Right Heart Catheterization Timing and Outcomes of Cardiogenic Shock: Analysis from the National Readmission Database.

INTRODUCTION: Recent studies showed significant mortality benefit with right heart catheterization (RHC) use in cardiogenic (CS). The optimal timing of RHC in those patients is unknown owing to the lack of available data.

METHODS: The Nationwide Readmission Database 2016-2018 was queried for hospitalizations with CS. We excluded patients presented with cardiac arrest or with a history of ventricular assist devices or heart transplantation. Complex samples multivariable logistic, cox, and linear regression models were used to determine the association between RHC timing in the index admission (<2 days [early RHC] vs ≥ 2 days [late RHC]) and in-hospital outcomes (mortality, acute kidney injury [AKI], mechanical circulatory device use [MCD], index length of stay [LOS], hospital charges), and all-cause 30-day readmissions.

RESULTS: A total of 46,963 hospitalizations [18,632 in the early group and 28,332 in the late group] were included in this analysis. RHC was more likely to happen in large teaching hospitals. Although there was no difference in mortality (adjusted odds ratio [aOR]: 1.05; Confidence interval [CI] 0.97 - 1.14; p=0.233). Patients in the early RHC group had a lower incidence of AKI (aOR: 0.69; CI: 0.64-0.74; p<0.01), higher rate of MCS use (aOR:1.67; CI:1.54-1.81; p<0.001), shorter LOS (aβ:-6.2; CI -6.62 to -5.77; p<0.001), lower hospital charges, and lower readmission rates (adjusted hazards ratio [aHR]: 0.91; CI: 0.84- 0.98; p=0.01) compared to the late RHC group.

CONCLUSIONS: Early RHC was associated with decreased incidence of AKI, decreased LOS, total charges, and readmission rates with no difference in survival. Subgroup analysis of patients who did not receive MCS during the index admission showed similar outcomes albeit with increased mortality. Further randomized controlled trials are needed to validate these results.