Hospitals With High ICU Use Have Worse Outcomes for Heart Patients

Patients who suffer heart attacks or flare-ups of congestive heart failure can fare worse in hospitals that are more likely to send them to the intensive care unit (ICU), according to a study published in CHEST.

Researchers with the University of Michigan examined rates that hospitals failed to deliver standard processes of care for patients with acute myocardial infarction (AMI) and heart failure, as well as 30-day mortality, 30-day readmissions, and Medicare spending.

“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,” first author Thomas Valley, MD, MSc, a critical care specialist in the University of Michigan Health System’s Critical Care Medicine Unit, said in a statement. “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?”

Valley and his colleagues found that of more than 150,000 hospitalizations for AMI at nearly 1700 hospitals, almost half (46%) included care in an ICU. In addition, 16% of 400,000 hospitalizations at more than 2100 hospitals for heart failure included an ICU stay.

Hospitals in the highest quintile for ICU admissions for AMI (more than 61%) or heart failure (more than 24%) had greater 30-day mortality, but no differences in 30-day readmissions or Medicare spending compared with hospitals in the lowest quintile (ICU admissions rates less than 29% for AMI or less than 8% for heart failure). Patients who had a heart attack and were admitted to hospitals with high ICU use were 6% more likely to die than patients admitted to hospitals with low ICU use. The difference was 8% for patients with heart failure.

The researchers found that while overall quality of care was good, hospitals in the highest quintile for ICU admissions tended to receive smaller numbers of heart attack or heart failure patients, were more likely to be for-profit hospitals, and the patients were more likely to be from lower income ZIP codes.

“These studies suggest that hospitals using the ICU frequently could be targets for improvement,” says Valley. “If we find out why hospitals are using ICU beds more often for these patients, we could intervene to improve care overall.”