Variation in Hospital Use and Outcomes Associated With Pulmonary Artery Catheterization in Heart Failure in the United States

Circ Heart Fail. 2016 Nov;9(11):e003226. doi: 10.1161/CIRCHEARTFAILURE.116.003226.

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.

Keywords: International Classification of Diseases; catheterization; heart failure; hospitalization; pulmonary artery.

MeSH terms

  • Aged
  • Arrhythmias, Cardiac / epidemiology
  • Arrhythmias, Cardiac / therapy
  • Case-Control Studies
  • Catheterization, Swan-Ganz / statistics & numerical data*
  • Catheterization, Swan-Ganz / trends
  • Cerebrovascular Disorders / epidemiology
  • Cerebrovascular Disorders / therapy
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / therapy
  • Databases, Factual
  • Disease Management
  • Female
  • Heart Arrest / epidemiology
  • Heart Arrest / therapy
  • Heart Failure / epidemiology
  • Heart Failure / mortality
  • Heart Failure / therapy*
  • Hospital Mortality*
  • Hospitals / statistics & numerical data*
  • Humans
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / therapy
  • Odds Ratio
  • Practice Patterns, Physicians'*
  • Propensity Score
  • Shock, Cardiogenic / epidemiology
  • Shock, Cardiogenic / therapy
  • United States