Hospitals with most heart patients in ICU have worse results: Study

Researchers say hospitals with a higher proportion of heart attack or heart failure patients in ICU are likely to be less experienced at treating either condition.

By Stephen Feller

ANN ARBOR, Mich., Aug. 3 (UPI) -- Hospitals with less experience dealing with heart attack and heart failure patients send more of them to the intensive care unit, where they receive fewer tests and treatments known to be effective for the conditions, new research shows.

Patients with either heart attack or heart failure flare-ups are more likely to see their conditions worsen, or die, at hospitals that are more likely to treat either condition in the ICU, researchers at the University of Michigan found in a review of hospital data.


While overall quality of care was generally good in hospitals with the highest percentage of patients admitted to ICU, small differences in care -- such as not giving patients aspirin upon arrival -- turned out to have significant effects on outcomes.

"These studies suggest that hospitals using the ICU frequently could be targets for improvement. If we find out why hospitals are using ICU beds more often for these patients, we could intervene to improve care overall," Dr. Thomas Valley, a researcher at the University of Michigan, said in a press release.

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For the study, published in the journal Chest, researchers analyzed Medicare patient records for more than 570,000 hospital stays in 2010, of which about 150,000 were for heart attack and about 400,000 for heart failure.


Of the two conditions, researchers found 46 percent of heart attack patients were treated in the ICU and 16 percent of heart failure patients received treatment in ICU. For patients treated at high-ICU hospitals, heart attack patients were 6 percent more likely to die within 30 days of discharge and heart failure patients were 8 percent more likely to die.

High-ICU hospitals tended to be those with the fewest heart attack and heart failure patients, which researchers suggest indicates a lack of experience treating the conditions. They were also more likely to be for-profit, and their patients were more likely to be from low-income ZIP codes.

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High-ICU facilities were less likely to give heart attack patients aspirin on arrival, or other drugs known to improve outcomes, and heart failure patients were less likely to receive tests of heart function or be counseled to quit smoking, though high-ICU hospitals performed as well as other hospitals educating patients on self-care after discharge.

"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," Valley said. "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."


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