Cardiac Care ICUs Increase Risk Of Death

Martha sat alone on the porch, wondering about the way her life had changed.  Just a month back, everything was normal and happy.  Bill, her husband had just returned home after visiting their daughter at college and they were making plans of going there for her graduation ceremony next year. And then, without any warning, Bill just collapsed.  Luckily for them, the hospital was just a short distance away and Bill was admitted to the ICU, having suffered a heart attack.  After a two week stay, Bill was discharged and came back home.  Last evening, Bill complained of feeling short of breath and before they could reach the hospital, Bill had become unconscious in the car. Immediately admitted to the ICU again, the physician informed Martha that Bill had suffered another heart attack.  This morning, their family physician, consulted with the doctors at the hospital and had Bill moved out of the ICU.  On being questioned about the move by Martha, the doctor explained his reasons, showing her the article in CHEST.

According to a study published in the , patients who suffer heart failure or heart attacks, fare worse in hospitals that rely on their intensive care units to treat them.  While patients who suffer heart attacks or heart failure can be treated in a variety of hospital locations, those treated in the ICU are likely to receive less than half of certain proven tests and treatments.  They are also less likely to survive more than a month after discharge.

The Study

Thomas Valley, M.D., M.Sc., and his colleagues at the University of Michigan Medical School, examined Medicare records of over 570,000 hospital stays that occurred in 2010, to glean the findings that made up the report.  Admission and treatment in the ICU accounted for more than 46% of the 150,000 hospitalizations at over 1,700 hospitals for acute myocardial infarction or heart attacks.  Out of the 400,000 heart failure patients admitted to one of the 2,199 hospitals, 16% were admitted and treated in the ICU.

The researchers used the Hospital Compare website, through which the federal government publicly reports hospital performance; to determine how efficient hospitals were at providing high-quality healthcare.  They also used the website to find out the percentage of patients who either passed away or were re-admitted within a month of their discharge from the hospital.  Based on the data gathered, they divided the hospitals into five groups – depending on their frequency of use of ICU beds.

Although the quality of care across the all the hospitals seemed to be good, the research findings threw up some notable disparities that lead to suboptimal care.  For example, the study shows that those hospitals which had high rates of ICU admissions and treatments were less likely to provide aspirin and other drugs to heart attack patients upon arrival at the hospital – this despite the known improved outcomes that these drugs offered. Similarly, patients suffering from heart failure were less likely to be administered key tests or receive important medications.  There was also the absence of counseling on the benefits of abstaining from smoking.

However, the biggest finding was the disparity in the 30 day mortality post discharge, Cardiac_Failure_expert_witness_indiana_dr-patel
between the low and high ICU usage facilities.  According to the findings, the risk of death within 30 days of discharge for heart failure patients stood at 8%, while for heart attack patients, it was 6%.

These findings only add to the growing evidence about the varied use of ICU beds.  The findings show, for the first time in heart care, that hospitals with high ICU admissions and treatments are the worst performers in terms of health care quality.  According to Thomas Valley, “In this country, we still have an open question of what to use the ICU for, and when, and very little evidence to guide physicians.  Is it for those who were already sick and got worse, or is it a place to send people proactively when we think they might get sicker? And the answer can vary on different days, or based on how many beds are available right then.  We hope to build a body of evidence about how to use this valuable resource in the most effective way.”

Going Forward

The researchers plan to continue their study from data collected from large groups of patients – to help understand which group benefits the most from ICU care and treatment along with finding out the best characteristics of ICU care that can be tried on general hospital floors.  It is possible that specially trained healthcare professionals might be able to administer the same care as in the ICU, thus providing the physician an option of whether to admit the patient in the ICU or not.

Thomas Valley points out that those patients hospitalized for heart failure or heart attack and their families need to be vocal about the patient’s wishes regarding the intensity of care that they want to receive.  According to Valley, “It’s important to understand why you or your loved one are being admitted to the ICU, and talk about whether it’s in line with your or their wishes. It’s important to understand both the benefits and risks of an ICU stay.”


References

  1. Hospitals that send the most heart patients to the ICU get the worst results, U-M study finds. (2016, August 03). Retrieved August 09, 2016, from http://www.uofmhealth.org: http://www.uofmhealth.org/news/archive/201608/hospitals-send-most-heart-patients-icu-get-worst-results-u-m
  2. Thomas S. Valley, M. M., Michael W. Sjoding, M. M., Zachary D. Goldberger, M. M., & Colin R. Cooke, M. M. (2016). Intensive care use and quality of care for patients with myocardial infarction and heart failure. CHEST Journal .
  3. Zimmerman, B. (2016, August 04). Heart patients fare worse in hospitals that rely on ICUs for cardiac care. Retrieved August 09, 2016, from http://www.beckershospitalreview.com: http://www.beckershospitalreview.com/quality/heart-patients-fare-worse-in-hospitals-that-rely-on-icus-for-cardiac-care.html
Advertisements