The use of pulmonary artery catheterization has declined

Introduction

Even without the proof of benefit by randomized controlled trials, pulmonary artery catheterization (PAC) has been in wide clinical use in critical care and cardiology since its introduction in 1970. However, during the past decade, several studies and editorials have questioned its safety and have suggested increased risk of morbidity and mortality from its use. During the same period, there were also publications supporting its continued wide use. We hypothesized that these publications had no effect on the frequency of use of the PAC. We performed this study to determine whether or not there was a change in the use of PAC, and if so in which direction and under what circumstances.

Methods

We studied all the PACs performed during the years 2000 and 2001 in all the hospitals within the state of Illinois, USA. We used the Illinois Health Care Cost Containment Council database for the years of this study. We used the International Classification of Diseases, ninth revision, Clinical Modification (ICD9M) code for PAC to identify all the PACs performed in the Illinois hospitals during 2000 and 2001. We then analyzed the data based upon age, gender, hospital size, and regions of the state using SPSS statistical software.

Results

There were 1,636,046 hospital discharges in 2000 and 1,684,089 discharges in 2001 with the PAC rates of 3.65 and 2.98 per 1000 discharges, respectively. In spite of the increase in the number of patients treated in 2001, there was an overall decrease in the use of PAC by 943 (15.8%), from 5965 in 2000 to 5022 in 2001 throughout the state. Among patients older than 75, there was a reduction of 297 (15.5%), from 1917 in 2000 to 1620 in 2001. Among patients 65–74 years of age, there was a reduction of 364 (21%), from 1739 in 2000 to 1375 in 2001. The largest reduction of 57% was seen in the age group of 0–17, from 21 in 2000 to nine in 2001. Among males there was a PAC usage reduction of 522 (15%), from 3492 in 2000 to 2970 in 2001. Among females there was a reduction of 421 (17%), from 2473 in 2000 to 2052 in 2001. Across the state, 10 large medical centers had a 177 (20%) decline in PAC use, from 873 in 2000 to 696 in 2001. All the other hospitals had a 766 (15%) decrease from 5092 to 4326. Among the regions of the state, the city of Chicago, the Rockford area, and the southern region of the state, close to St Louis, had the largest reductions of 431 (39.4%), 199 (40%), and 94 (33.6%), respectively. The central region of the state had a reduction of 15%.

Conclusion

The use of PAC has decreased on the average of 15% in 1 year. The larger cities and metropolitan areas had a greater decline of 40% in the use of PAC during the same period of time, indicating rapid adaptation of new knowledge.