Although its name might suggest otherwise, the intensive care unit (ICU) in hospitals is actually not the best place for most people brought in for heart attacks or bouts of congestive heart failure, a new study from the University of Michigan Health System finds.
Using Medicare records from almost 600,000 hospital stays in 2010, researchers investigated the trends in the quality of care in ICUs, focusing specifically on patients with heart disease. The use of ICUs across America is far from uniform, but researchers knew that the hospitals sending the highest percentage of patients to the ICU performed the worst overall on measures of health care quality. What does this mean for heart disease patients?
Scientists found that nearly half of the 150,000 hospitalizations for heart attacks seen in the 2010 records included patients send to the ICU, and 16 percent of the more than 400,000 hospitalizations for heart failure involved patients in an ICU. Overall, the health outcomes of heart disease patients were much worse when they were treated in a hospital with heavy reliance on the ICU. But why? What’s wrong with the ICU?
First author Thomas Valley, MD, MSc, asks: “Is [the ICU] 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’s recent study was published in the journal CHEST
Using the federal government’s Hospital Compare website, the researchers found reason to believe that hospitals sending the highest percentage of patients to the ICU were more likely to have a lack of familiarity with heart attack and heart failure, since these hospitals were also the ones with the smallest percentage of heart attack and heart failure patients admitted.
Moreover, scientists think that this relationship stems from the same hospitals being less likely to give heart attack patients aspirin and other drugs known to be effective upon their admittance, less likely to administer similarly importance medication for heart failure patients, less likely to perform key tests of heart function, and less likely to counsel patients on smoking cessation.
The most striking difference for heart disease patients between hospitals sending a large percentage of patients to the ICU and hospitals sending a less people to the ICU was a patient’s risk of dying within 30 days of being discharged. For heart attack patients at a hospital with a high percentage of ICU reliance, patients were six percent more likely to die, and heart failure patients were eight percent more likely to die.
Recent studies have found very similar trends for patients hospitalized with pneumonia as well.
The numbers are disconcerting, and families with loved ones needing hospitalization for heart disease might think twice before trusting the ICU to provide the most helpful care. Researchers from the study believe that doctors need to put more thought into deciding which patients truly need to go to the ICU, as well as reassess the protocols in place for ICU care.
“Hospitals using the ICU frequently could be targets for improvement,” Valley suggested. Valley and the rest of the University of Michigan researchers from the study will continue studying data from large groups of patients to determine which patients benefit the most from ICU-level care, in an effort to improve the decision process for sending patients to the ICU.
Source: University of Michigan Health System