title: Right- and left-sided heart catheterization as a quality marker for catheterization laboratories (from the national Veterans Affairs clinical assessment reporting and tracking program).
abstract: The rate of concurrent right-heart catheterization (RHC) in patients undergoing left-heart catheterization (LHC) for coronary artery disease (CAD) indications or bilateral heart catheterization (BHC) is recommended as a measure of hospital quality, with higher rates suggesting over utilization. Our aim was to describe the prevalence of BHC and abnormal RHC findings in patients undergoing BHC with a primary indication for LHC. A retrospective analysis was performed for patients undergoing cardiac catheterization for CAD indications using the Department of Veterans Affairs Clinical Assessment Reporting and Tracking Program. Patients undergoing catheterization from October 2007 to September 2011 in 76 Veterans Affairs hospitals were included. Among 95,656 patients undergoing catheterization for CAD, 6,611 (6.9%) underwent BHC and 88,929 (93.0%) LHC. Among the patients undergoing BHC, 61.3% had at least 1 of the following abnormal RHC values: mean pulmonary artery (PA) pressure >25 mm Hg, pulmonary capillary wedge pressure (PCWP) >15 mm Hg, or pulmonary vascular resistance (PVR) >3 Woods units. A total of 37.5% of patients had mean PA pressures of 26 to 40 mm Hg and 11.1% had mean PA pressures >40 mm Hg. A total of 34.4% of patients had mean PCWP of 16 to 25 mm Hg and 13.6% had mean PAWP >25 mm Hg. A total of 16.5% of patients had PVR between 3 and 6 WU and 2.9% had PVR >6 WU. A total of 4.3% of patients met formal criteria for pulmonary arterial hypertension (defined as the combination of PA mean >25 mm Hg, PCWP ≤15 mm Hg, and PVR >3). In conclusion, these findings suggest that most BHC were performed for appropriate clinical reasons. Future studies should further explore BHC rate as an effective quality indicator.
authors.affiliation: Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California; Department of Cardiology, National Heart Centre Singapore, Singapore. Electronic address: khung.yeo@ucdmc.ucdavis.edu.
authors.forename: Khung Keong
authors.initials: KK
authors.lastname: Yeo
authors.affiliation: Cardiology Section, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado; Division of Cardiology, University of Colorado School of Medicine, Denver, Colorado.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: Veterans Affairs Clinical Assessment Reporting and Tracking Program, Denver, Colorado.
authors.forename: Evan
authors.initials: E
authors.lastname: Carey
authors.affiliation: Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California.
authors.forename: Reginald I
authors.initials: RI
authors.lastname: Low
authors.affiliation: Department of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California.
authors.forename: Kendrick A
authors.initials: KA
authors.lastname: Shunk
mesh_terms: D000368:Aged; D002300:Cardiac Care Facilities / Q000592:standards*; D006328:Cardiac Catheterization / Q000379:methods / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D006331:Heart Diseases / Q000175:diagnosis*; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis*; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health / Q000592:standards*