Right Heart Catheterization Timing and Outcomes of Cardiogenic Shock: Analysis from the National Readmission Database |
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| Institution: | 1. Division of Cardiovascular Medicine, University of Toledo, Toledo, OH;2. Department of Hospital Medicine, University of North Dakota, Bismarck, ND;3. Department of Internal Medicine, Lincoln Medical Center, New York, NY;4. Departement of Medicine, Carl Foundation Hospital, Urbana, IL, USA;1. Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA;2. Department of Hospital Medicine, University of North Dakota, Bismarck, ND, USA;3. Department of Internal Medicine, Lincoln Medical Center, New York, NY, USA;4. Department of Cardiovascular Medicine, Tanta University, Tanta, Egypt;5. Department of Internal Medicine, University of Toledo, Toledo, OH, USA;6. Center for Advanced Heart and Lung Diseases, Baylor University, Dallas, TX, USA;7. Department of Internal Medicine, East Carolina University, Greenville, NC, USA;8. Department of Medicine, Weil Cornell Medicine-Qatar, Doha, Qatar;1. Department of Medicine, University of Toledo, Toledo, OH;2. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Toledo, Toledo, OH;3. Division of Cardiovascular Medicine, Department of Medicine, University of Toledo, Toledo, OH;1. Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar;2. Drug Information Centre, Hamad Medical Corporation, Doha, Qatar;3. Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar;4. College of Pharmacy, QU Health, Qatar University, Doha, Qatar;1. Department of Medicine, Division of Cardiology, Baylor College of Medicine, Houston, TX.;2. Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH.;3. Division of Medicine, Forrest General Hospital, Hattiesburg, MS.;4. Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Texas Medical Branch, Galveston, TX.;5. Division of Internal Medicine, University of Texas Medical Branch, Galveston, TX.;6. Department of Cardiology, Division of Internal Medicine, University of Texas Medical Branch, Galveston, TX.;1. Department of Cardiovascular Medicine, Reading Hospital Tower Health, West Reading, PA;2. Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH;3. Department of Cardiovascular Medicine, University of Toledo, Toledo, OH;4. Department of Medicine, University of Toledo, Toledo, OH;5. ProMedica Heart Institute, ProMedica Toledo Hospital, Toledo, OH |
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| Abstract: | Recent studies showed significant mortality benefit with right heart catheterization (RHC) use in cardiogenic (CS). The optimal timing of RHC in those patients is unknown owing to the lack of available data. The Nationwide Readmission Database 2016-2018 was queried for hospitalizations with CS. We excluded patients presented with cardiac arrest or with a history of ventricular assist devices or heart transplantation. Complex samples multivariable logistic, cox, and linear regression models were used to determine the association between RHC timing in the index admission (<2 days early RHC] vs ≥ 2 days late RHC]) and in-hospital outcomes (mortality, acute kidney injury AKI], mechanical circulatory device use MCD], index length of stay LOS], hospital charges), and all-cause 30-day readmissions. A total of 46,963 hospitalizations 18,632 in the early group and 28,332 in the late group] were included in this analysis. RHC was more likely to happen in large teaching hospitals. Although there was no difference in mortality (adjusted odds ratio aOR]: 1.05; Confidence interval CI] 0.97-1.14; P= 0.233). Patients in the early RHC group had a lower incidence of AKI (aOR: 0.69; CI: 0.64-0.74; P < 0.01), higher rate of MCS use (aOR:1.67; CI:1.54-1.81; P < 0.001), shorter LOS (aβ :-6.2; CI -6.62 to -5.77; P <.001), lower hospital charges, and lower readmission rates (adjusted hazards ratio aHR]: 0.91; CI: 0.84- 0.98; P = 0.01) compared to the late RHC group. Early RHC was associated with decreased incidence of AKI, decreased LOS, total charges, and readmission rates with no difference in survival. Subgroup analysis of patients who did not receive MCS during the index admission showed similar outcomes albeit with increased mortality. Further randomized controlled trials are needed to validate these results. |
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