Association Between Pulmonary Artery Catheterization (PAC) Mortality, Length of Stay, and Cost utilizing a National Electronic Health Record Database in 2020

Samuel Y Huang1 1 Icahn School of Medicine At Mount Sinai and Mount Sinai South Nassau, Oceanside, NY, United States of America

Abstract

Importance Pulmonary artery catheters (PACs) play a pivotal role in managing acute hemodynamic decompensation, allowing for the assessment of right and left ventricular hemodynamic parameters and can allow for determination of SVO2 over echocardiogram. However, because of their invasive nature, increased understanding of their overall benefits is important. In certain populations with decrease compliance such as in patients with ischemia, information from PACs may be hard to utilize.

Aim This study focuses on evaluating the impact of Pulmonary Artery Catheterizations (PAC) in patients with heart failure and ischemia admitted to the inpatient setting to discern whether PAC usage is associated with increased in hospital mortality rates, prolonged length of stay, costs, and complications. A subgroup analysis will be performed to see if there is a change in outcomes in individuals with and without cardiogenic shock as well as in individuals with mechanical circulatory support devices such as Intra-aortic balloon pumps (IABP), intraoperative Extracorporeal mechanical oxygenation (ECMO), mechanical ventilation, and renal dialysis.

Objective The utilization of pulmonary artery catheters (PACs) in guiding decision-making for the management of cardiogenic shock is a common practice. However, despite their widespread use, there is a paucity of robust evidence delineating the optimal application of PACs in the context of cardiogenic shock. The existing literature lacks conclusive support for the efficacy and benefits of obtaining hemodynamic data through early PAC placement in patients experiencing CS. This study seeks to address this gap by rigorously examining the association between early PAC placement and pertinent clinical outcomes, aiming to contribute evidence that can inform and optimize the management of cardiogenic shock.

Design, setting, and participants This retrospective study utilized the National Inpatient Sample (NIS) data for the year 2020, focusing on patients with heart failure and diagnosis of ST elevation myocardial infarction (STEMI) with description of those experiencing cardiogenic shock, individuals receiving intra-aortic balloon pumps (IABPs), undergoing mechanical interventions, and those treated with extracorporeal membrane oxygenation (ECMO). Additionally, the study included patients who underwent Pulmonary Artery Catheterization (PAC). Methods ICD-10 codes lung cancers were identified from the American Medical Association Complete Official Handbook. Heart failure, Ischemia, and pulmonary artery catheterizationss ICD-10 codes. Multivariable linear regression and logistic regression models were employed, incorporating Charlson comorbidity, age, gender, race, and cardiogenic shock, to assess the impact of catheterization on length of stay, healthcare costs, and mortality in patients with heart failure, ischemia, and cardiogenic shock. Additionally, a Kaplan-Meier analysis was conducted to evaluate the time to 30-day discharge for patients who underwent catheterization, considering demographic variables and cardiogenic shock as potential influencing factors.

Results The final minimal dataset comprised a total of 114,647 individuals who had both congestive heart failure and ischemia, with a mean age of 70.66 years (SD = 13.37). Among these patients, 11.47% (13,147 individuals) experienced mortality. Females constituted 42.19% of the cohort. The mean length of hospital stay (LOS) for this population was 7.16 days (SD = 8.64). Notably, 5.52% of patients received pulmonary artery catheterization (PAC). Upon multivariable analysis pulmonary catheterization was associated with a 18% decreased mortality (95% CI: 0.76 – 0.89, pvalue < 0.001), increase length of stay of 2.1 days (95% CI 1.88 to 2.32, p<0.001), and increased cost of $20,150.37 (95% CI $19,109.28 to $21,191.46, pvalue < 0.001).

Conclusion Using a nationally representative sample and a large dataset, pulmonary artery catheterizations in patients with congestive heart failure and a diagnosis of STEMI who received a PAC was associated with decreased mortality, increased length of stay and increased cost. Further studies are needed to characterize causation and to apply for each specific region and population of interest.