Hospital intensive care units (ICU) are usually thought of as the place where patients will get the best care, but in the case of certain types of heart problems, the patients who were sent there fared worse, a new study suggests.
The intensive care unit is a designated area of a hospital facility that is dedicated to the care of patients who are seriously ill.
However, there is a growing concern that the use of ICU beds in hospitals varies widely, and this study, for the first time, found that heart patients in those that relied heavily on them were less likely to survive a month after such a stay.
Researchers at the University of Michigan Medical School examined Medicare records from more than 570,000 hospital stays that took place in 2010. Of the more than 150,000 hospitalizations at nearly 1,700 hospitals due to 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 also included an ICU stay, at one of 2,199 hospitals.
Then they compared that data with the federal government's Hospital Compare website, which publicly reports hospital performance, to examine how well each hospital did at providing high-quality care, and what percentage of their patients died or ended up back in the hospital within a month of the hospital stay.
The study, which appears in CHEST, found that hospitals with the highest percentage of patients admitted to the ICU tended to be those with the smallest numbers of heart attack and heart failure patients over all, which perhaps suggested a lack of familiarity with these conditions.
For instance, the high-ICU hospitals were less likely to give heart attack patients aspirin when they arrived and other drugs that are known to improve outcomes after heart attacks. 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.
But the biggest difference was in the risk of dying within 30 days of discharge. The study showed the heart attack patients treated in high-ICU hospitals were 6 percent more likely to die than patients admitted to low-ICU hospitals, and the difference was about 8 percent for heart failure patients.
These findings suggest that there needs to be more standardization in deciding which patients need an ICU, and also more focus on quality of care in hospitals that patients receive in hospitals that make the most use of ICU, say the study's authors.
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