Abstract 15447: Trends in Use of Pulmonary Artery Catheterization in Heart Failure in the United States, 2006 - 2012

Abstract

Introduction: Use of pulmonary artery(PA) catheterization in heart failure(HF) patients without cardiogenic shock has not been shown to improve clinical outcomes (ESCAPE trial, 2005) and is not routinely recommended in the absence of shock or respiratory failure. However, contemporary trends in PA catheter use among HF patients are not known. Methods: The National Inpatient Sample (2006-2012) was used to identify adults(>18 years) hospitalized with a primary diagnosis of HF using ICD-9 codes 402.x1, 404.x1, 404.x3 and 428.x. PA catheter use was identified using procedure codes 89.6x. Patients undergoing major surgery or receiving mechanical circulatory support were excluded. Propensity-matched analyses were performed to compare risk-adjusted in-hospital mortality in patients with and without PA catheter use. Results: During 2006-2012, PA catheters were used in 39,247 HF hospitalizations, at a rate of 6 per 1000 HF admissions. Patients with PA catheter placement were younger and more commonly had cardiogenic shock (11%) or respiratory failure (11%). PA catheter use increased significantly over time from 5.3/1000 HF(2006) to 7.9/1000 HF(2012)(P<0.001,Figure). In subgroup analyses, in patients with cardiogenic shock, the proportional use of PA catheter was higher and increased only modestly (118 to 121/1000 HF cases,Ptrend 0.04). In contrast, patients without shock or respiratory failure had lower proportional use of PA catheter with a substantial increase during the study period (4.2 to 6.5 per 1000 HF cases, Ptrend< 0.001). In propensity-matched analyses of patients without shock or respiratory failure, mortality in HF was higher with the use of PA catheter compared to no PA catheter use (Risk-adjusted odd ratio 1.42, 95%CI 1.30, 1.56) Conclusions: PA catheter use has increased significantly over time among patients hospitalized with HF after ESCAPE, even in patients without cardiogenic shock/respiratory failure and is associated with worse outcomes.