ICU Versus High-Dependency Care Unit for Patients With Acute Myocardial Infarction: A Nationwide Propensity Score-Matched Cohort Study.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 06 2022
01 06 2022
Historique:
pubmed:
13
1
2022
medline:
28
5
2022
entrez:
12
1
2022
Statut:
ppublish
Résumé
To compare the outcomes of patients with acute myocardial infarction who were treated in ICUs versus high-dependency care units (HDUs). A nationwide, propensity score-matched, retrospective cohort study of a national administrative inpatient database in Japan from July 2010 to March 2018. Six hundred sixty-six acute-care hospitals with ICU and/or HDU beds covering about 75% of all ICU beds and 70% of all HDU beds in Japan. Adult patients who were hospitalized for acute myocardial infarction and admitted to the ICU or HDU on the day of hospital admission. Propensity score-matching analysis was performed to compare the inhospital mortality between patients treated in the ICU and HDU on the day of hospital admission. ICU or HDU admission on the day of hospital admission. Of 135,142 eligible patients, 89,382 (66%) were admitted to the ICU and 45,760 (34%) were admitted to the HDU on the day of admission. After propensity score matching, there was no statistically significant difference in inhospital mortality between the ICU and HDU groups (5.0% vs 5.5%; difference, -0.5%; 95% CI, -1.0% to 0.1%). In the subgroup analyses, inhospital mortality was significantly lower in the ICU group than that in the HDU group among patients with Killip class IV (25.6% vs 28.4%; difference, -2.9%; 95% CI, -5.4% to -0.3%), patients who underwent intubation (40.0% vs 46.6%; difference, -6.6%; 95% CI, -10.6% to -2.7%), and patients who received mechanical circulatory support (21.8% vs 24.7%; difference, -2.8%; 95% CI, -5.5% to -0.2%). Critical care in the ICU compared with that in the HDU was not associated with reduced inhospital mortality among the entire cohort of patients with acute myocardial infarction but was associated with reduced inhospital mortality among the subsets of patients with Killip class IV, intubation, or mechanical circulatory support.
Identifiants
pubmed: 35020671
doi: 10.1097/CCM.0000000000005440
pii: 00003246-202206000-00008
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
977-985Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Dr. Yasunaga’s institution received funding from the Ministry of Health, Labour, and Welfare, Japan and the Ministry of Education, Culture, Sports, Science and Technology, Japan. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Julian DG: Treatment of cardiac arrest in acute myocardial ischaemia and infarction. Lancet 1961; 2:840–844
Julian DG: The history of coronary care units. Br Heart J 1987; 57:497–502
Killip T 3rd, Kimball JT: Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 1967; 20:457–464
Lee TH, Goldman L: The coronary care unit turns 25: Historical trends and future directions. Ann Intern Med 1988; 108:887–894
Ishihara M, Fujino M, Ogawa H, et al.; J-MINUET investigators: Clinical presentation, management and outcome of Japanese patients with acute myocardial infarction in the troponin era - Japanese Registry of Acute Myocardial Infarction Diagnosed by Universal Definition (J-MINUET) -. Circ J 2015; 79:1255–1262
Pronovost PJ, Angus DC, Dorman T, et al.: Physician staffing patterns and clinical outcomes in critically ill patients: A systematic review. JAMA 2002; 288:2151–2162
Valentin A, Ferdinande P; ESICM Working Group on Quality Improvement: Recommendations on basic requirements for intensive care units: Structural and organizational aspects. Intensive Care Med 2011; 37:1575–1587
Nates JL, Nunnally M, Kleinpell R, et al.: ICU admission, discharge, and triage guidelines: A framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med 2016; 44:1553–1602
Morrow DA, Fang JC, Fintel DJ, et al.; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Clinical Cardiology, Council on Cardiovascular Nursing, and Council on Quality of Care and Outcomes Research: Evolution of critical care cardiology: Transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: A scientific statement from the American Heart Association. Circulation 2012; 126:1408–1428
