Heart Monitor Procedure Linked to Higher Fatalities, Study Finds

A heart monitoring procedure used a million or more times a year in this country to treat critically ill patients may actually be killing some of them, researchers say.

Patients who underwent the procedure, called right heart catheterization, had a 21% higher risk of death in the succeeding 30 days, according to figures on 5,735 intensive-care unit patients at five U.S. medical centers.

Right heart catheterization involves inserting a balloon-tipped catheter into a neck vein and guiding it into the heart’s right atrium. The procedure allows doctors to measure how the heart is performing and choose the right treatment.

The procedure, in use for 25 years, is a central element of care for critically ill patients who are in shock or whose hearts are functioning abnormally. The annual cost associated with its use is more than $2 billion.

Though some patients might benefit from the procedure, Dr. Alfred F. Connors Jr. of the University of Virginia said his study failed to identify any who did.

“What we determined is that there clearly is an association between the use of right heart catheters and a higher rate of death,” Connors said.

Connors offered some possible reasons: Any time a foreign agent like a catheter is inserted into the body, there’s an infection risk. And the procedure has been known to irritate the heart muscle and sometimes cause irregular heartbeats.

Besides the higher death rate, his study linked the procedure to longer stays in the intensive-care unit and higher hospital costs.

Connors and his colleagues said the research is the largest, most detailed study on right heart catheterization. It was published in today’s Journal of the American Medical Assn.

“There’s no question that the health establishment should pay attention to that,” said Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute at the National Institutes of Health. But he said banning the procedure without further research is “perhaps a little bit jumping to conclusions.”

In an accompanying JAMA editorial, two doctors said the findings are alarming enough to warrant either immediate clinical trials by the institute or a government moratorium on the procedure.