ICU Use and Quality of Care for Patients With Myocardial Infarction and Heart Failure

Valley, Thomas S.; Sjoding, Michael W.; Goldberger, Zachary D.; Cooke, Colin R.

doi:10.1016/j.chest.2016.05.034

Cited by 11 publications

(13 citation statements)

References 32 publications

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“…High-ICU-use hospitals were determined separately for each condition. The distribution of ICU admission rates was examined across all hospitals, and consistent with prior work (8), high-ICU-use hospitals were empirically defined as those with an ICU admission rate for each condition in the top 40% of the included hospitals to include a broad sample of hospitals with higher use of the ICU, including those known to provide higher quality of care and those known to provide lower quality of care to patients, based on previous research (18,37). Distances were calculated using the linear arc distance function, which measures the number of miles between the centroids of two ZIP codes.…”

Section: Original Researchmentioning

confidence: 99%

“…Like pneumonia, many elderly Americans are hospitalized with exacerbations of chronic obstructive pulmonary disease (COPD), heart failure (HF), or acute myocardial infarction (AMI) (16,17). Although patients with these three conditions are frequently admitted to the ICU, there is great variability in the rates of ICU admission for these conditions across hospitals (18,19). We sought to determine the association between ICU admission and patients' outcomes, including mortality and costs, for all three conditions individually.…”

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confidence: 99%

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Intensive Care Unit Admission and Survival among Older Patients with Chronic Obstructive Pulmonary Disease, Heart Failure, or Myocardial Infarction

et al. 2017

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Section: Original Researchmentioning

confidence: 99%

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confidence: 99%

Intensive Care Unit Admission and Survival among Older Patients with Chronic Obstructive Pulmonary Disease, Heart Failure, or Myocardial Infarction

et al. 2017

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“… 43 Thus, the results of this study may have more to do with limitations of non-ICU care rather than the direct benefits of ICU care, suggesting that certain hospitals may be better prepared to care for STEMI patients across different units. 44 …”

Section: Discussionmentioning

confidence: 99%

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

Valley

Iwashyna

Cooke

et al. 2019

BMJ

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ObjectiveTo evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).DesignRetrospective cohort study.Setting1727 acute care hospitals in the United States.ParticipantsMedicare beneficiaries (aged 65 years or older) admitted with STEMI to either an ICU or a non-ICU unit (general/telemetry ward or intermediate care) between January 2014 and October 2015.Main outcome measure30 day mortality. An instrumental variable analysis was done to account for confounding, using as an instrument the additional distance that a patient with STEMI would need to travel beyond the closest hospital to arrive at a hospital in the top quarter of ICU admission rates for STEMI.ResultsThe analysis included 109 375 patients admitted to hospital with STEMI. Hospitals in the top quarter of ICU admission rates admitted 85% or more of STEMI patients to an ICU. Among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates, ICU admission was associated with lower 30 day mortality than non-ICU admission (absolute decrease 6.1 (95% confidence interval −11.9 to −0.3) percentage points). In a separate analysis among patients with non-STEMI, a group for whom evidence suggests that routine ICU care does not improve outcomes, ICU admission was not associated with differences in mortality (absolute increase 1.3 (−0.9 to 3.4) percentage points).ConclusionsICU care for STEMI is associated with improved mortality among patients who could be treated in an ICU or non-ICU unit. An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial.

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“…Patients with acute myocardial infarction or HF that were admitted to hospitals with the highest ICU or CICU admission rates showed lower quality of care, lower adherence to guidelines, and a higher 30-day mortality [71].…”

Section: Ethical Issues Of Palliative Care In the Cicumentioning

confidence: 99%

The Role of Palliative Care in the Cardiac Intensive Care Unit

Romanò

2019

Healthcare

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In the last few years, important changes have occurred in the clinical and epidemiological characteristics of patients that were admitted to cardiac intensive care units (CICU). Care has shifted from acute coronary syndrome patients towards elderly patients, with a high prevalence of non-ischemic cardiovascular diseases and a high burden of non-cardiovascular comorbid conditions: both increase the susceptibility of patients to developing life-threatening critical conditions. These conditions are associated with a significant symptom burden and mortality rate and an increased length of stay. In this context, palliative care programs, including withholding/withdrawing life support treatments or the deactivation of implanted cardiac devices, are frequently needed, according to the specific guidelines of scientific societies. However, the implementation of these recommendations in clinical practice is still inconsistent. In this review, we analyze the reasons for this gap and the main cultural changes that are required to improve the care of patients with advanced illness.

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ICU Use and Quality of Care for Patients With Myocardial Infarction and Heart Failure

Cited by 11 publications

References 32 publications

Intensive Care Unit Admission and Survival among Older Patients with Chronic Obstructive Pulmonary Disease, Heart Failure, or Myocardial Infarction

Intensive Care Unit Admission and Survival among Older Patients with Chronic Obstructive Pulmonary Disease, Heart Failure, or Myocardial Infarction

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study

The Role of Palliative Care in the Cardiac Intensive Care Unit

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