Introduction: While recent studies have shown declining trends for bedside pulmonary artery catheterization (PAC) use, data describing diagnostic right heart catheterization (RHC) is lacking.
Hypothesis: To analyze temporal trends of hospitalization characteristics for RHC use in United States, and compare utilization rates with those of PAC.
Methods: Using Nationwide Inpatient Sample databases and International Classification of Diseases, Ninth Revision, Clinical Modification (37.21), we identified all adult hospitalizations (age≥ 18 years) during which RHC was performed. We studied RHC rates per 10,000 admissions, top five primary reasons for admissions and changes in patient demographics, regional variations and hospital characteristics. Additionally we compared RHC versus PAC utilization rates over these 12 years.
Results: Among 374,319,838 hospitalizations between 2003 and 2014, 375,119 (1%) had RHC. Utilization rates for RHC increased by approximately 104% while for PAC decreased by 37%.(Figure 1) Heart failure (30.4%), acute myocardial infarction (9.8%), coronary artery disease (8.5%), valvular heart disease (6.6%) and pulmonary-heart disease (6.1%) were top primary admission causes. From 2003 to 2014, RHC use increased significantly among males (57.1% to 60.8%), blacks (18.0% to 20.6%), public insurers (63.6% to 70.1%), Southern US hospitals (28.5% to 34.2%) and urban-teaching facilities (79.2% to 88.2%). Also RHC use increased for hospitalizations related to heart failure (28.3% to 33.6%), pulmonary-heart disease (5.9% to 6.4%) and valvular heart disease (5.2% to 7.3%), while declined for acute myocardial infarction (11.8% to 9.3%) and coronary artery disease(12.2% to 6.2%). In-hospital mortality declined from 8.6% to 7.1%. (all p trend <0.001)
Conclusion: Over a span of 12 years, diagnostic RHC use almost doubled while bedside PAC use has decreased. There has been a significant change in hospitalization characteristics for RHC use.