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Intensive care unit versus high-dependency care unit for patients with acute heart failure: a nationwide propensity
Hiroyuki Ohbe1, Hiroki Matsui2, Hideo Yasunaga2
1Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan. hohbey@gmail.com.
Insights
Intensive care units (ICUs) did not show better outcomes than high-dependency care units (HDUs) for acute heart failure patients overall. However, ICUs demonstrated improved survival for patients requiring noninvasive ventilation or intubation.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- Cardiac intensive care units (CICUs) often adopt structures similar to general intensive care units (ICUs).
- Limited evidence exists regarding the optimal structure and staffing models for CICUs.
- This study investigates the comparative effectiveness of ICU versus high-dependency care unit (HDU) care for acute heart failure.
Purpose of the Study:
- To determine if intensive care unit (ICU) critical care for acute heart failure patients is associated with improved outcomes compared to high-dependency care unit (HDU) care.
- To compare in-hospital mortality rates between patients with acute heart failure treated in ICUs versus HDUs.
Main Methods:
- Nationwide, propensity score-matched, retrospective cohort study using Japanese administrative inpatient data (April 2014 - March 2019).
- Identified patients hospitalized for acute heart failure and admitted to ICU or HDU on admission day.
- Compared in-hospital mortality between ICU and HDU groups using propensity score matching.
Main Results:
- Of 202,866 patients, 39% went to ICU and 61% to HDU.
- No significant difference in in-hospital mortality between ICU (10.7%) and HDU (11.4%) overall.
- ICU care was associated with lower mortality in subgroups receiving noninvasive ventilation (9.4% vs 10.5%) and intubation (32.5% vs 40.6%).
Conclusions:
- Intensive care unit (ICU) critical care is not associated with lower in-hospital mortality than high-dependency care unit (HDU) care for all acute heart failure patients.
- ICU care demonstrated a significant survival benefit for acute heart failure patients requiring noninvasive ventilation or intubation.
- Findings suggest a nuanced approach to critical care allocation for acute heart failure based on respiratory support needs.
Background:
A structure and staffing model similar to that in general intensive care unit (ICUs) is applied to cardiac intensive care unit (CICUs) for patients with acute heart failure. However, there is limited evidence on the structure and staffing model of CICUs. The present study aimed to assess whether critical care for patients with acute heart failure in the ICUs is associated with improved outcomes than care in the high-dependency care units (HDUs), the hospital units in which patient care levels and costs are between the levels found in the ICU and general ward.
Methods:
This nationwide, propensity score-matched, retrospective cohort study was performed using a national administrative inpatient database in Japan. We identified all patients who were hospitalized for acute heart failure and admitted to the ICU or HDU on the day of hospital admission from April 2014 to March 2019. Propensity score-matching analysis was performed to compare the in-hospital mortality between acute heart failure patients treated in the ICU and HDU on the day of hospital admission.
Results:
Of 202,866 eligible patients, 78,646 (39%) and 124,220 (61%) were admitted to the ICU and HDU, respectively, on the day of admission. After propensity score matching, there was no statistically significant difference in in-hospital mortality between patients who were admitted to the ICU and HDU on the day of admission (10.7% vs. 11.4%; difference, - 0.6%; 95% confidence interval, - 1.5% to 0.2%). In the subgroup analyses, there was a statistically significant difference in in-hospital mortality between the ICU and HDU groups among patients receiving noninvasive ventilation (9.4% vs. 10.5%; difference, - 1.0%; 95% confidence interval, - 1.9% to - 0.1%) and patients receiving intubation (32.5% vs. 40.6%; difference, - 8.0%; 95% confidence interval, - 14.5% to - 1.5%). There were no statistically significant differences in other subgroup analyses.
Conclusions:
Critical care in ICUs was not associated with lower in-hospital mortality than critical care in HDUs among patients with acute heart failure. However, critical care in ICUs was associated with lower in-hospital mortality than critical care in HDUs among patients receiving noninvasive ventilation and intubation.
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