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Medicine (Baltimore). 2018 Oct;97(40):e12677. doi: 10.1097/MD.0000000000012677.

Admissions to intensive cardiac care units in France in 2014: A cross-sectional, nationwide population-based study.

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Economic Evaluation Unit, University Hospital of Montpellier.
CEPEL, UMR CNRS Université de Montpellier, Montpellier.
Intensive Cardiac Care Unit, Cardiology department, University Hospital of Rangueil, Toulouse.
Department of cardiology, Inserm U942, Lariboisière Hospital, AP-HP, Paris Diderot University, Paris.
CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, F-35000.
Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon.
Cardiology Department, University Hospital of Montpellier, Montpellier.
PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier Cedex, France.


Geographic variation in admission to the intensive cardiac care unit (ICCU) might question about the efficiency and the equity of the healthcare system. The aim was to explain geographic variation in the rate of admission to ICCU for coronary artery disease (CAD) or heart failure (HF) in France.We conducted a retrospective study based on the French national hospital discharge database. All inpatient stays for CAD or HF with an admission to an ICCU in 2014 were included. We estimated population-based age and sex-standardized ICCU admission rates at the department level. We separately modeled the department-level admission rates for HF and CAD using generalized linear models.In all, 61,010 stays for CAD and 27,828 stays for HF had at least 1 ICCU admission. The ICCU admission rates were explained by the admission rate for CAD, by the diabetes prevalence, by the proportion of the population >75 years, and by the drive time to the ICCU.This work sheds light on the finding of substantial geographic variation in the ICCU admission rates for CAD and HF in France. This variation is explained by both the age and the health status of the population and also by the drive time to the closest ICCU for HF. Moreover, ICCU admission for HF might be more prone to unwarranted variations due to medical practice patterns.

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