Hospitals Sending the Most Heart Patients to ICUs Report Worst Results

A new study raises questions on the best use of intensive care units, and the need to improve use of vetted tests and treatments.

2:00 PM

Author | Kara Gavin

Patients who have heart attacks, or flare-ups of congestive heart failure, can receive care in a variety of hospital locations. But a new study suggests that they'll fare worse in hospitals that rely heavily on intensive care units for patients like them.

SEE ALSO: 30% of Female Physicians Report Sexual Harassment at Work

In fact, depending on where patients go, they may be half as likely to get certain proven tests and treatments — and less likely to survive a month after their hospital stay.

The findings add to growing evidence that the use of ICU beds in America varies widely. For the first time in heart care, the study shows that hospitals sending the highest percentage of patients to ICUs perform worse on measures of health care quality.

This suggests that more standardization in deciding which patients need an ICU, and increased focus on care quality in hospitals with the highest ICU use, could benefit patients nationwide, according to the authors of the paper published online in the journal CHEST.

"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," says first author Thomas Valley, M.D., a critical care specialist who takes care of patients in the U-M Health System's Critical Care Medicine Unit.

"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."

We hope to build a body of evidence about how to use ICUs in the most effective way.
Thomas Valley, M.D.

High ICU use and patient outcomes

Valley and his colleagues at the University of Michigan Medical School examined Medicare records from more than 570,000 hospital stays in 2010.

SEE ALSO: How Hospitals Can Improve Crisis Management When Tragedy Strikes

Of more than 150,000 hospitalizations at nearly 1,700 hospitals for heart attack, 46 percent included care in an ICU. A lower, but still sizable, 16 percent of the more than 400,000 hospitalizations for heart failure included an ICU stay at one of 2,199 hospitals.

The team used the federal government's Hospital Compare website, which reports hospital performance, to study how well each hospital did at providing high-quality care, and what percentage of their patients died or returned to the hospital within a month of the hospital stay. They divided all the hospitals into five groups, from lowest ICU use to highest.

The results show that hospitals with the highest percentage of patients admitted to the ICU tended to be those with the smallest total numbers of heart attack and heart failure patients, perhaps suggesting a lack of familiarity with these conditions. They were also more likely to be for-profit hospitals. Patients treated in them were more likely to be from low-income ZIP codes.

The overall quality of care tended to be good and the differences in evidence-based care were relatively small. Although the data still indicate tens of thousands of patients received suboptimal care.

For instance, the high-ICU hospitals were less likely to give heart attack patients aspirin and other drugs known to improve outcomes when they arrived. But they performed as well as other hospitals on several other quality measures.

In heart failure, the high-ICU hospitals were less likely to give important medications, perform key tests of heart function and counsel patients on stopping smoking. They performed as well as other hospitals on educating patients about caring for themselves after they left the hospital.

The biggest difference was in the risk of dying within 30 days of discharge. Heart attack patients treated in high-ICU hospitals were 6 percent more likely to die than patients admitted to low-ICU hospitals. The difference was about 8 percent for heart failure patients. There were no differences in the odds of being hospitalized again, or in total spending on care.

"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," says Valley.

What the findings mean for patients

Valley and his colleagues note that patients and families of people hospitalized for heart attack and heart failure need to speak up about the patient's wishes for the intensity of care they should receive.

"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," says Valley.

It's important to understand both the benefits and risks of an ICU stay, he notes, such as closer monitoring from nurses, but also the risk of infections and complications resulting from the more invasive nature of care in ICUs.

The group will continue to study data from large groups of patients to determine which ones benefit most from ICU-level care — and which characteristics of ICU care could be safely tried on general hospital floors.


More Articles About: Industry DX Health Care Quality Cardiovascular: Treatment & Surgery
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories Provider takes a pulse oximetry reading from a patient's finger
Health Lab
Inaccurate pulse oximeter readings could limit transplants, heart pumps for Black patients with heart failure
Racially biased readings of oxygen levels in the blood using pulse oximeters may further limit opportunities for Black patients with heart failure to receive potentially lifesaving treatments, such as heart pumps and transplants
News Release
Statewide cardiovascular consortium, hosted at Michigan Medicine, receives national award for patient safety, quality efforts
A collaborative partnership dedicated to improving statewide cardiovascular care and outcomes — hosted at Michigan Medicine — received national recognition for efforts in patient safety and quality. BMC2 received the award for its significant improvements in the documentation of radiation use, a decrease in high-dose radiation exposure and reduction in opioid prescribing rates for patients.
Health Lab
Teen turns EKG heart readings into art
Teenage heart patient transforms EKG paper into art creations, sold as notecards to support research at University of Michigan Health C.S. Mott Children’s Hospital
Closeup of medical ventilator breathing tube
Health Lab
Patients on respiratory support in rural intermediate care units have higher death rates
Patients receiving ventilator life support in intermediate care units of rural hospitals had significantly higher death rates than patients in the same type of unit at urban hospitals, according to new study.
Illustration of Plan B contraceptive in the palm of a hand
Health Lab
Emergency contraception related ER visits dropped significantly over 14 year period
After federal approval for over the counter emergency contraception in 2006, emergency departments across the U.S. saw dramatic decreases in related visits.
doctor heart floating stethoscope
Health Lab
AI model predicts death, complications for patients undergoing angioplasty, stents
Researchers at Michigan Medicine developed an AI-driven algorithm that accurately predicts death and complications after PCI — which could emerge as a tool for clinicians as they determine treatment for blocked heart arteries.