Invasive versus non-invasive hemodynamic monitoring of heart failure patients and their outcomes

Abstract

A cute decompensated heart failure (HF) is the most common cause of hospital admission in patients older than 65 years. Mean length of hospital stay is about 5–6 days and with a frequent number of hospital readmission rates of 25% to 50% at 30 days and 6–12 months, respectively. Treatment options are vast and depend on certain patient characteristics, including hemodynamics, which drive the acute management. A popular modality to assess hemodynamics in acute HF is the right heart catheterization (RHC). While invasive, the use of RHC gives providers the opportunity to evaluate values that directly contribute to the management of the patient. These numbers can calculate the cardiac output as well as help establish the underlying etiology of the patient’s symptoms and guide therapy. Per Doshi, the use of right artery catheterization increased from 2010−2014 per 1000 hospitalizations compared to 2005−2010. The ESCAPE trial was a large trial that evaluated the use of RHC to guide therapy, however, results were shown to increase adverse events without affecting overall mortality and hospitalization. It was not until its use was studied in patients with cardiogenic shock (CS) in which RHC was shown to be associated with lower mortality and in-hospital cardiac arrest. Furthermore, another study compared RHC with N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements in the prognosis of chronic HF patients. It concluded that NT-proBNP was a better predictor of all-cause mortality with the benefit of being non-invasive. The role of RHC is still not clearly defined and its necessity in guiding therapy of HF patients is controversial. It is also not wellknown which patient’s populations benefit most from it. A retrospective study was conducted at a safetynet hospital in Jacksonville, Florida, USA. Through electronic medical record review, data was collected on HF admissions, procedures, medications, and medical history between January 2020 and December 2020. Inclusion criteria involved those patients over the age of 18 years who were admitted to the cardiac care unit. A total of 176 patients fitting this criteria were reviewed and stratified by age, gender, race, comorbidities, length of stay, ejection fraction (reduced vs. preserved), etiology of cardiomyopathy (ischemic vs. nonischemic), NT-proBNP and creatinine levels. Statistical analysis was performed using SPSS 22.0 (SPSS Inc., IBM, Chicago, IL, USA). Categorical variables are presented as counts (percentages). Continuous variables are presented as mean ± SD or median (interquartile range) as appropriate. Differences were assessed using the Pearson’s chi-squared test and Mann-Whitney U test as appropriate. The study was approved by the regional Institutional Review Board. All authors were involved in data collection and interpretation of results. This study resulted in 176 total patients. As shown in Table 1, out of these 176 patients, 95 patients were Caucasian and 81 patients were African American. 139 patients had HF with reduced ejection fraction (HFrEF) and 37 patients had HF with preserved ejection fraction (HFpEF). Furthermore, 14 patients Journal of Geriatric Cardiology