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Am Heart J. 2015 Dec;170(6):1161-9. doi: 10.1016/j.ahj.2015.09.003. Epub 2015 Sep 11.

Hospital variation in admission to intensive care units for patients with acute myocardial infarction.

Author information

1
University of California San Francisco, San Francisco, CA.
2
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
3
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
4
University of Sydney, Sydney, NSW, Australia.
5
Premier Inc, Washington, DC.
6
Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
7
Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
8
Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
9
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Veterans Affairs (VA) Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI.
10
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Electronic address: harlan.krumholz@yale.edu.

Abstract

BACKGROUND:

The treatment for patients with acute myocardial infarction (AMI) was transformed by the introduction of intensive care units (ICUs), yet we know little about how contemporary hospitals use this resource-intensive setting and whether higher use is associated with better outcomes.

METHODS:

We identified 114,136 adult hospitalizations for AMI from 307 hospitals in the 2009 to 2010 Premier database using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Hospitals were stratified into quartiles by rates of ICU admission for AMI patients. Across quartiles, we examined in-hospital risk-standardized mortality rates and usage rates of critical care therapies for these patients.

RESULTS:

Rates of ICU admission for AMI patients varied markedly among hospitals (median 48%, Q1-Q4 20%-71%, range 0%-98%), and there was no association with in-hospital risk-standardized mortality rates (6% all quartiles, P = .7). However, hospitals admitting more AMI patients to the ICU were more likely to use critical care therapies overall (mechanical ventilation [from Q1 with lowest rate of ICU use to Q4 with highest rate 13%-16%], vasopressors/inotropes [17%-21%], intra-aortic balloon pumps [4%-7%], and pulmonary artery catheters [4%-5%]; P for trend < .05 in all comparisons).

CONCLUSIONS:

Rates of ICU admission for patients with AMI vary substantially across hospitals and were not associated with differences in mortality, but were associated with greater use of critical care therapies. These findings suggest uncertainty about the appropriate use of this resource-intensive setting and a need to optimize ICU triage for patients who will truly benefit.

PMID:
26678638
PMCID:
PMC5459386
DOI:
10.1016/j.ahj.2015.09.003
[Indexed for MEDLINE]
Free PMC Article

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