Dataset Information

Discordance Between Clinical Assessment and Invasive Hemodynamics in Patients With Advanced Heart Failure.

ABSTRACT:

Background

Historically, invasive hemodynamic guidance was not superior compared to clinical assessment in patients admitted with acute decompensated heart failure (ADHF). This study assessed the accuracy of clinical assessment vs invasive hemodynamics in patients with ADHF.

Methods and results

We conducted a prospective cohort study of patients admitted with ADHF. Prior to right-heart catheterization (RHC), physicians categorically predicted right atrial pressure, pulmonary capillary wedge pressure, cardiac index and hemodynamic profile (wet/dry, warm/cold) based on physical examination and clinical data evaluation (warm?=?cardiac index > 2.2 L/min/m²; wet?=?pulmonary capillary wedge pressure > 18 mmHg). We collected 218 surveys (of 83 cardiology fellows, 55 attending cardiologists, 45 residents, 35 interns) evaluating 97 patients. Of those patients, 46% were receiving inotropes prior to RHC. The positive and negative predictive values of clinical assessment compared to RHC for the cold and wet subgroups were 74.7% and 50.4%. The accuracy of categorical prediction was 43.6% for right atrial pressure, 34.4% for pulmonary capillary wedge pressure and 49.1% for cardiac index, and accuracy did not differ by clinician (P > 0.05 for all). Interprovider agreement was 44.4%. Therapeutic changes following RHC occurred in 71.1% overall (P < 0.001).

Conclusions

Clinical assessment of patients with advanced heart failure presenting with ADHF has low accuracy across all training levels, with exaggerated rates of misrecognition of the most high-risk patients.

SUBMITTER: Narang N

PROVIDER: S-EPMC7108664 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Publications

Discordance Between Clinical Assessment and Invasive Hemodynamics in Patients With Advanced Heart Failure.

Narang Nikhil N Chung Ben B Nguyen Ann A Kalathiya Rohan J RJ Laffin Luke J LJ Holzhauser Luise L Ebong Imo A IA Besser Stephanie A SA Imamura Teruhiko T Smith Bryan A BA Kalantari Sara S Raikhelkar Jayant J Sarswat Nitasha N Kim Gene H GH Jeevanandam Valluvan V Burkhoff Daniel D Sayer Gabriel G Uriel Nir N

Journal of cardiac failure 20190821 2

<h4>Background</h4>Historically, invasive hemodynamic guidance was not superior compared to clinical assessment in patients admitted with acute decompensated heart failure (ADHF). This study assessed the accuracy of clinical assessment vs invasive hemodynamics in patients with ADHF.<h4>Methods and results</h4>We conducted a prospective cohort study of patients admitted with ADHF. Prior to right-heart catheterization (RHC), physicians categorically predicted right atrial pressure, pulmonary capil ...[more]

PMID: 31442494

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Dataset Information

Discordance Between Clinical Assessment and Invasive Hemodynamics in Patients With Advanced Heart Failure.

Background

Methods and results

Conclusions

Publications

Discordance Between Clinical Assessment and Invasive Hemodynamics in Patients With Advanced Heart Failure.

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