View source for Congestive heart failure invasive monitoring

__NOTOC__
{{Congestive heart failure}}
{{CMG}}; {{AOEIC}} {{LG}}

==Overview==
Based upon the results of the ESCAPE trial, there is no benefit in clinical outcomes associated with the routine use of a [[pulmonary artery]] line in patients with decompensated [[CHF]].<ref name="pmid16204662">{{cite journal |author=Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G, Stevenson LW, Francis GS, Leier CV, Miller LW |title=Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=294 |issue=13 |pages=1625–33 |year=2005 |month=October |pmid=16204662 |doi=10.1001/jama.294.13.1625 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=16204662 |accessdate=2012-04-09}}</ref>

==Supportive Trial Data==
The '''''ESCAPE trial (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness)''''', was the first large, multicenter, randomized controlled trial that enrolled 433 patients across 26 sites, to determine the safety of pulmonary artery catheter (PAC) or Swan-Ganz catheter use to improve clinical outcomes in patients hospitalized with severe symptomatic and recurrent [[heart failure]]. Off the total 433 patients enrolled, 218 patients were randomized to clinical assessment alone ''(clinical arm)'' and the remaining 215 were randomized to both PAC and clinical assessment ''(PAC arm)''; with almost all patients being treated with [[loop diuretics]] ''(98%)'', [[ACE inhibitors]] ''(79%)'', [[beta-blockers]] ''(62%)'', and [[spironolactone]] ''(51%)'' and only a small percentage received [[inotrope|inotropes]] ''(15%)'' and intravenous [[vasodilators]] ''(8%)'' at the time of randomization. At 6-month follow up, the primary endpoint achieved was '''''identical and non-significant''''' among both the arms with an '''''overall mortality of 19%'''''. Thus, the study concluded no benefit demonstrated with the use of PAC for the improvement of clinical outcomes in patients with advanced heart failure.<ref name="pmid16204662">{{cite journal |author=Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G, Stevenson LW, Francis GS, Leier CV, Miller LW |title=Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=294 |issue=13 |pages=1625–33 |year=2005 |month=October |pmid=16204662 |doi=10.1001/jama.294.13.1625 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=16204662 |accessdate=2012-04-09}}</ref>

==2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>==

===Invasive Hemodynamic Monitoring in Patients Presenting With Heart Failure (DO NOT EDIT) <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>===

{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]

|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Invasive hemodynamic monitoring should be performed to guide therapy in patients who are in [[respiratory distress]] or with clinical evidence of impaired perfusion in whom the adequacy or excess of intracardiac filling pressures cannot be determined from clinical assessment. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}

{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Routine use of invasive hemodynamic monitoring in normotensive patients with acute [[decompensated HF]] and congestion with symptomatic response to [[Congestive heart failure diuretics|diuretics]] and [[Congestive heart failure vasodilators|vasodilators]] is not recommended. <ref name="pmid16204662">{{cite journal |author=Binanay C, Califf RM, Hasselblad V, O'Connor CM, Shah MR, Sopko G, Stevenson LW, Francis GS, Leier CV, Miller LW |title=Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=294 |issue=13 |pages=1625–33 |year=2005 |month=October |pmid=16204662 |doi=10.1001/jama.294.13.1625 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=16204662 |accessdate=2012-04-06}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}

{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Invasive hemodynamic monitoring can be useful for carefully selected patients with acute [[heart failure]] who have persistent symptoms despite empiric adjustment of standard therapies, and ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''a.''' Whose fluid status, perfusion, or [[systemic vascular resistance|systemic]] or [[pulmonary vascular resistance]]s are uncertain,<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''b.''' Whose systolic pressure remains low, or is associated with symptoms, despite initial therapy,<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''c.''' Whose [[renal dysfunction|renal function is worsening]] with therapy,<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''d.''' Who require parenteral [[Congestive heart failure positive inotropics|vasoactive agents]] or<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''e.''' Who may need consideration for advanced device therapy or [[Congestive heart failure cardiac transplantation|transplantation]]. <nowiki>"</nowiki>
|}

==Vote on and Suggest Revisions to the Current Guidelines==
*[[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure | The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]

==Sources==
*[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation] <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>

*[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult] <ref name="pmid16160202">Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16160202 ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.] ''Circulation'' 112 (12):e154-235. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.167586 DOI:10.1161/CIRCULATIONAHA.105.167586] PMID: [http://pubmed.gov/16160202 16160202]</ref>

==References==
{{Reflist|2}}

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