Right Heart Catheterization in Cardiogenic Shock Is Associated With Improved Outcomes: Insights From the Nationwide Readmissions Database

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Andrew J. Sauer¹  Zubair Shah¹  Amandeep Goyal¹  Kamal Gupta¹  Nicholas Haglund¹  Ioannis Mastoris¹  Prakash Acharya¹  Sagar Ranka¹  Bhanu Gupta¹  Robert Weidling²  Ryan J. Tedford³  James C. Fang⁴  JoAnn Lindenfeld⁵  Aniket Rali⁶  Navin K. Kapur⁷ 

[1] Department of Cardiovascular Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS;Department of Internal Medicine The University of Kansas Health SystemUniversity of Kansas School of Medicine Kansas City KS;Division of Cardiology Department of Medicine Medical University of South Carolina Charleston SC;Division of Cardiovascular Medicine University of Utah Salt Lake City UT;Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN;Division of Pulmonary Critical Care and Sleep Medicine Department of Internal Medicine Baylor College of Medicine Houston TX;The Cardiovascular Center Tufts Medical Center Tufts University School of Medicine Boston MA;

关键词: cardiogenic shock;    catheterization;    outcome;    readmission;   

DOI  :  10.1161/JAHA.120.019843

来源: DOAJ

【 摘 要 】

Background The usefulness of right heart catherization (RHC) has long been debated, and thus, we aimed to study the real‐world impact of the use of RHC in cardiogenic shock. Methods and Results In the Nationwide Readmissions Database using International Classification of Diseases, Tenth Revision (ICD‐10), we identified 236 156 patient hospitalizations with cardiogenic shock between 2016 and 2017. We sought to evaluate the impact of RHC during index hospitalization on management strategies, complications, and outcomes as well as on 30‐day readmission rate. A total 25 840 patients (9.6%) received RHC on index admission. The RHC group had significantly more comorbidities compared with the non‐RHC group. During the index admission, the RHC group had lower death (25.8% versus 39.5%, P<0.001) and stroke rates (3.1% versus 3.4%, P<0.001). Thirty‐day readmission rates (18.7% versus 19.7%, P=0.04) and death on readmission (7.9% versus 9.3%, P=0.03) were also lower in the RHC group. After adjustment, RHC was associated with lower index admission mortality (odds ratio, 0.69; 95% CI, 0.66–0.72), lower stroke rate (odds ratio, 0.81; 95% CI, 0.72–0.90), lower 30‐day readmission (odds ratio, 0.83; 95% CI, 0.78–0.88), and higher left ventricular assist device implantations/orthotopic heart transplants (odds ratio, 6.05; 95% CI, 4.43–8.28) during rehospitalization. Results were not meaningfully different after excluding patients with cardiac arrest. Conclusions RHC use in cardiogenic shock is associated with improved outcomes and increased use of downstream advanced heart failure therapies. Further blinded randomized studies are required to confirm our findings.

【 授权许可】

Unknown