Impact of pulmonary artery catheter on outcome in patients with acute heart failure syndromes with hypotension or receiving inotropes: From the ATTEND Registry

Background: Randomized controlled trials concerning pulmonary artery catheters (PACs) use have yielded little evidence of their beneficial effects on survival. This study aimed to evaluate the association between PACs and in-hospital mortality in patients with acute heart failure syndromes (AHFS). Methods: The Acute Decompensated Heart Failure Syndromes (ATTEND) Registry is a prospective, observational, multicenter cohort study performed in Japan, since April 2007. We analyzed data from the ATTEND Registry and evaluated the effectiveness of PAC in AHFS treatment using propensity score-matching and the Cox proportional hazards model. Results: Final follow-up examinations of the 4842 patients were conducted in December 2012. During the study period, 813 patients (16.8%) were managed with PACs, of which 502 patients (PAC group) were propensity score-matched with 502 controls (Control group). Of the 1004 score-matched patients, 22 (4.4%) patients from the Control group and 7 (1.4%) from the PAC group died. The risk of all-cause death was lower in the PAC group than that in the Control group [ hazard ratio (HR), 0.3; 95% confidence interval (CI), 0.13-0.70; p = 0.006]. PAC-guided therapy decreased all-cause mortality in patients with lower systolic blood pressure (SBP <= 100 mm Hg; HR, 0.09; 95% CI, 0.01-0.70; p = 0.021) or inotropic therapy (HR, 0.22; 95% CI, 0.08-0.57; p = 0.002). Conclusions: This study revealed that appropriate PAC use effectively decreases in-hospital mortality in AHFS patients, particularly those with lower SBP or receiving inotropic therapy, suggesting that real-world PAC use could improve AHFS management. (C) 2014 Elsevier Ireland Ltd. All rights reserved.