Every year, more than a million Americans undergo a procedure called right heart catheterization (RHC). By running a balloon-tipped tube into a critically ill patient's heart, doctors can monitor bodily functions from second to second, responding promptly to problems as they arise.
Assuming that such tight monitoring can only improve the quality of care, physicians have never bothered to gauge the benefits of RHC in a controlled clinical trial. That may have been a big mistake. According to a study published in last week's Journal of the American Medical Association (JAMA), the procedure may needlessly increase the cost and duration of hospital stays - and may kill more patients than it helps.
For the new study, a team led by Dr. Alfred Connors Jr. of Case Western Reserve University observed 5,700 critically ill patients treated at five major teaching hospitals. Instead of actively assigning people to one form of monitoring or another, the researchers simply compared patients who happened to receive RHC with equally sick patients who didn't. The results weren't pretty. The study found that RHC recipients spent more time in intensive care than patients spared the catheter (14.8 days versus 13 days), paid nearly 30 percent more in hospital costs ($49,300 versus $35,700) and were 24 percent less likely to survive for a month. "this should be troubling to people who care for critically ill patients," Connor says.
The study leaves many questions unanswered. Since RHC rarely causes direct complications, no one knows just how it may hasten death - or whether certain patients might still benefit from it. In a commentary published with the new findings, a JAMA editor and a University of Arizona specialist call on federal health officials to organize a controlled study of the procedure or call a halt to it. But regulators at the Food and Drug Administration dismiss the call for a moratorium, saying the main question is whether doctors are performing the technique correctly. And officials at the National Institute of Health, while accepting the need for a controlled study, say the community-based physicians should organize it themselves.
Unfortunately, many doctors still oppose randomly assigning critically ill patients to receive or forgo RHC. The procedure, they say, is too valuable to withhold from anyone who might benefit. As the new study makes clear, that's a belief based purely on faith.
GEOFFREY COWLEY with MARY HAGER