Impact of pulmonary artery catheter on outcome in patients with acute heart failure syndromes with hypotension or receiving inotropes: From the ATTEND Registry.
Int J Cardiol. 2014 Jan 9;
Authors: Sotomi Y, Sato N, Kajimoto K, Sakata Y, Mizuno M, Minami Y, Fujii K, Takano T, On behalf of the investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) Registry
Abstract
BACKGROUND: Randomized controlled trials concerning pulmonary artery catheters (PACs) use have yielded little evidence of their beneficial effects on survival. This study aimed to evaluate the association between PACs and in-hospital mortality in patients with acute heart failure syndromes (AHFS).
METHODS: The Acute Decompensated Heart Failure Syndromes (ATTEND) Registry is a prospective, observational, multicenter cohort study performed in Japan, since April 2007. We analyzed data from the ATTEND Registry and evaluated the effectiveness of PAC in AHFS treatment using propensity score-matching and the Cox proportional hazards model.
RESULTS: Final follow-up examinations of the 4842 patients were conducted in December 2012. During the study period, 813 patients (16.8%) were managed with PACs, of which 502 patients (PAC group) were propensity score-matched with 502 controls (Control group). Of the 1004 score-matched patients, 22 (4.4%) patients from the Control group and 7 (1.4%) from the PAC group died. The risk of all-cause death was lower in the PAC group than that in the Control group [hazard ratio (HR), 0.3; 95% confidence interval (CI), 0.13-0.70; p=0.006]. PAC-guided therapy decreased all-cause mortality in patients with lower systolic blood pressure (SBP≤100mmHg; HR, 0.09; 95% CI, 0.01-0.70; p=0.021) or inotropic therapy (HR, 0.22; 95% CI, 0.08-0.57; p=0.002).
CONCLUSIONS: This study revealed that appropriate PAC use effectively decreases in-hospital mortality in AHFS patients, particularly those with lower SBP or receiving inotropic therapy, suggesting that real-world PAC use could improve AHFS management.
PMID: 24447746 [PubMed - as supplied by publisher]