Results:

A total of 9,431,944 patients was hospitalized with primary diagnosis of heart failure (HF) (n = 8,516,528) and cardiogenic shock (n = 915, 416) during the 2004-2014 study period. Patients with cardiogenic shock represented 51% of all pulmonary artery catheter (PAC) use. In patients with cardiogenic shock, the patients with PAC were younger than those without PAC (64 ± 15 vs. 68 ± 14; p < 0.001) and were more commonly male (63.8% vs. 59.3%). Primary diagnosis was ST-segment elevation myocardial infarction (24.3%), followed by non-ST-segment elevation myocardial infarction (12.9%), acute HF (11.4%), and sepsis (9.3%). The use of PAC in patients with HF without cardiogenic shock was associated with a higher incidence of in-hospital mortality (9.9% vs. 3.3%; odds ratio [OR] 3.96; 95% confidence interval [CI], 3.68-4.26; p < 0.001). In patients with HF who were in cardiogenic shock, there was a reduction in mortality when PAC was used (35.1% vs. 39.2%; OR 0.91; 95% CI, 0.88-0.95; p < 0.001). In patients with cardiogenic shock, PAC was associated with lower rates of in-hospital cardiac arrest compared with those with cardiogenic shock and no PAC (14.9% vs. 18.3%; OR 0.77; 95% CI, 0.74-0.81; p < 0.001). Between 2004 and 2014, there was a 39% absolute reduction in mortality with use of PAC in patients with and without cardiogenic shock.