25 Nov PA Catheterization Use Increases in CHF Without Shock or Respiratory Failure

Dr. Ambarish Pandey

Ambarish 

MedicalResearch.com Interview with:
Ambarish Pandey M.D.
Division of Cardiology
University of Texas Southwestern Medical Center
Dallas, TX

Medical Research: What is the background for this study? What are the main findings?

Dr. Pandey: Pulmonary artery (PA) catheters have been used for invasive bedside hemodynamic monitoring for past four decades. The ESCAPE trial, published in October 2005, demonstrated that use of  Pulmonary Artery catheter was not associated with a significant improvement in clinical outcomes of patients with heart failure. Accordingly, the current ACC/AHA guidelines discourage the routine use of PA catheter for routine management of acute heart failure in absence of cardiogenic shock or respiratory failure (Class III). Despite the significant evolution of available evidence base and guideline recommendations regarding use of  Pulmonary Artery catheters, national patterns of PA catheter utilization in hospitalized heart failure patients remain unknown.

In this study, we observed that use of PA catheter among patients with heart failure decline significantly in the Pre-ESCAPE era (2001 – 2006) followed by a consistent increase in its use in the Post-ESCAPE era (2007-2012). We also observed that the increase in use of  Pulmonary Artery catheters is most significant among heart failure patients without underlying cardiogenic shock or respiratory failure.

Medical Research: What should clinicians and patients take away from your report?

Dr. Pandey: Our study findings demonstrate a temporal increase in non-evidence-based use of Pulmonary Artery catheterization among heart failure patients without cardiogenic shock or respiratory failure, driving the upward trend in overall use.  These findings suggest a potential opportunity for improvement in quality of care and reduction in healthcare cost among patients hospitalized with acute heart failure. Some strategies for improvement include greater education of physicians about guideline recommendations regarding the use of such invasive strategies and incorporation of additional clinical decision support tools in day-to-day care of heart failure patients to assist physicians with real-time guidance about the appropriateness of invasive monitoring.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Pandey: Future research is needed to identify factors responsible for the observed increase in use of Pulmonary Artery catheters among heart failure patients.

Citation:

Use of Pulmonary Artery Catheterization in US Patients With Heart Failure, 2001-2012

Ambarish Pandey MD, Rohan Khera MD, Nilay Kumar MD, Harsh Golwala MD, Saket Girotra MD, SM, Gregg C. Fonarow MD

JAMA Internal Medicine Published online November 30, 2015

[wysija_form id=”5″]

Last Updated on November 25, 2015 by Marie Benz MD FAAD