Clinical Perspective
What Is New?
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TAP-IT (Thoracentesis to Alleviate Cardiac Pleural Effusion–Interventional Trial) is the first randomized controlled trial to investigate the effectiveness of upfront therapeutic thoracentesis in addition to standard medical therapy compared with medical therapy alone in patients admitted to the hospital with acute heart failure and pleural effusion.
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A strategy of referring to upfront therapeutic thoracentesis did not increase the number of days alive out of the hospital over the following 90 days, survival probability, or patient-reported quality of life, and did not reduce the duration of the index admission.
What Are the Clinical Implications?
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In patients with acute heart failure, left ventricular ejection fraction ≤45%, and sizable pleural effusion (amenable for thoracentesis but less than two-thirds of the hemithorax), reducing filling pressures with diuretics and guideline-directed medical therapy should be the primary treatment target, because the addition of therapeutic thoracentesis does not contribute to a shorter duration of admission or a more favorable prognosis in the following 90 days.
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Routine referral to upfront therapeutic thoracentesis is not recommended, but can be considered on an individual basis after carefully considering potential complications.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.073521
