Circulation

Thoracentesis in acute heart failure doesn’t improve clinical outcomes

April 29, 2025

Routine thoracentesis in addition to standard medical therapy doesn’t improve clinical outcomes in acute heart failure patients with pleural effusion. These findings suggest that thoracentesis shouldn’t be routinely performed in this patient population, and standard medical therapy remains the cornerstone of treatment.

Study details: The Thoracentesis to Alleviate Cardiac Pleural Effusion-Interventional Trial (TAP-IT; NCT05017753) included 135 patients (median age, 81 years; 33% female) with acute heart failure, left ventricular ejection fraction ≤45%, and non-negligible pleural effusion. Participants were randomized to either ultrasound-guided pleural pigtail catheter thoracentesis plus standard medical therapy or standard medical therapy alone. The primary outcome was days alive out of the hospital over 90 days, with secondary outcomes including length of admission and 90-day all-cause mortality.

Results: The primary outcome showed no significant difference between the thoracentesis group and the control group (84 days vs. 82 days; P=0.42). Mortality rates were identical at 13% in both groups (P=0.90). Duration of index admission wasn't significantly different between groups (P=0.69). Major complications from thoracentesis were rare (1% of cases).

Source:

Glargaard S, et al. (2025, April 22). Circulation. A Randomized Controlled Trial of Thoracentesis in Acute Heart Failure. https://pubmed.ncbi.nlm.nih.gov/40166829/