Right Heart Catheterization in Cardiogenic Shock Is Associated With Improved Outcomes: Insights From the Nationwide Readmissions Database
Why the study?
The usefulness of right heart catheterization has long been debated, prompting an evaluation of its real-world impact in cardiogenic shock.
Does right heart catheterization improve outcomes in patients hospitalized with cardiogenic shock?
Population
236 156 patient hospitalizations with cardiogenic shock
Comparison
RHC during index admission vs non-RHC
Design
Retrospective database study
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
RHC was associated with lower mortality in cardiogenic shock; leaves open whether routine use improves outcomes pending randomized trials.
Key Points
- To determine the real-world association between right heart catheterization and in-hospital outcomes, complications, and 30-day readmissions in patients admitted with cardiogenic shock.
- Retrospective cohort study analyzing 236,156 hospitalizations with cardiogenic shock from the US Nationwide Readmissions Database (2016–2017).
- Compared outcomes between patients managed with right heart catheterization (N=25,840; 9.6%) and without it, adjusting for baseline comorbidities and cardiac arrest.
- Right heart catheterization was associated with lower index hospitalization mortality (25.8% vs 39.5%, P<0.001; adjusted OR 0.69, 95% CI, 0.66–0.72) and lower stroke rates (3.1% vs 3.4%, P<0.001; adjusted OR 0.81, 95% CI, 0.72–0.90).
- Patients receiving catheterization had lower 30-day readmission rates (18.7% vs 19.7%, P=0.04; adjusted OR 0.83, 95% CI, 0.78–0.88) and significantly higher rates of receiving left ventricular assist devices or heart transplants on readmission (adjusted OR 6.05, 95% CI, 4.43–8.28).
Structured PICO
Does right heart catheterization improve outcomes in patients hospitalized with cardiogenic shock?
P
Population
236,156 patient hospitalizations with cardiogenic shock between 2016 and 2017 identified in the Nationwide Readmissions Database.
I
Intervention
Right heart catheterization (RHC) during index hospitalization.
C
Comparator
No right heart catheterization during index hospitalization.
O
Outcome
Index admission mortality, stroke rate, 30-day readmission rate, and death on readmission.hard clinical
Right heart catheterization in cardiogenic shock is associated with improved survival and lower readmission rates, supporting its use to guide management.
Cite This Study
Ranka et al. (2021) studied this question.