Patients suffering from a heart attack or congestive heart failure encounter worse outcomes in hospitals that rely on intensive care units to treat these conditions, according to a new study published in CHEST.
For the study, researchers examined Medicare records for more than 570,000 hospital stays that occurred in 2010. For the more than 150,000 hospitalizations for acute myocardial infarction, 46 percent received treatment in the ICU. Researchers also determined that 16 percent of the more than 400,000 heart failure hospitalizations included a stay in the ICU.
Using the federal government's Hospital Compare website, researchers divided the thousands of hospitals examined in the study into quantiles, from lowest to highest ICU use. While quality of care across the spectrum appeared to be good, there were some notable disparities leading to suboptimal care for thousands.
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Hospitals with high rates of ICU usage were less likely to give heart attack patients aspirin and other drugs known to improve outcomes upon arrival at the hospital, for instance. High-ICU facilities were also less likely to give heart failure patients important medications, administer key tests regarding heart function and counsel patients on the benefits of smoking abstention.
The most significant disparity between high-ICU and low-ICU facilities was in 30-day mortality post-discharge. Heart attack patients were found to be 6 percent more likely to die within 30 days of discharge after being treated at a high-ICU hospital. For heart failure patients, the increased risk of death was 8 percent.
"In this country, we still have an open question of what to use the ICU for, and when, and very little evidence to guide physicians," said Thomas Valley, MD, the study's first author and a critical care specialist at the University of Michigan Health System's critical care medicine unit in Ann Arbor. "Is it for those who were already sick and got worse, or is it a place to send people proactively when we think they might get sicker? And the answer can vary on different days, or based on how many beds are available right then. We hope to build a body of evidence about how to use this valuable resource in the most effective way."
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