High ICU admission rates for heart failure patients were not associated with improved in-hospital risk-standardized mortality compared to lower admission rates (3.4% vs 3.5%; P=0.2).
Observational (n=166,224)
Yes
Does admission to hospitals with high ICU admission rates improve in-hospital mortality for heart failure patients?
ICU admission rates for heart failure vary widely across hospitals and higher ICU use is not associated with improved in-hospital mortality, suggesting opportunities to reduce resource consumption.
Absolute Event Rate: 3.4% vs 3.5%
p-value: p=0.2
BACKGROUND: Despite increasing attention on reducing relatively costly hospital practices while maintaining the quality of care, few studies have examined how hospitals use the intensive care unit (ICU), a high-cost setting, for patients admitted with heart failure (HF). We characterized hospital patterns of ICU admission for patients with HF and determined their association with the use of ICU-level therapies and patient outcomes. METHODS AND RESULTS: We identified 166 224 HF discharges from 341 hospitals in the 2009-2010 Premier Perspective database. We excluded hospitals with <25 HF admissions, patients <18 years old, and transfers. We defined ICU as including medical ICU, coronary ICU, and surgical ICU. We calculated the percent of patients admitted directly to an ICU. We compared hospitals in the top quartile (high ICU admission) with the remaining quartiles. The median percentage of ICU admission was 10% (interquartile range, 6%-16%; range, 0%-88%). In top-quartile hospitals, treatments requiring an ICU were used less often; the percentage of ICU days receiving mechanical ventilation was 6% for the top quartile versus 15% for the others; noninvasive positive pressure ventilation, 8% versus 19%; vasopressors and/or inotropes, 9% versus 16%; vasodilators, 6% versus 12%; and any of these interventions, 26% versus 51%. Overall HF in-hospital risk-standardized mortality was similar (3.4% versus 3.5%; P=0.2). CONCLUSIONS: ICU admission rates for HF varied markedly across hospitals and lacked association with in-hospital risk-standardized mortality. Greater ICU use correlated with fewer patients receiving ICU interventions. Judicious ICU use could reduce resource consumption without diminishing patient outcomes.
Safavi et al. (Sat,) conducted a observational in Heart failure (n=166,224). High ICU admission rate (top quartile hospitals) vs. Lower ICU admission rate (remaining quartiles) was evaluated on In-hospital risk-standardized mortality (p=0.2). High ICU admission rates for heart failure patients were not associated with improved in-hospital risk-standardized mortality compared to lower admission rates (3.4% vs 3.5%; P=0.2).
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