title: Variation in Hospital Use and Outcomes Associated With Pulmonary Artery Catheterization in Heart Failure in the United States.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
authors: From the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., A.P., S.B., D.J.K.); Cambridge Health Alliance Hospital, Harvard Medical School, Boston, MA (N.K.); Division of Cardiology, Indiana University School of Medicine, Indianapolis (R.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.G.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City (S.G.); and Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Ronald Reagan-University of California at Los Angeles Medical Center (G.C.F.).
authors: Rohan
authors: R
authors: Khera
authors: From the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., A.P., S.B., D.J.K.); Cambridge Health Alliance Hospital, Harvard Medical School, Boston, MA (N.K.); Division of Cardiology, Indiana University School of Medicine, Indianapolis (R.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.G.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City (S.G.); and Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Ronald Reagan-University of California at Los Angeles Medical Center (G.C.F.).
authors: Ambarish
authors: A
authors: Pandey
authors: From the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., A.P., S.B., D.J.K.); Cambridge Health Alliance Hospital, Harvard Medical School, Boston, MA (N.K.); Division of Cardiology, Indiana University School of Medicine, Indianapolis (R.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.G.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City (S.G.); and Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Ronald Reagan-University of California at Los Angeles Medical Center (G.C.F.).
authors: Nilay
authors: N
authors: Kumar
authors: From the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., A.P., S.B., D.J.K.); Cambridge Health Alliance Hospital, Harvard Medical School, Boston, MA (N.K.); Division of Cardiology, Indiana University School of Medicine, Indianapolis (R.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.G.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City (S.G.); and Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Ronald Reagan-University of California at Los Angeles Medical Center (G.C.F.).
authors: Rajeev
authors: R
authors: Singh
authors: From the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., A.P., S.B., D.J.K.); Cambridge Health Alliance Hospital, Harvard Medical School, Boston, MA (N.K.); Division of Cardiology, Indiana University School of Medicine, Indianapolis (R.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.G.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City (S.G.); and Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Ronald Reagan-University of California at Los Angeles Medical Center (G.C.F.).
authors: Shah
authors: S
authors: Bano
authors: From the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., A.P., S.B., D.J.K.); Cambridge Health Alliance Hospital, Harvard Medical School, Boston, MA (N.K.); Division of Cardiology, Indiana University School of Medicine, Indianapolis (R.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.G.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City (S.G.); and Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Ronald Reagan-University of California at Los Angeles Medical Center (G.C.F.).
authors: Harsh
authors: H
authors: Golwala
authors: From the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., A.P., S.B., D.J.K.); Cambridge Health Alliance Hospital, Harvard Medical School, Boston, MA (N.K.); Division of Cardiology, Indiana University School of Medicine, Indianapolis (R.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.G.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City (S.G.); and Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Ronald Reagan-University of California at Los Angeles Medical Center (G.C.F.).
authors: Dharam J
authors: DJ
authors: Kumbhani
authors: From the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., A.P., S.B., D.J.K.); Cambridge Health Alliance Hospital, Harvard Medical School, Boston, MA (N.K.); Division of Cardiology, Indiana University School of Medicine, Indianapolis (R.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.G.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City (S.G.); and Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Ronald Reagan-University of California at Los Angeles Medical Center (G.C.F.).
authors: Saket
authors: S
authors: Girotra
authors: From the Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., A.P., S.B., D.J.K.); Cambridge Health Alliance Hospital, Harvard Medical School, Boston, MA (N.K.); Division of Cardiology, Indiana University School of Medicine, Indianapolis (R.S.); Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.G.); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine Iowa City (S.G.); and Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Ronald Reagan-University of California at Los Angeles Medical Center (G.C.F.). gfonarow@mednet.ucla.edu.
authors: Gregg C
authors: GC
authors: Fonarow
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000628:therapy; D016022:Case-Control Studies; D002407:Catheterization, Swan-Ganz / Q000706:statistics & numerical data* / Q000639:trends; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000628:therapy; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy; D016208:Databases, Factual; D019468:Disease Management; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D057216:Propensity Score; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000628:therapy; D014481:United States
keywords: International Classification of Diseases; catheterization; heart failure; hospitalization; pulmonary artery