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No increase in deaths for heart failure patients with pulmonary artery catheter

rimary goal of the study was to evaluate whether the increased precision that a PAC offers regarding heart and lung pressures translates to improved patient survival and reduced time spent in the hospital over 6 months compared with therapy primarily guided by clinical assessment of physical signs and symptoms. Other study objectives included comparisons of quality of life, ability to exercise, and changes in the heart's structure and function as measured by echocardiograms. The study also sought to evaluate costs and resources associated with the PAC. These results are not yet available.

Study patients had "Class 4" advanced heart failure (severe physical limits, symptoms at rest, and low 2-year survival rate). The average patient age was 56 years. Seventy-four percent of the participants were male and 40 percent were minority. About half (215) of the patients were randomly assigned to receive PACs and 218 patients were assigned to the clinical assessment group. Patients could receive any of the other standard therapies and medications for heart failure.

The PAC is a thin catheter that is inserted via a neck vein and passed through the right side of the heart into the pulmonary artery. Once the catheter is in place, pressures and flows can be measured from the right side of the heart and the lungs. A tiny balloon is inflated to allow measurement of pressures from the left side of the heart. Excess pressure can build up in the heart when it is not pumping effectively. This can further weaken the heart and lead to the hallmark symptoms of heart failure, which are shortness of breath and fluid buildup in the lungs, ankles, and legs.

The PAC, which is used in 3 to 5 percent of heart failure hospitalizations, is used not only to diagnose the specific part of the heart that is not functioning or pumping properly but also to gauge the effect of medications on heart function and symptoms. Physicians can use the PAC to
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Contact: NHLBI Communications Office
nhlbi_news@nhlbi.nih.gov
301-496-4236
NIH/National Heart, Lung, and Blood Institute
9-Nov-2004


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