Right- and left-sided heart catheterization as a quality marker for catheterization laboratories (from the national...

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Health Services Research

Background:

• Concurrent right-heart catheterization (RHC) during left-heart catheterization (LHC) for coronary artery disease (CAD) is a quality metric, with high rates potentially indicating overuse.
• Understanding the prevalence and findings of bilateral heart catheterization (BHC) is crucial for evaluating its appropriate utilization.

Purpose of the Study:

• To determine the prevalence of BHC in patients undergoing cardiac catheterization for CAD indications.
• To describe the frequency of abnormal RHC findings in patients who underwent BHC primarily for LHC.

Main Methods:

• Retrospective analysis of cardiac catheterization data from the Department of Veterans Affairs Clinical Assessment Reporting and Tracking Program.
• Inclusion of patients undergoing catheterization for CAD indications between October 2007 and September 2011 across 76 VA hospitals.
• Analysis focused on patients undergoing BHC, examining RHC parameters including mean pulmonary artery pressure (PA), pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance (PVR).

Main Results:

• Out of 95,656 patients with CAD undergoing catheterization, 6.9% had BHC, while 93.0% had LHC.
• In the BHC group (n=6,611), 61.3% exhibited at least one abnormal RHC value (mean PA >25 mm Hg, PCWP >15 mm Hg, or PVR >3 Woods units).
• Specific abnormal findings included elevated mean PA pressure (48.6%), elevated PCWP (48.0%), and elevated PVR (19.4%). Notably, 4.3% met criteria for pulmonary arterial hypertension.

Conclusions:

• The high prevalence of abnormal RHC findings in patients undergoing BHC for LHC suggests that most BHC procedures are performed for valid clinical reasons.
• The findings support the need for further research into the utility of BHC rates as a reliable quality indicator in cardiovascular care.