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

Rohan Khera, Ambarish Pandey, Nilay Kumar, Rajeev Singh, Shah Bano, Harsh Golwala, Dharam J. Kumbhani, Saket Girotra, Gregg C. Fonarow

Research output: Contribution to journalArticle

11 Citations (Scopus)

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.

Original languageEnglish (US)
Article numbere003226
JournalCirculation: Heart Failure
Volume9
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Swan-Ganz Catheterization
Heart Failure
Pulmonary Artery
Catheters
Mortality
Confidence Intervals
International Classification of Diseases
Hospital Mortality
Inpatients
Teaching
Hospitalization
Odds Ratio

Keywords

  • Catheterization
  • heart failure
  • hospitalization
  • International Classification of Diseases
  • pulmonary artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Variation in Hospital Use and Outcomes Associated with Pulmonary Artery Catheterization in Heart Failure in the United States. / Khera, Rohan; Pandey, Ambarish; Kumar, Nilay; Singh, Rajeev; Bano, Shah; Golwala, Harsh; Kumbhani, Dharam J.; Girotra, Saket; Fonarow, Gregg C.

In: Circulation: Heart Failure, Vol. 9, No. 11, e003226, 01.11.2016.

Research output: Contribution to journalArticle

Khera, Rohan ; Pandey, Ambarish ; Kumar, Nilay ; Singh, Rajeev ; Bano, Shah ; Golwala, Harsh ; Kumbhani, Dharam J. ; Girotra, Saket ; Fonarow, Gregg C. / Variation in Hospital Use and Outcomes Associated with Pulmonary Artery Catheterization in Heart Failure in the United States. In: Circulation: Heart Failure. 2016 ; Vol. 9, No. 11.
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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.",
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T1 - Variation in Hospital Use and Outcomes Associated with Pulmonary Artery Catheterization in Heart Failure in the United States

AU - Khera, Rohan

AU - Pandey, Ambarish

AU - Kumar, Nilay

AU - Singh, Rajeev

AU - Bano, Shah

AU - Golwala, Harsh

AU - Kumbhani, Dharam J.

AU - Girotra, Saket

AU - Fonarow, Gregg C.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - 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.

AB - 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.

KW - Catheterization

KW - heart failure

KW - hospitalization

KW - International Classification of Diseases

KW - pulmonary artery

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