Rohan Khera1, Ambarish Pandey1, Nilay Kumar1, Rajeev Singh1, Shah Bano1, Harsh Golwala1, Dharam J Kumbhani1, Saket Girotra1, Gregg C Fonarow2. 1. From the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., A.P., S.B., D.J.K.); Cambridge Health Alliance Hospital, Harvard Medical School, Boston, MA (N.K.); Division of Cardiology, Indiana University School of Medicine, Indianapolis (R.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.G.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City (S.G.); and Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Ronald Reagan-University of California at Los Angeles Medical Center (G.C.F.). 2. From the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., A.P., S.B., D.J.K.); Cambridge Health Alliance Hospital, Harvard Medical School, Boston, MA (N.K.); Division of Cardiology, Indiana University School of Medicine, Indianapolis (R.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.G.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City (S.G.); and Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Ronald Reagan-University of California at Los Angeles Medical Center (G.C.F.). gfonarow@mednet.ucla.edu.
Abstract
BACKGROUND: There has been an increase in the use of pulmonary artery (PA) catheters in heart failure (HF) in the United States in recent years. However, patterns of hospital use and trends in patient outcomes are not known. METHODS AND RESULTS: In the National Inpatient Sample 2001 to 2012, using International Classification of Diseases-Ninth Revision codes, we identified 11 888 525 adult (≥18 years) HF hospitalizations nationally, of which an estimated 75 209 (SE 0.6%) received a PA catheter. In 2001, the number of hospitals with ≥1 PA catheterization was 1753, decreasing to 1183 in 2011. The mean PA catheter use per hospital trended from 4.9 per year in 2001 (limits 1-133) to 3.8 per year in 2007 (limits 1-46), but increased to 5.5 per year in 2011 (limits 1-70). During 2001 to 2006, PA catheterization declined across hospitals; however, in 2007 to 2012, there was a disproportionate increase at hospitals with large bedsize, teaching programs, and advanced HF capabilities. The overall in-hospital mortality with PA catheter use was higher than without PA catheter use (13.1% versus 3.4%; P<0.0001); however, in propensity-matched analysis, differences in mortality between these groups have attenuated over time-risk-adjusted odds ratio for mortality for PA catheterization, 1.66 (95% confidence interval, 1.60-1.74) in 2001 to 2003 down to 1.04 (95% confidence interval, 0.97-1.12) in 2010 to 2012. CONCLUSIONS: There is substantial hospital-level variability in PA catheterization in HF along with increasing volume at fewer hospitals over-represented by large, academic hospitals with advanced HF capabilities. This is accompanied by a decline in excess mortality associated with PA catheterization.
BACKGROUND: There has been an increase in the use of pulmonary artery (PA) catheters in heart failure (HF) in the United States in recent years. However, patterns of hospital use and trends in patient outcomes are not known. METHODS AND RESULTS: In the National Inpatient Sample 2001 to 2012, using International Classification of Diseases-Ninth Revision codes, we identified 11 888 525 adult (≥18 years) HF hospitalizations nationally, of which an estimated 75 209 (SE 0.6%) received a PA catheter. In 2001, the number of hospitals with ≥1 PA catheterization was 1753, decreasing to 1183 in 2011. The mean PA catheter use per hospital trended from 4.9 per year in 2001 (limits 1-133) to 3.8 per year in 2007 (limits 1-46), but increased to 5.5 per year in 2011 (limits 1-70). During 2001 to 2006, PA catheterization declined across hospitals; however, in 2007 to 2012, there was a disproportionate increase at hospitals with large bedsize, teaching programs, and advanced HF capabilities. The overall in-hospital mortality with PA catheter use was higher than without PA catheter use (13.1% versus 3.4%; P<0.0001); however, in propensity-matched analysis, differences in mortality between these groups have attenuated over time-risk-adjusted odds ratio for mortality for PA catheterization, 1.66 (95% confidence interval, 1.60-1.74) in 2001 to 2003 down to 1.04 (95% confidence interval, 0.97-1.12) in 2010 to 2012. CONCLUSIONS: There is substantial hospital-level variability in PA catheterization in HF along with increasing volume at fewer hospitals over-represented by large, academic hospitals with advanced HF capabilities. This is accompanied by a decline in excess mortality associated with PA catheterization.
