Critical reappraisal of pulmonary artery catheterization and invasive hemodynamic assessment in acute heart failure

Use of the pulmonary artery catheter (PAC) in the management of heart failure has declined precipitously despite guideline-supported indications, especially among patients hospitalized with acute heart failure (HF) syndromes. Here, the authors critically review the current role of the PAC and the management of patients with HF, and discuss the role of the PAC in the development of new therapies for HF. Pulmonary artery catheterization is a safe procedure when performed by experienced operators, and invasive hemodynamic evaluation with the PAC is recommended in select clinical settings. The PAC may have a unique role in identifying high-risk HF patients with persistent hemodynamic abnormalities during hospitalization. Early-phase trials of novel therapies to improve outcomes in patients with acute HF should include an assessment of hemodynamic effects utilizing the PAC. Once therapies that are effective in improving outcomes are available, the PAC might be a useful or necessary tool in the initiation and titration of such treatments and improved outcomes from PAC guided therapy may be demonstrated. Adequate training and experience are required to successfully use the PAC to minimize complications, ensure proper data collection and appropriate decision-making. Improved education and guidelines are required to ensure continued safe and appropriate contemporary use of the PAC.