Abstract 12738: Right Heart Catheterization in Patients with Acute Decompensated Heart Failure Syndromes: Short-term Analysis of ATTEND Registry from Japan

Abstract

Background: Recent studies have reported that right heart catheterization (RHC) may lead to increase mortality in critically ill patients. The randomized controlled trial of the RHC for patients with congestive heart failure previously revealed that RHC did not affect overall mortality and hospitalization. In this study, we evaluated the effectiveness of RHC limited for the patients with acute heart failure syndromes (AHFS).

Methods: This study analyzed the use of RHC in the acute decompensated heart failure syndromes (ATTEND) registry comprising 4,796 patients in Japan. This registry is a prospective, observational, multicenter cohort study performed in Japan from 2007 to 2011 and is the first epidemiological study of AHFS in the Asia Pacific region. A propensity score for RHC was constructed using multivariable logistic regression. Case-matching and multivariable regression modeling techniques were used to estimate the association of RHC with in-hospital mortality after adjusting for treatment selection using the propensity score.

Results: A total of 806 (16.8 %) patients received RHC. During 5 years from 2007, the use of RHC decreased from 22.5% to 12.7%. By case-matching analysis, there was no significant difference in the in-hospital mortality between patients with or without RHC (odds ratio, 0.64; 95 % confidence interval, 0.37-1.13; p= 0.125). Subgroup analysis based on age, gender, ischemic etiology, history of heart failure, left ventricular ejection fraction (EF > 40 % or EF ≦ 40 %), systolic blood pressure on admission (SBP > 100 mmHg or SBP ≦100 mmHg), New York Heart Association classification (NYHA II,III or IV) revealed that no significant improvement for the in-hospital mortality with RHC was found in each stratum except for NYHA subclass IV (odds ratio 0.43; 95 % confidence interval, 0.20-0.92; p= 0.03).

Conclusion: It is possible that RHC can reduce the in-hospital mortality of the patients with AHFS limited to NYHA subclass IV. These findings justify reconsideration of randomized controlled trial of RHC for the patients with AHFS.