Interhospital Variation in Admissions Managed With Critical Care Therapies or Invasive Hemodynamic Monitoring in Tertiary Cardiac Intensive Care Units: An Analysis From the Critical Care Cardiology Trials Network Registry-Reference-Cited by-同舟云学术

Interhospital Variation in Admissions Managed With Critical Care Therapies or Invasive Hemodynamic Monitoring in Tertiary Cardiac Intensive Care Units: An Analysis From the Critical Care Cardiology Trials Network Registry

Published:2024-01 Issue:1 Volume:17 Page:
ISSN:1941-7713
Container-title:Circulation: Cardiovascular Quality and Outcomes
language:en
Short-container-title:Circ: Cardiovascular Quality and Outcomes

Author:

Donnelly Sarah¹,Barnett Christopher F.²^ORCID,Bohula Erin A.³^ORCID,Chaudhry Sunit-Preet⁴^ORCID,Chonde Meshe D.⁵^ORCID,Cooper Howard A.⁶,Daniels Lori B.⁷^ORCID,Dodson Mark W.⁸^ORCID,Gerber Daniel⁹^ORCID,Goldfarb Michael J.¹⁰^ORCID,Guo Jianping³^ORCID,Kontos Michael C.¹¹,Liu Shuangbo¹²^ORCID,Luk Adriana C.¹³^ORCID,Menon Venu¹⁴^ORCID,O’Brien Connor G.²^ORCID,Papolos Alexander I.¹⁵^ORCID,Pisani Barbara A.¹⁶^ORCID,Potter Brian J.¹⁷^ORCID,Prasad Rajnish¹⁸,Schnell Gregory¹⁹,Shah Kevin S.²⁰,Sridharan Lakshmi²¹^ORCID,So Derek Y.F.²²^ORCID,Teuteberg Jeffrey J.^ORCID,Tymchak Wayne J.²³²⁴^ORCID,Zakaria Sammy²⁵^ORCID,Katz Jason N.²⁶,Morrow David A.³^ORCID,van Diepen Sean^ORCID

Affiliation:

1. Division of General Internal Medicine, Department of Medicine (S.D.), University of Alberta, Edmonton, Canada.

2. Division of Cardiology, Department of Medicine, University of California, San Francisco (C.F.B., C.G.O.).

3. Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (E.A.B., J.G., D.A.M.).

4. Division of Cardiology, Ascension St. Vincent Heart Center, Indianapolis, IN (S.-P.C.).

5. Cedars-Sinai Smidt Heart Institute, Los Angeles, CA (M.D.C.).

6. Westchester Medical Center and New York Medical College, Valhalla (H.A.C.).

7. Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla (L.B.D.).

8. Department of Medicine, Intermountain Medical Center, Murray, UT (M.W.D.).

9. Division of Cardiovascular Medicine, Department of Medicine, Stanford University, CA (D.G.).

10. Division of Cardiology, Jewish General Hospital, Montreal, QC, Canada (M.J.G).

11. Division of Cardiology, Virginia Commonwealth University, Richmond (M.C.K.).

12. Max Rady College of Medicine, St. Boniface Hospital, Winnipeg, MB, Canada (S.L.).

13. Peter Munk Cardiac Centre at Toronto General Hospital, Division of Cardiology and Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada (A.C.L.).

14. Cardiovascular Medicine, Cleveland Clinic Foundation, OH (V.M.).

15. Division of Cardiology, Department of Critical Care, MedStar Washington Hospital Center, DC (A.I.P.).

16. Atrium Wake Forest Baptist, Winston-Salem, NC (B.A.P.).

17. Centre Hospitalier de l’Université de Montréal Research Center and Cardiovascular Center, QC, Canada (B.J.P.).

18. Wellstar Health System, Marietta, GA (R.P.).

19. Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (G.S.).

20. University of Utah Health Sciences Center, Salt Lake City (K.S.S.).

21. Division of Cardiology, Emory University, Atlanta, GA (L.S.).

22. University of Ottawa Heart Institute, ON, Canada (D.Y.F.S.).

23. Department of Critical Care Medicine (W.J.T.), University of Alberta, Edmonton, Canada.

24. Division of Cardiology, Department of Medicine (W.J.T.), University of Alberta, Edmonton, Canada.

25. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (S.Z.).

26. Duke University, Durham, NC (J.N.K.).

Abstract

BACKGROUND: Wide interhospital variations exist in cardiovascular intensive care unit (CICU) admission practices and the use of critical care restricted therapies (CCRx), but little is known about the differences in patient acuity, CCRx utilization, and the associated outcomes within tertiary centers. METHODS: The Critical Care Cardiology Trials Network is a multicenter registry of tertiary and academic CICUs in the United States and Canada that captured consecutive admissions in 2-month periods between 2017 and 2022. This analysis included 17 843 admissions across 34 sites and compared interhospital tertiles of CCRx (eg, mechanical ventilation, mechanical circulatory support, continuous renal replacement therapy) utilization and its adjusted association with in-hospital survival using logistic regression. The Pratt index was used to quantify patient-related and institutional factors associated with CCRx variability. RESULTS: The median age of the study population was 66 (56–77) years and 37% were female. CCRx was provided to 62.2% (interhospital range of 21.3%–87.1%) of CICU patients. Admissions to CICUs with the highest tertile of CCRx utilization had a greater burden of comorbidities, had more diagnoses of ST–elevation myocardial infarction, cardiac arrest, or cardiogenic shock, and had higher Sequential Organ Failure Assessment scores. The unadjusted in-hospital mortality (median, 12.7%) was 9.6%, 11.1%, and 18.7% in low, intermediate, and high CCRx tertiles, respectively. No clinically meaningful differences in adjusted mortality were observed across tertiles when admissions were stratified by the provision of CCRx. Baseline patient-level variables and institutional differences accounted for 80% and 5.3% of the observed CCRx variability, respectively. CONCLUSIONS: In a large registry of tertiary and academic CICUs, there was a >4-fold interhospital variation in the provision of CCRx that was primarily driven by differences in patient acuity compared with institutional differences. No differences were observed in adjusted mortality between low, intermediate, and high CCRx utilization sites.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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