Why the study?
The role of patient characteristics, including age, in prioritising ICU admission for high-risk ACS patients and the impact of clinical practice guidelines on this prioritisation were unclear.
Does the implementation of clinical practice guidelines alter intensive care unit bed allocation in high-risk acute coronary syndrome patients?
Observational (n=692)
No
Does the implementation of clinical practice guidelines alter intensive care unit bed allocation in high-risk acute coronary syndrome patients?
Absolute Event Rate: 38.9% vs 44.4%
Implementation of explicit clinical practice guidelines for ICU admission in high-risk ACS patients can reduce gender-based triage disparities, though age-based prioritization may persist.
Guideline implementation was associated with fewer ICU admissions and eliminated male bias in high-risk ACS; extends observations on equity but requires prospective validation.
QUESTION UNDER STUDY: To assess which high-risk acute coronary syndrome (ACS) patient characteristics played a role in prioritising access to intensive care unit (ICU), and whether introducing clinical practice guidelines (CPG) explicitly stating ICU admission criteria altered this practice. PATIENTS AND METHODS: All consecutive patients with ACS admitted to our medical emergency centre over 3 months before and after CPG implementation were prospectively assessed. The impact of demographic and clinical characteristics (age, gender, cardiovascular risk factors, and clinical parameters upon admission) on ICU hospitalisation of high-risk patients (defined as retrosternal pain of prolonged duration with ECG changes and/or positive troponin blood level) was studied by logistic regression. RESULTS: Before and after CPG implementation, 328 and 364 patients, respectively, were assessed for suspicion of ACS. Before CPG implementation, 36 of the 81 high-risk patients (44.4%) were admitted to ICU. After CPG implementation, 35 of the 90 high-risk patients (38.9%) were admitted to ICU. Male patients were more frequently admitted to ICU before CPG implementation (OR=7.45, 95% CI 2.10-26.44), but not after (OR=0.73, 95% CI 0.20-2.66). Age played a significant role in both periods (OR=1.57, 95% CI 1.24-1.99), both young and advanced ages significantly reducing ICU admission, but to a lesser extent after CPG implementation. CONCLUSION: Prioritisation of access to ICU for high-risk ACS patients was age-dependent, but focused on the cardiovascular risk factor profile. CPG implementation explicitly stating ICU admission criteria decreased discrimination against women, but other factors are likely to play a role in bed allocation.
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A 2006 study conducted an observational in High-risk acute coronary syndrome (n=692). Clinical practice guidelines (CPG) explicitly stating ICU admission criteria vs. Before CPG implementation was evaluated on ICU admission. Implementation of clinical practice guidelines for ICU admission in high-risk ACS patients resulted in 38.9% admission vs 44.4% before implementation, and eliminated the prior male admission bias.
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