Authors: Clyde W Yancy; Mariell Jessup; Biykem Bozkurt; Javed Butler; Donald E Casey; Mark H Drazner; Gregg C Fonarow; Stephen A Geraci; Tamara Horwich; James L Januzzi; Maryl R Johnson; Edward K Kasper; Wayne C Levy; Frederick A Masoudi; Patrick E McBride; John J V McMurray; Judith E Mitchell; Pamela N Peterson; Barbara Riegel; Flora Sam; Lynne W Stevenson; W H Wilson Tang; Emily J Tsai; Bruce L Wilkoff Journal: Circulation Date: 2013-06-05 Impact factor: 29.690
Authors: Cynthia Binanay; Robert M Califf; Vic Hasselblad; Christopher M O'Connor; Monica R Shah; George Sopko; Lynne W Stevenson; Gary S Francis; Carl V Leier; Leslie W Miller Journal: JAMA Date: 2005-10-05 Impact factor: 56.272
Authors: G C Fonarow; L W Stevenson; J A Walden; N A Livingston; A E Steimle; M A Hamilton; J Moriguchi; J H Tillisch; M A Woo Journal: J Am Coll Cardiol Date: 1997-09 Impact factor: 24.094
Authors: Gregg C Fonarow; Nancy M Albert; Anne B Curtis; Wendy Gattis Stough; Mihai Gheorghiade; J Thomas Heywood; Mark L McBride; Patches Johnson Inge; Mandeep R Mehra; Christopher M O'Connor; Dwight Reynolds; Mary Norine Walsh; Clyde W Yancy Journal: Circulation Date: 2010-07-26 Impact factor: 29.690
Authors: Rohan Khera; Ambarish Pandey; Thomas Koshy; Colby Ayers; Brahmajee K Nallamothu; Sandeep R Das; Mark H Drazner; Michael E Jessen; Ajay J Kirtane; Timothy J Gardner; James A de Lemos; Deepak L Bhatt; Dharam J Kumbhani Journal: JAMA Cardiol Date: 2017-12-01 Impact factor: 14.676
Authors: Jessica H Huston; Robinson Ferre; Peter S Pang; Ovidiu Chioncel; Javed Butler; Sean Collins Journal: Am J Ther Date: 2018 Jul/Aug Impact factor: 2.688
Authors: Shiva P Ponamgi; Muhammad Haisum Maqsood; Pranathi R Sundaragiri; Michael G DelCore; Arun Kanmanthareddy; Wissam A Jaber; William J Nicholson; Saraschandra Vallabhajosyula Journal: World J Cardiol Date: 2021-12-26
Authors: Rohan Khera; Eric A Secemsky; Yongfei Wang; Nihar R Desai; Harlan M Krumholz; Thomas M Maddox; Kendrick A Shunk; Salim S Virani; Deepak L Bhatt; Jeptha Curtis; Robert W Yeh Journal: JAMA Intern Med Date: 2020-10-01 Impact factor: 44.409
Authors: Saraschandra Vallabhajosyula; Aditi Shankar; Sri Harsha Patlolla; Abhiram Prasad; Malcolm R Bell; Jacob C Jentzer; Shilpkumar Arora; Saarwaani Vallabhajosyula; Bernard J Gersh; Allan S Jaffe; David R Holmes; Shannon M Dunlay; Gregory W Barsness Journal: ESC Heart Fail Date: 2020-04-02
Authors: Anthony A Bavry; Edward Hess; Stephen W Waldo; Anna E Barón; Dharam J Kumbhani; Deepak L Bhatt; Ambarish Pandey Journal: Clin Cardiol Date: 2020-07-30 Impact factor: 2.882
Authors: Sagar Ranka; Ioannis Mastoris; Navin K Kapur; Ryan J Tedford; Aniket Rali; Prakash Acharya; Robert Weidling; Amandeep Goyal; Andrew J Sauer; Bhanu Gupta; Nicholas Haglund; Kamal Gupta; James C Fang; JoAnn Lindenfeld; Zubair Shah Journal: J Am Heart Assoc Date: 2021-08-21 Impact factor: 5.501