TY - JOUR
T1 - Association between intensive care unit usage and long-term medication adherence, mortality, and readmission among initially stable patients with non–st-segment–elevation myocardial infarction
AU - Fanaroff, Alexander C.
AU - Chen, Anita Y.
AU - van Diepen, Sean
AU - Peterson, Eric D.
AU - Wang, Tracy Y.
N1 - Funding Information:
Dr Fanaroff reported a career development grant from the American Heart Association (17FTF33661087), research grant support to the Duke Clinical
Funding Information:
This manuscript was supported by a career development grant from the American Heart Association to Dr Fanaroff, and by internal grants to Dr Fanaroff from the Duke Clinical Research Institute.
Publisher Copyright:
© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2020
Y1 - 2020
N2 - BACKGROUND: Hospitals in the United States vary in their use of intensive care units (ICUs) for hemodynamically stable patients with non–ST-segment–elevation myocardial infarction (NSTEMI). The association between ICU use and long-term outcomes after NSTEMI is unknown. METHODS AND RESULTS: Using data from the National Cardiovascular Data Registry linked to Medicare claims, we identified 65 256 NSTEMI patients aged ≥ 65 years without cardiogenic shock or cardiac arrest on presentation between 2011 and 2014. We compared 1-year medication non-adherence, cardiovascular readmission, and mortality across hospitals by ICU use using multivariable regression models. Among 520 hospitals, 154 (29.6%) were high ICU users (>70% of stable NSTEMI patients admitted to ICU), 270 (51.9%) were intermediate (30%–70%), and 196 (37.7%) were low (<30%). Compared with low ICU usage hospitals, no differences were observed in the risks of 1-year medication non-adherence (adjusted odds ratio 1.08, 95% CI, 0.97–1.21), mortality (adjusted hazard ratio 1.06, 95% CI, 0.98–1.15), and cardiovascular readmission (adjusted hazard ratio 0.99, 95% CI, 0.95–1.04) at high usage hospitals. Patients hospitalized at intermediate ICU usage hospitals had lower rates of evidence-based therapy and diagnostic catheterization within 24 hours of hospital arrival, and higher risks of 1-year mortality (adjusted hazard ratio 1.07, 95% CI, 1.02–1.12) and medication non-adherence (adjusted odds ratio 1.09, 95% CI, 1.02–1.15) compared with low ICU usage hospitals. CONCLUSIONS: Routine ICU use is unlikely to be beneficial for hemodynamically stable NSTEMI patients; medication adher-ence, long-term mortality, and cardiovascular readmission did not differ for high ICU usage hospitals compared with hospitals with low ICU usage rates.
AB - BACKGROUND: Hospitals in the United States vary in their use of intensive care units (ICUs) for hemodynamically stable patients with non–ST-segment–elevation myocardial infarction (NSTEMI). The association between ICU use and long-term outcomes after NSTEMI is unknown. METHODS AND RESULTS: Using data from the National Cardiovascular Data Registry linked to Medicare claims, we identified 65 256 NSTEMI patients aged ≥ 65 years without cardiogenic shock or cardiac arrest on presentation between 2011 and 2014. We compared 1-year medication non-adherence, cardiovascular readmission, and mortality across hospitals by ICU use using multivariable regression models. Among 520 hospitals, 154 (29.6%) were high ICU users (>70% of stable NSTEMI patients admitted to ICU), 270 (51.9%) were intermediate (30%–70%), and 196 (37.7%) were low (<30%). Compared with low ICU usage hospitals, no differences were observed in the risks of 1-year medication non-adherence (adjusted odds ratio 1.08, 95% CI, 0.97–1.21), mortality (adjusted hazard ratio 1.06, 95% CI, 0.98–1.15), and cardiovascular readmission (adjusted hazard ratio 0.99, 95% CI, 0.95–1.04) at high usage hospitals. Patients hospitalized at intermediate ICU usage hospitals had lower rates of evidence-based therapy and diagnostic catheterization within 24 hours of hospital arrival, and higher risks of 1-year mortality (adjusted hazard ratio 1.07, 95% CI, 1.02–1.12) and medication non-adherence (adjusted odds ratio 1.09, 95% CI, 1.02–1.15) compared with low ICU usage hospitals. CONCLUSIONS: Routine ICU use is unlikely to be beneficial for hemodynamically stable NSTEMI patients; medication adher-ence, long-term mortality, and cardiovascular readmission did not differ for high ICU usage hospitals compared with hospitals with low ICU usage rates.
KW - Acute coronary syndrome
KW - Healthcare quality
KW - Hospital readmission
KW - Intensive care unit
KW - Medication adherence
KW - Non–ST-segment–elevation myocardial infarction
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U2 - 10.1161/JAHA.119.015179
DO - 10.1161/JAHA.119.015179
M3 - Article
C2 - 32174210
AN - SCOPUS:85082067345
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 6
M1 - e015179
ER -