Outcomes of indwelling pleural catheter placement for heart failure-related pleural effusions: a multicenter...

Pleural effusions occur in 50% to 80% of patients with heart failure (HF), and their presence carries approximately 50% 1-year mortality. Indwelling pleural catheters (IPCs) provide palliative drainage for recurrent effusions and have proven benefit in malignant pleural effusions. However, evidence for IPC use in HF-related effusions remains limited to small studies showing dyspnea relief and acceptable safety. More generalizable outcomes data are needed to guide clinical decision-making in this population.

To evaluate safety and clinical outcomes after IPC placement for refractory HF-related pleural effusions.

We conducted a retrospective cohort study using the TriNetX Research Network. Adults with HF who underwent IPC placement for pleural effusion were identified using ICD-10-CM and procedure codes. Outcomes included IPC-related complications, all-cause mortality up to 1 year, additional pleural interventions, catheter removal, and hospital or emergency department visits within 90 days after IPC placement.

Among 1017 patients who underwent IPC placement, pneumothorax was the most common complication (14.7% by 90 days), whereas empyema (4.0%) and cellulitis (1.3%) were less frequent. By 90 days, only 9.7% required repeat thoracentesis, and 14.3% underwent IPC removal. All-cause mortality was 43.2% at 1 year. Within 90 days after IPC placement, 26.9% had an emergency department visit and 67.0% had hospital inpatient or observation care services, compared with 50% and 75%, respectively, before IPC placement.

IPC placement was associated with low repeat drainage needs and a possible reduction in acute care utilization. Complications were generally manageable and prolonged catheter dependence was common.