Pulmonary artery catheter use among heart failure patients increases despite guideline recommendations

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Although guidelines recommend against the use of pulmonary artery catheters for routine management of heart failure, physicians have significantly increased their use of pulmonary artery catheters in recent years, according to an analysis of heart failure hospitalizations.

Lead researcher Ambarish Pandey, MD, of the University of Texas Southwestern Medical Center in Dallas, and colleagues published their results in JAMA Internal Medicine on Nov. 30.

They noted that the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial in 2005 found adding pulmonary artery catheterization to standard management in heart failure was associated with an increase in adverse events and did not improve outcomes. Since then, guidelines were changed to recommend using pulmonary artery catheters only in patients with cardiogenic shock or mechanical ventilation.

In this study, the researchers identified 15,786 patients who were hospitalized for heart failure and used pulmonary artery catheters from Jan. 1, 2001 to Dec. 31, 2012. They obtained the data from the National Inpatient Sample, an inpatient healthcare database of hospital stays in the U.S.

They excluded hospitalizations in which pulmonary artery catheters were used for monitoring in a surgical procedure. They also excluded instances in which providers used mechanical circulatory support and performed right-sided heart catheterization without using pulmonary artery catheters.

Pulmonary artery catheters were used in 0.6 percent of all heart failure hospitalizations during the study period, according to the researchers. Of the patients who received pulmonary artery catheters, 74 percent did not have cardiogenic shock or mechanical ventilation.

In 2007, the use of pulmonary artery catheters was 4.9 per 1,000 heart failure hospitalizations, a decrease from 7.9 per 1,000 heart failure hospitalizations in 2001. However, the ratio increased to 7.9 per 1,000 heart failure hospitalizations in 2012.

Of patients with cardiogenic shock, the use of pulmonary artery catheters was 190 per 1,000 heart failure hospitalizations in 2001, 86 per 1,000 heart failure hospitalizations in 2007 and 121 per 1,000 heart failure hospitalizations in 2012. Of patients with respiratory failure, the use of pulmonary artery catheters was 50 per 1,000 heart failure hospitalizations in 2001 and 10 per 1,000 heart failure hospitalizations in 2012.

Meanwhile, among the patients who did not have cardiogenic shock or mechanical ventilation, the use of pulmonary artery catheters was 5.6 per 1,000 heart failure hospitalizations in 2001, 4.2 per 1,000 heart failure hospitalizations in 2007 and 6.5 per 1,000 heart failure hospitalizations in 2012.

The researchers mentioned a few possibilities for the increased use of pulmonary artery catheters in recent years, including the increasing use of advanced heart failure therapies and preparatory hemodynamic evaluations. They also noted the increasing prevalence of pulmonary hypertension, chronic kidney disease and other comorbidities could have led to more patients receiving catheters.

“Future studies are needed to determine whether a proportion of the increase in the use of [pulmonary artery] catheters among patients with [heart failure] is attributable to inappropriate overuse,” they wrote.