Impact of pulmonary artery catheter on outcome in patients with acute heart failure syndromes with hypotension or receiving inotropes: from the ATTEND Registry.
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 ≤ 100 mm Hg; 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.
Sakurabashi Watanabe Hospital, Cardiovascular Center, Osaka, Japan. Electronic address: sotomiyohei@yahoo.co.jp.
Yohei
Y
Sotomi
Nippon Medical School Musashi Kosugi Hospital, Department of Internal Medicine and Cardiology, Kanagawa, Japan.
Naoki
N
Sato
Sensoji Hospital, Division of Cardiology, Tokyo, Japan.
Katsuya
K
Kajimoto
Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Osaka, Japan.
Yasushi
Y
Sakata
Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan.
Masayuki
M
Mizuno
Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan.
Yuichiro
Y
Minami
Sakurabashi Watanabe Hospital, Cardiovascular Center, Osaka, Japan.
Kenshi
K
Fujii
Nippon Medical School, Department of Cardiovascular Medicine, Tokyo, Japan.
Teruo
T
Takano
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002407:Catheterization, Swan-Ganz / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors
D002316:Cardiotonic Agents
Acute decompensated heart failure syndrome; In-hospital mortality; Pulmonary artery catheter