To see if you may qualify for participation in the CATALYST study, please answer the following questions to the best of your knowledge. This should take approximately 5 minutes. The information you provide will be used ONLY for the purpose of determining your potential eligibility for the study. It will not be sold, shared or transferred to any party not directly involved in CATALYST. At the completion of the study (approximately March of 2018), your information will be destroyed.

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FIRST NAME

PHONE NUMBER

EMAIL ADDRESS

POSTAL CODE

Are you between the ages of 18 and 75 years old?

Is your Body Mass Index (BMI) greater than 18.5 kg/m2?

Have you been diagnosed with Pulmonary Arterial Hypertension (PAH) associated with Connective Tissue Disease (CTD)?

Have you been diagnosed with pulmonary hypertension either WHO/NYHA FC class II or WHO/NYHA FC class III?

Have you been diagnosed with any of the following Connective Tissue Diseases?

Are you willing to participate in at least 8 study visits and 7 phone assessments over 7 months?

Are you currently participating in another research study?

Are you currently pregnant, planning on becoming pregnant or breastfeeding?

Are you currently receiving intravenous inotropes?

Are you currently being treated with intravenous (IV) or subcutaneous (SC) prostacyclin or prostacyclin analogues?

Have you been diagnosed with coronary artery disease in the last 3 years?

Have you been diagnosed with left-sided heart disease and/or cardiac diseases such as congenital (at birth) or acquired heart valve disease, pericardial constriction or restrictive/congestive cardiomyopathy?

Have you been diagnosed with Down syndrome?

Do you have a history of uncontrolled obstructive sleep apnea?

Do you have an untreated or uncontrolled active bacterial, fungal, or viral infection?

Have you been diagnosed with portal hypertension or chronic liver disease, including hepatitis B and/or hepatitis C?

Have you been diagnosed with a malignancy, other than localized skin or cervical carcinomas (cancer), within the last 5 years?

Are you planning to have major surgery during the next 8 months?

Please select all of the following that apply to you. If you are unsure, please leave blank:

Please provide the name of the doctor currently treating your PAH. If you are unsure, please leave blank.

Are you currently on any of the following types of PAH therapies?

Are you currently receiving treatment for CTD with prednisone or any other drugs (steroids)?

Have you ever had an atrial septostomy?

Have you had a diagnostic right heart catheterization within the last 36 months?

What treatments do you currently take for PAH? If you are unsure if you’re taking a particular medication, please leave it blank.

Endothelin Receptor Antagonist (ERA)

Phosphodiesterase Inhibitors (PDE 5)

Oral Prostacyclin

Inhaled Prostacyclin

Intravenous

Soluble Guanylate Cyclase