title: Hospital variation in admission to intensive care units for patients with acute myocardial infarction.
abstract: BACKGROUND
  The treatment for patients with acute myocardial infarction (AMI) was transformed by the introduction of intensive care units (ICUs), yet we know little about how contemporary hospitals use this resource-intensive setting and whether higher use is associated with better outcomes.
  
  
  METHODS
  We identified 114,136 adult hospitalizations for AMI from 307 hospitals in the 2009 to 2010 Premier database using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Hospitals were stratified into quartiles by rates of ICU admission for AMI patients. Across quartiles, we examined in-hospital risk-standardized mortality rates and usage rates of critical care therapies for these patients.
  
  
  RESULTS
  Rates of ICU admission for AMI patients varied markedly among hospitals (median 48%, Q1-Q4 20%-71%, range 0%-98%), and there was no association with in-hospital risk-standardized mortality rates (6% all quartiles, P = .7). However, hospitals admitting more AMI patients to the ICU were more likely to use critical care therapies overall (mechanical ventilation [from Q1 with lowest rate of ICU use to Q4 with highest rate 13%-16%], vasopressors/inotropes [17%-21%], intra-aortic balloon pumps [4%-7%], and pulmonary artery catheters [4%-5%]; P for trend < .05 in all comparisons).
  
  
  CONCLUSIONS
  Rates of ICU admission for patients with AMI vary substantially across hospitals and were not associated with differences in mortality, but were associated with greater use of critical care therapies. These findings suggest uncertainty about the appropriate use of this resource-intensive setting and a need to optimize ICU triage for patients who will truly benefit.
authors.affiliation: University of California San Francisco, San Francisco, CA.
authors.forename: RuiJun
authors.initials: R
authors.lastname: Chen
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Strait
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Kumar
authors.initials: K
authors.lastname: Dharmarajan
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
authors.forename: Shu-Xia
authors.initials: SX
authors.lastname: Li
authors.affiliation: University of Sydney, Sydney, NSW, Australia.
authors.forename: Isuru
authors.initials: I
authors.lastname: Ranasinghe
authors.affiliation: Premier Inc, Washington, DC.
authors.forename: John
authors.initials: J
authors.lastname: Martin
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Reza
authors.initials: R
authors.lastname: Fazel
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Cooke
authors.affiliation: Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Veterans Affairs (VA) Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI.
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Electronic address: harlan.krumholz@yale.edu.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056988:Anterior Wall Myocardial Infarction / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D003325:Coronary Care Units / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D015276:Health Care Rationing / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000592:standards*; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D014218:Triage / Q000458:organization & administration / Q000592:standards; D014481:United States