Research from Duke Clinical Research Institute (DCRI) and Brigham and Women's Hospital, Boston, shows that hospitalized patients whose therapy was guided by pulmonary artery catheterization (PAC) experienced the same survival and re-hospitalization outcomes as patients whose therapy was evaluated with expert physical assessment.

The value of PAC, an invasive diagnostic procedure used to guide treatment for patients with critical illness, has remained one of the most controversial topics in critical care medicine, following publication of a major observational study in 1996 by researchers at Case Western Reserve University that suggested the procedure may increase risk of death in severely ill patients.

While some physicians have urged the procedure be banned altogether, the Duke-Brigham researchers believe that their findings should put an end to many aspects of an ongoing debate over its use specifically for heart failure patients.

The researchers say that a lack of benefit from the procedure suggests that PAC use should be limited to experienced centers and used only on patients with severe symptoms that persist despite previous therapies.

Research Findings

Published in the same edition is a DCRI-led meta-analysis of 13 randomized clinical trials involving PAC which found that the device does not appear to improve outcomes nor confer added risks to patients.

The researchers concluded from that study that PACs should not be used routinely in patients in intensive care units, patients with severe heart failure, or patients undergoing surgery until further studies can uncover any correlations between outcomes from the use of the device with specific treatments.

"What may startle many people is that we have absolutely no therapies that have been proven by modern standards of evidence to benefit patients with acute heart failure, which is the fastest growing reason for hospitalization in the United States," says Robert Califf, MD, director of the DCRI and study member.