The associations between direct and delayed critical care unit admission with mortality and readmissions among patients with heart failure - 18/02/21
Résumé |
Background |
Although greater than 20% of patients hospitalized with heart failure (HF) are admitted to a critical care unit, associated outcomes, and costs have not been delineated. We determined 30-day mortality, 30-day readmissions, and hospital costs associated with direct or delayed critical care unit admission.
Methods |
In a population-based analysis, we compared HF patients who were admitted to critical care directly from the emergency department (direct), after initial ward admission (delayed), or never admitted to critical care during their hospital stay (ward-only).
Results |
Among 178,997 HF patients (median age 80 [IQR 71-86] years, 49.6% men) 36,175 (20.2%) were admitted to critical care during their hospitalization (April 2003 to March 2018). Critical care patients were admitted directly from the emergency department (direct, 81.9%) or after initial ward admission (delayed, 18.1%). Multivariable-adjusted hazard ratios (HR) for all-cause 30-day mortality were: 1.69 for direct (95% confidence interval [CI]; 1.55, 1.84) and 4.92 for delayed (95% CI; 4.26, 5.68) critical care-admitted compared to ward-only patients. Multivariable-adjusted repeated events analysis demonstrated increased risk for all-cause 30-day readmission with both direct (HR 1.04, 95% CI; 1.01, 1.08, P = .013) and delayed critical care unit admissions (HR 1.20, 95% CI; 1.13, 1.28, P < .001). Median 30-day costs were $12,163 for direct admissions, $20,173 for delayed admissions, and $9,575 for ward-only patients (P < .001).
Conclusions |
While critical care unit admission indicates increased risk of mortality and readmission at 30 days, those who experienced delayed critical care unit admission exhibited the highest risk of death and highest costs of care.
Le texte complet de cet article est disponible en PDF.Plan
| Disclosures: The authors have no conflicts of interest to declare. |
|
| Funding: The Institute for Clinical Evaluative Sciences (ICES) is supported in part by a grant from the Ontario Ministry of Health and Long Term Care. The opinions, results and conclusions are those of the authors and no endorsement by the Ministry of Health and Long-Term Care or by the Institute for Clinical Evaluative Sciences is intended or should be inferred. Parts of this material are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI. This study was supported by a Foundation Grant from the Canadian Institutes of Health Research (grant # FDN 148446). Dr. Lee is the Ted Rogers Chair in Heart Function Outcomes, a Hospital Chair of the University Health Network at the University of Toronto. Dr. Austin is a Mid-Career investigator of the Heart and Stroke Foundation. Dr. Tu is a Tier 1 Canada Research Chair in Health Services Research and an Eaton Scholar of the Department of Medicine, University of Toronto. Parts of this report are based on Ontario Registrar General information on deaths, the original source of which is ServiceOntario. The views expressed therein are those of the author and do not necessarily reflect those of ORG or Ministry of Government Services. |
Vol 233
P. 20-38 - mars 2021 Retour au numéro
Article précédent
- Individual Patient Data from the Pivotal Randomized Controlled Trials of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation (COMBINE AF): Design and Rationale : From the COMBINE AF (A Collaboration between Multiple institutions to Better Investigate Non-vitamin K antagonist oral anticoagulant use in Atrial Fibrillation) Investigators
- Anthony P Carnicelli, Hwanhee Hong, Robert P Giugliano, Stuart J Connolly, John Eikelboom, Manesh R Patel, Lars Wallentin, David A Morrow, Daniel Wojdyla, Kaiyuan Hua, Stefan H Hohnloser, Jonas Oldgren, Christian T Ruff, Jonathan P Piccini, Renato D Lopes, John H Alexander, Christopher B Granger, on behalf of the COMBINE AF Investigators
- Paclitaxel-coated devices in the treatment of femoropopliteal stenosis among patients ?65 years old: An ACC PVI Registry Analysis
- Elizabeth Hope Weissler, Amarnath Annapureddy, Yongfei Wang, Eric A. Secemsky, Mehdi H. Shishehbor, Carlos Mena-Hurtado, Qurat-Ul-Ain Jelani, Herbert D. Aronow, Thomas T. Tsai, Manesh R. Patel, Jeptha P. Curtis, William Schuyler Jones
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?