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Cardiologists Use Pulmonary Artery Catheter Information to Make Homogenous Treatment Decisions

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, m-jain{at}northwestern.edu

Daya Upadhyay, MD

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL

Rajesh Balagani, MD

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL

Borko Jovanovic, PhD

Division of Preventive Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL

Dan Fintel, MD

Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL

Medical intensivists make heterogenous decisions using pulmonary artery catheter (PAC) data in medical intensive care unit patients. The object was to determine if cardiologists given PAC data from critically ill cardiology patients make uniform management choices. A survey questionnaire containing 3 coronary care unit (CCU) clinical vignettes was designed and mailed to board-certified cardiologists who are members of the American College of Cardiology. Twenty board-certified medical intensivists were also asked to complete the vignettes. Each vignette contained PAC data and one-half of the surveys contained echocardiographic (ECHO) information. Every respondent was asked to select 1 of 6 interventions for each vignette. In 2 of 3 vignettes 1 intervention was selected by more than 70% of cardiologists. In the third vignette, 1 intervention was selected by more than 50% of cardiologists. For each vignette, 1 intervention was selected by at least 75% of medical intensivists. There was no significant difference in the distribution of management choices between the ECHO and the non-ECHO subgroups. There is relative homogeneity in selecting an intervention based on PAC data among cardiologists and medical intensivists in CCU patients and is probably due to patient-related factors. The presence of ECHO information did not change the intervention selected. Cardiology patients may represent an ideal group in which to evaluate PAC efficacy.

Key Words: Pulmonary artery catheter • vignette • echocardiography • coronary care unit • decision making • outcomes

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