Hasin Y, Danchin N, Filippatos GS, et al.; Working Group on Acute Cardiac Care of the European Society of Cardiology: Recommendations for the structure, organization, and operation of intensive cardiac care units. Eur Heart J 2005; 26:1676–1682
Kimura K, Kimura T, Ishihara M, et al.; Japanese Circulation Society Joint Working Group: JCS 2018 guideline on diagnosis and treatment of acute coronary syndrome. Circ J 2019; 83:1085–1196
Taenaka N, Ueshima K, Kimura K, et al; JSICM Investigative Committee for standards for establishing intensive care units: CCU establishment guidelines. J Jpn Soc Intensive Care Med 2004; 11:259–267
van Diepen S, Granger CB, Jacka M, et al.: The unmet need for addressing cardiac issues in intensive care research. Crit Care Med 2015; 43:128–134
Katz JN, Minder M, Olenchock B, et al.: The genesis, maturation, and future of critical care cardiology. J Am Coll Cardiol 2016; 68:67–79
Na SJ, Chung CR, Jeon K, et al.: Association between presence of a cardiac intensivist and mortality in an adult cardiac care unit. J Am Coll Cardiol 2016; 68:2637–2648
Shmueli A, Sprung CL: Assessing the in-hospital survival benefits of intensive care. Int J Technol Assess Health Care 2005; 21:66–72
Ohbe H, Sasabuchi Y, Kumazawa R, et al.: Intensive care unit occupancy in Japan, 2015-2018: A nationwide inpatient database study. J Epidemiol 2021 Apr 10. [online ahead of print]
Yasunaga H: Real world data in Japan: Chapter II the diagnosis procedure combination database. Ann Clin Epidemiol 2019; 1:76–79
Yamana H, Moriwaki M, Horiguchi H, et al.: Validity of diagnoses, procedures, and laboratory data in Japanese administrative data. J Epidemiol 2017; 27:476–482
The Ministry of Health, Labour and Welfare, Japan: Statistical Surveys 2017. Available at: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/open_data.html . Accessed August 6, 2021
Prin M, Wunsch H: The role of stepdown beds in hospital care. Am J Respir Crit Care Med 2014; 190:1210–1216
Boots R, Lipman J: High dependency units: Issues to consider in their planning. Anaesth Intensive Care 2002; 30:348–354
Shigematsu K, Nakano H, Watanabe Y: The eye response test alone is sufficient to predict stroke outcome–reintroduction of Japan Coma Scale: A cohort study. BMJ Open 2013; 3:e002736
Mahoney FI, Barthel DW: Functional evaluation: The Barthel Index. Md State Med J 1965; 14:61–65
Rosenbaum PR, Rubin DB: Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 1985; 39:33–38
Austin PC: Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 2009; 28:3083–3107
Wilcox ME, Chong CA, Niven DJ, et al.: Do intensivist staffing patterns influence hospital mortality following ICU admission? A systematic review and meta-analyses. Crit Care Med 2013; 41:2253–2274
Lott JP, Iwashyna TJ, Christie JD, et al.: Critical illness outcomes in specialty versus general intensive care units. Am J Respir Crit Care Med 2009; 179:676–683
Diringer MN, Edwards DF: Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med 2001; 29:635–640
Patel HC, Menon DK, Tebbs S, et al.: Specialist neurocritical care and outcome from head injury. Intensive Care Med 2002; 28:547–553
Kurtz P, Fitts V, Sumer Z, et al.: How does care differ for neurological patients admitted to a neurocritical care unit versus a general ICU? Neurocrit Care 2011; 15:477–480
Gotsman MS, Schrire V: Acute myocardial infarction–an ideal concept of progressive coronary care. S Afr Med J 1968; 42:829–832
Needleman J, Buerhaus P, Pankratz VS, et al.: Nurse staffing and inpatient hospital mortality. N Engl J Med 2011; 364:1037–1045
Penoyer DA: Nurse staffing and patient outcomes in critical care: A concise review. Crit Care Med 2010; 38:1521–1528
Eagle KA, Lim MJ, Dabbous OH, et al.; GRACE Investigators: A validated prediction model for all forms of acute coronary syndrome: Estimating the risk of 6-month postdischarge death in an international registry. JAMA 2004; 291:2727–2733
Fox KA, Dabbous OH, Goldberg RJ, et al.: Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: Prospective multinational observational study (GRACE). BMJ 2006; 333:1091