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Letters
December 19, 2001

Does Right Heart Catheterization Prevent Perioperative Complications?—Reply

Author Affiliations
 

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(23):2940-2941. doi:10.1001/jama.286.23.2940

In Reply: Dr Myla raises the issue of detection bias—that is, the possibility that the use of RHC might simply improve diagnosis of CHF by providing data on PCWP. Such a bias would not explain the significantly increased odds of our combined end point of major cardiac events, which included pulmonary edema as well as less severe heart failure, or the increased length of stay among patients who underwent RHC.

We agree with Dr Spodick on the need for trials to identify patient subsets for whom RHC is beneficial. As Dr Trzeciak and colleagues point out, such trials are especially challenging because they must evaluate not only the accuracy of data obtained from RHC, but also how the data are used to guide interventions. Thus, any RCT should include guidelines for the clinical response to specific findings from RHC. In response to Dr De Backer and colleagues, we noted that the potential for incomplete adjustment for confounding was noted in our article and we called for trials that would address this issue.

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