Outcomes of indwelling pleural catheter placement for heart failure-related pleural effusions: a multicenter retrospective study.

BACKGROUND: Pleural effusions occur in 50% to 80% of patients with heart failure (HF), and their presence carries approximately 50% 1-year mortality. Indwelling pleural catheters (IPCs) provide palliative drainage for recurrent effusions and have proven benefit in malignant pleural effusions. However, evidence for IPC use in HF-related effusions remains limited to small studies showing dyspnea relief and acceptable safety. More generalizable outcomes data are needed to guide clinical decision-making in this population. OBJECTIVES: To evaluate safety and clinical outcomes after IPC placement for refractory HF-related pleural effusions. METHODS: We conducted a retrospective cohort study using the TriNetX Research Network. Adults with HF who underwent IPC placement for pleural effusion were identified using ICD-10-CM and procedure codes. Outcomes included IPC-related complications, all-cause mortality up to 1 year, additional pleural interventions, catheter removal, and hospital or emergency department visits within 90 days after IPC placement. RESULTS: Among 1017 patients who underwent IPC placement, pneumothorax was the most common complication (14.7% by 90 days), whereas empyema (4.0%) and cellulitis (1.3%) were less frequent. By 90 days, only 9.7% required repeat thoracentesis, and 14.3% underwent IPC removal. All-cause mortality was 43.2% at 1 year. Within 90 days after IPC placement, 26.9% had an emergency department visit and 67.0% had hospital inpatient or observation care services, compared with 50% and 75%, respectively, before IPC placement. CONCLUSIONS: IPC placement was associated with low repeat drainage needs and a possible reduction in acute care utilization. Complications were generally manageable and prolonged catheter dependence was common.