Does Thoracentesis Benefit Patients with Acute Heart Failure and Pleural Effusions?

Upfront thoracentesis often is employed for immediate symptom relief in patients with heart failure and substantial pleural effusions. However, thoracenteses carry risk, and data are lacking on whether this procedure improves outcomes compared with goal-directed medical therapy alone.

Researchers in Denmark conducted a multicenter trial in 135 patients who presented with acute heart failure, ejection fraction of ≤45%, and pleural effusion amendable to thoracentesis (via pigtail catheter) but filling less than two thirds of the hemithorax; patients were excluded if conditions other than heart failure were potential causes of (or contributors to) the pleural effusion. Patients were randomized to medical therapy alone or medical therapy plus up…