Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
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.
Lee, Jr TH. Does Right Heart Catheterization Prevent Perioperative Complications?—Reply. JAMA. 2001;286(23):2940-2941. doi:10.1001/jama.286.23.2940