Use of pulmonary artery catheterization in patients with HF increased in recent years

A new study highlighted a significant increase in the use of pulmonary artery catheters in patients with HF in recent years, with the largest increase observed in patients without a definite indication for pulmonary artery catheterization.

Previously, results of the ESCAPE trial in 2005 demonstrated that pulmonary artery catheterization added to standard HF management did not improve outcomes for patients with HF and was associated with an increase in adverse events. Current guidelines from the American College of Cardiology and American Heart Association recommend limited use of pulmonary artery catheters for patients with cardiogenic shock or mechanical ventilation (class I, level of evidence C) and recommend against its use in routine management of HF (class III, level of evidence B).

Researchers for the new study examined trends in contemporary use of pulmonary artery catheters before and after the ESCAPE trial. The cohort included 2.5 million adults with a primary diagnosis of HF included in the National Inpatient Sample from 2001 to 2012.

 

During that period, the researchers identified 75,209 hospitalizations with pulmonary artery catheter use (0.6% of all HF hospitalizations).

Pulmonary artery catheter use decreased from 7.9 per 1,000 HF hospitalizations in 2001 to 4.9 per 1,000 HF hospitalizations in 2007, then increased to 7.9 per 1,000 HF hospitalizations in 2012.

When the researchers looked at specific subgroups, they found that the use of pulmonary artery catheters in patients with cardiogenic shock decreased from 190 per 1,000 HF hospitalizations in 2001 to 86 per 1,000 HF hospitalizations in 2007 (P < .001) and increased to 121 per 1,000 HF hospitalizations in 2012 (P = .04). Use of pulmonary artery catheters in patients without cardiogenic shock or mechanical ventilation (74% of all use) rose to 6.5 per 1,000 HF hospitalizations in 2012, after an initial decrease from 2001 to 2007 (P < .001).

“Despite evidence against routine use in HF in the ESCAPE trial, we observed a significant increase in the use of [pulmonary artery] catheters in HF management in recent years,” the researchers wrote. “Moreover, the largest increase is seen in patients without a definite indication. This finding highlights the discordance between guideline recommendations and current clinical practice regarding management of acute HF.”

According to the researchers, factors that may explain the increase in pulmonary artery catheter use observed in this study include rising use of advanced HF therapies and a higher prevalence of comorbidities such as chronic kidney disease and pulmonary hypertension. – by Tracey Romero

Disclosure: One researcher reports receiving research support from the Agency for Healthcare Research and Quality and the NIH and consulting for Amgen, Bayer, Gambro, Medtronic and Novartis.