Pulmonary artery catheterization use and mortality in hospitalizations with HFrEF and HFpEF: A nationally representative trend analysis from 2005 to 2014

Abstract

BackgroundThe aim of our study was to analyze the trends in use of pulmonary artery catheterization (PAC) in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) and adjusted mortality from 2005 to 2014 using National Inpatient Sample (NIS) database. MethodsThe International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes were used to identify patients with HFrEF and HFpEF from the National Inpatient Sample database. ResultsWe identified a total of 3,225,529 hospitalizations with HFrEF and 3,419,834 hospitalizations with HFpEF. Per 1000 hospitalizations, use of PAC declined from 2005 to 2010 in both HFrEF (12.9 to 7.9, Ptrend < 0.001) and HFpEF (12.9 to 5.5, Ptrend < 0.001). However, from 2010 to 2014, the use of PAC per 1000 hospitalizations increased in both HFrEF (7.9 to 9.7, Ptrend < 0.001) and HFpEF (5.5 to 6.7, Ptrend < 0.001). We noted a temporal decline in risk-adjusted mortality during the study period for HFrEF (odds ratio, 3.93 in 2005–06 to 2.7 in 2013–14, Ptrend < 0.001) and HFpEF (odd ratio, 2.72 in 2005–06 to 2.62 in 2013–14, Ptrend < 0.001). The length of stay and cost were significantly higher with PAC use in both HFrEF and HFpEF. ConclusionThe use of PAC declined from 2005 to 2010 in both HFrEF and HFpEF but has since increased from 2010 to 2014 in both HFrEF and HFpEF. There is also a temporal decline in excess mortality associated with PAC use in both HFrEF and HFpEF from 2005 to 2014.