Tag Archive for: TAP-IT study

Why My Grandmother Died

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You may be wondering why the TAP-IT study created that stop-in-my-tracks moment. In the mid-1980s, my grandmother Frances was 80 years old and was always my biggest fan. She had congestive heart failure, so doctors tried the needle procedure, which drained close to 20 lbs. of fluid from around her lungs; you can imagine the pressure that caused on her heart. But congestive heart failure is an unforgiving disease—at least it was back then. Without a real treatment other than thoracentesis, there’s no cure.

Months later, the pulmonary effusion happened again, but she refused treatment because the procedure had hurt too much the first time. She died a couple of weeks later. The study prompted my realization that a medication like a diuretic might have prevented a rather difficult death with multiple bedsores.

The fact that there was never a randomized controlled trial to compare the two approaches until 45 years later just absolutely astounds me. At least now there are treatment options for people with the same condition without the same type of complications.

Just to be clear: there was no coming back from advanced congestive heart failure as my grandmother had. Using either procedure would not have cured her—it would have eventually killed her anyway. But the difference was really in her quality of life. She may have lived longer and certainly less painfully using the diuretic, which as I said was available even back then. But there was no research to support it.

What Was the Cause of Death?

There appears to be a lot of misinformation today about cause of death. I’m going to use my grandmother as an example. I mentioned that she had severe pulmonary effusion due to the congestive heart failure. But she also had bedsores. If they had gone septic, resulting in a whole-body infection, what would have been the official cause of death? That’s what we’ll explore next week. Please share your thoughts.

What are you prepared to do today?

        Dr. Chet

Reference: Circulation. 2025 Apr 1;151(16):1150–1161

TAP-IT to Stop It

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Have you ever had a moment where you were reading something, listening to an audio, or watching a video where you just had a moment of realization and absolutely stopped in your tracks? The reason is that you got hit with a discovery of some fact that you didn’t know. More than that, you realized what it meant. That’s what happened to me while listening to a podcast from a cardiologist about pulmonary effusion and how to treat it.  Let’s start there.

Pulmonary effusion (PE) is the buildup of fluids in the connective tissue surrounding the lungs and the chest cavity.  If enough fluid builds, it’s going to push on the lungs and ultimately push on the heart and make it very hard to breathe. To restore function, the fluid has to be removed. This happens to people who have congestive heart failure.

The TAP-IT study, formally called Thoracentesis to Alleviate Cardiac Pleural Effusion–Interventional Trial, was recently published in a leading heart journal. The researchers selected subjects who were 80+ years of age with less than a 25% ejection fraction. This population was chosen because they are the ones most likely to suffer from pleural effusion. They compared subjects who took diuretics to alleviate the fluid with subjects who got thoracentesis. The goal was to determine if there were any differences in outcomes as assessed by the number of days lived after beginning treatment.

The results? There were no differences in outcomes between the two groups. That’s amazing! Both reduced the pleural effusion, but there were differences in patient comfort and quality of life. As you might imagine, sticking a 2- to 5-inch needle through the rib space and into the pleural cavity to drain the fluid is going to be uncomfortable if not downright painful. There were also 20 out of 80 pneumothoraxes with the needle approach, while there were no complications noted in the group that took the medication.

The realization? This was the first randomized controlled trial that compared thoracentesis with diuretics, even though diuretics have been available for 75 years and thoracentesis for 175 years! Why did that matter to me? I’ll tell you on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Circulation. 2025 Apr 1;151(16):1150–1161