Variation exists in rates of admission to intensive care units for heart failure patients across hospitals in the United States.
BACKGROUND
Despite increasing attention on reducing relatively costly hospital practices while maintaining the quality of care, few studies have examined how hospitals use the intensive care unit (ICU), a high-cost setting, for patients admitted with heart failure (HF). We characterized hospital patterns of ICU admission for patients with HF and determined their association with the use of ICU-level therapies and patient outcomes.


RESULTS
We identified 166 224 HF discharges from 341 hospitals in the 2009-2010 Premier Perspective database. We excluded hospitals with <25 HF admissions, patients <18 years old, and transfers. We defined ICU as including medical ICU, coronary ICU, and surgical ICU. We calculated the percent of patients admitted directly to an ICU. We compared hospitals in the top quartile (high ICU admission) with the remaining quartiles. The median percentage of ICU admission was 10% (interquartile range, 6%-16%; range, 0%-88%). In top-quartile hospitals, treatments requiring an ICU were used less often; the percentage of ICU days receiving mechanical ventilation was 6% for the top quartile versus 15% for the others; noninvasive positive pressure ventilation, 8% versus 19%; vasopressors and/or inotropes, 9% versus 16%; vasodilators, 6% versus 12%; and any of these interventions, 26% versus 51%. Overall HF in-hospital risk-standardized mortality was similar (3.4% versus 3.5%; P=0.2).


CONCLUSIONS
ICU admission rates for HF varied markedly across hospitals and lacked association with in-hospital risk-standardized mortality. Greater ICU use correlated with fewer patients receiving ICU interventions. Judicious ICU use could reduce resource consumption without diminishing patient outcomes.
Yale University School of Medicine, New Haven, CT, USA.
Kyan C
KC
Safavi
Kumar
K
Dharmarajan
Nancy
N
Kim
Kelly M
KM
Strait
Shu-Xia
SX
Li
Serene I
SI
Chen
Tara
T
Lagu
Harlan M
HM
Krumholz
D015331:Cohort Studies; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000639:trends*; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000639:trends*; D008297:Male; D010343:Patient Admission / Q000191:economics / Q000639:trends*; D014481:United States / Q000453:epidemiology