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In this issue of JAMA Internal Medicine, Pandey et al1 examine national trends in the use of pulmonary artery (PA) catheters for acute episodes of heart failure. The PA catheter, a central venous line thread through the right side of the heart so that its tip resides in the PA, provides multiple central oxygenation, pressure, and volume measures. Following the first report of a case series by Swan et al in 1970,2 the PA catheter was adopted rapidly in intensive care, coronary care, and operating rooms for conditions involving shock or hemodynamic compromise. However, a large observational study by Connors et al3 in 1996 associated the PA catheter with no benefit and possible harm. That study prompted several randomized clinical trials (RCTs), all of which had negative findings,4- 7 leading to a dramatic drop in the use of PA catheters. Pandey et al1 used the National Inpatient Sample from 2001 to 2012 and focused only on acute heart failure. They reported dropping rates initially. However, since 2007, use appears to be climbing, although the reasons are unknown. This finding prompts several thoughts.
Angus DC. Ongoing Use of Pulmonary Artery Catheters Despite Negative Trial Findings. JAMA Intern Med. 2016;176(1):133-134. doi:10.1001/jamainternmed.2015.6547