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July 6, 1994

Studies Question Right Heart Catheterization

JAMA. 1994;272(1):8. doi:10.1001/jama.1994.03520010016004

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LIKE MANY technologies, right heart catheterization became established in clinical practice without ever being studied in randomized controlled trials.

Physicians often consider data provided by the procedure, in which a catheter is threaded into the heart to provide continuous readings of central venous blood pressure and estimate intravascular volume, to be essential in making treatment decisions.

An attempt to conduct a randomized controlled trial in Canada failed because physicians would not submit enough patients for randomization, believing that they already knew when and how to use the procedure. Yet there is wide variation in when and how it is used. Right heart catheterization is performed on more than 1 million patients in the United States each year, at an average cost of $2000 each.

Now, however, two studies that controlled for severity of illness are raising questions about possible benefits of the procedure. One study could find no overall benefit

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