson, the college’s associate dean of clinical research and a Sarver Heart Center member, has spent recent months sharing new findings at major international and national forums while continuing to build momentum behind innovative research initiatives.

Taking patient engagement to Europe

At the Pulmonary Vascular Research Institute’s 20th Annual Meeting in Dublin, Jan. 28-Feb. 1, he presented results from a randomized clinical trial exploring use of a shared decision-making tool designed to improve health-related quality of life for patients with PH and other rare diseases by engaging them more directly in their own care. He referred to it as the “fourth pillar” of PH care for successful interventions.

The trial centers on a structured process that brings physicians and patients together to define goals, map out treatment approaches and determine what’s realistically achievable. While collaboration between doctor and patient may seem intuitive, Dr. Rischard emphasized that formalizing the process is relatively new — especially in rare diseases, where long-term, highly specialized care is often required.

“So, basically, a way of establishing goals and the route to get there in shared decision making is actually a formal process,” he said, underscoring that patients themselves helped design the tool that makes the study a form of patient-oriented research.

Presented during a PVRI session on clinical trial design, the work stood out for its focus on subjective, patient-centered interventions. His team’s model goes further by incorporating social workers and community health workers into implementation, reflecting the reality that specialists in rare diseases like PH often serve as long-term partners in care. A recording of the lecture can be viewed here.

Dr. Rischard said the international audience response was enthusiastic, with growing interest in validating and expanding the model. The study is now under review for funding from the Patient-Centered Outcomes Research Institute (PCORI), supported by a broad collaborative network that includes Banner Health, the University of Maryland, Pulmonary Hypertension Association — the preeminent national patient-led organization in PH — and multiple University of Arizona Health Sciences colleges.

Cardiothoracic reverse remodeling 

Dr. Rischard’s other recent and upcoming lectures also reflect the breadth of his research.

On May 8, he’s scheduled to speak at the Combined Yale and Brigham & Women's Hospital Pulmonary Hypertension Symposium in New Haven, Connecticut, focusing on the need for exercise testing in drug response assessment in PH patients due to differences in resting and active hemodynamics. And May 29-30, he’ll travel to Lisbon, Portugal, to present at a meeting, “Defining Low Risk in PAH,” of the Sociedade Portuguesa de Cardiologia and an allied cardiology consortium, on redefining treatment goals — particularly how clinicians can measure “reverse remodeling,” or the heart’s return toward normal function with effective treatment.

That focus on measurable outcomes is central to the work of Dr. Rischard’s research team. PH places extreme strain on the right side of the heart and can lead to heart failure, the leading cause of death in these patients. His research has helped define how clinicians can track improvements and evaluate the impact of newer therapies aimed at restoring cardiac function.

A Western U.S. epidemic

At the same time, he’s contributing to research addressing an emerging, urgent and evolving challenge in his field: methamphetamine-associated pulmonary arterial hypertension, or Meth-PAH. In collaboration with colleagues, including Cole Uhland, MD, a physician in the U of A Pulmonary & Critical Care Medicine Fellowship, Michael Insel, MD, a PACCS assistant professor, Lillian Hansen, FNP, and Saad Kubba, MD, a Cardiology division assistant professor, Dr. Rischard helped develop a standardized treatment approach that’s now gaining national attention.

“One might say, ‘Well, that’s not a big deal. But methamphetamine is an epidemic in the Western U.S. right now. In fact, there are more methamphetamine-related deaths than there are opiate-related deaths this side of the Mississippi,” he said.

Their work is detailed in a paper published last fall in the Journal of the American Heart Association, which examines treatment response and survival in patients with Meth-PAH. The study found that with an aggressive, protocol-driven treatment strategy, patients can experience meaningful improvements in heart function and survival outcomes comparable to other forms of the disease.

Dr. Rischard emphasized the significance of the publication and its origins within the program’s training pipeline.

“This was just published in October as the first known treatment protocol directed toward methamphetamine-associated pulmonary hypertension,” he said, noting that Dr. Uhland and a past PCCM fellow, Angela Gibbs, MD, now a PH program director in Portland, Oregon, served as lead authors on the paper. Drs. Rischard and Uhland presented on the topic during a PVRI Community Call webinar in November.

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“It’s groundbreaking in that, with this algorithm or approach, Dr. Uhland has shown the scientific community how to treat this in such that we can save lives,” Dr. Rischard said.

The findings are particularly important as Meth-PAH, with over 80% of patients diagnosed in the Western U.S., represents a growing and historically understudied subset of the disease with often worse outcomes and fewer standardized treatment approaches.

Building on this work, Dr. Rischard and collaborators are pursuing additional research and funding aimed at identifying which individuals are most susceptible to developing the condition, with the goal of enabling earlier diagnosis and intervention.

Other new strategies

His program also, exploring other interventional approaches, recently successfully completed a Potts shunt procedure, which relieves pressure on the heart by creating a controlled channel between major blood vessels to restore normal blood flow in cases of severe PH and right ventricular failure. This experience demonstrates the procedure can be performed safely, opening the door to earlier use with carefully selected patients.

Dr. Rischard added that, for these procedures and balloon pulmonary angioplasties (BPAs), a newer, innovative minimally invasive catheter-based procedure to treat chronic thromboembolic PH (CTEPH) without surgery, the PH Team relies on Michael Seckeler, MD, professor of pediatrics and Pediatric & Adult Congenital Cardiac Cath Lab director. He has handled over 100 BPA cases and his lab is a CTEPH referral center for the Southwest.

Across all these efforts, Dr. Rischard’s work reflects a consistent theme: integrating research, clinical care and patient engagement to address a complex disease from multiple angles. As his lectures and collaborations continue to expand globally, so too does the reach of that mission — bringing new strategies, data and hope to patients with pulmonary hypertension.

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