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January 8, 1997

Effectiveness of Right Heart Catheterization: Time for a Randomized Trial-Reply

Author Affiliations

University of Virginia School of Medicine Charlottesville

JAMA. 1997;277(2):113-114. doi:10.1001/jama.1997.03540260027027

In Reply.  —In our prospective observational cohort study of RHC, we adjusted for treatment selection bias using a multivariable propensity score. The adjustment was done using 2 standard techniques: multivariable analysis in all 5735 patients, which should yield the best estimate of the treatment effect, and matched-pair analysis in 2016 patients, which is less powerful but more easily understood. As reported, the results were essentially identical.Dr Baxter and colleagues and Drs Jackson, Lewis, Punch, and Kaufman express several concerns about the generalizability of our results. We agree that surgical patients and patients with acute MI, head injury, and subarachnoid hemorrhage are not well represented in this analysis. We do not recommend applying our results to these populations. While our population represented the sickest patients in the ICUs at the 5 study hospitals (hence, the high mortality), we contend that this is the appropriate population for an analysis of the procedure. Right