Association between intensive care unit utilization for patients with non–ST-segment elevation myocardial infarction and patient experience

2021 ◽  
Vol 231 ◽  
pp. 32-35
Author(s):  
Alexander C. Fanaroff ◽  
Anita Y Chen ◽  
Sean van Diepen ◽  
Deirdre Mylod ◽  
Eric D Peterson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Experience ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract 327: Electronic Health Record Integration of Predictive Analytics to Select High-risk Stable Patients With Non-st-segment Elevation Myocardial Infarction for Intensive Care Unit Admission

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Aman D Kansal ◽  
Alexander Fanaroff ◽  
Cynthia Green ◽  
Manesh R Patel ◽  
Tracy Y Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Risk Score ◽  
Predictive Analytics ◽  
Health Record ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Risk Patients

Background: Nationwide, intensive care unit (ICU) utilization for initially stable patients with non-ST-segment elevation myocardial infarction (NSTEMI) is not associated with patient risk. Use of the ACTION ICU risk score, which predicts clinical deterioration requiring ICU care in initially stable NSTEMI patients, could guide admission of high-risk patients to the ICU and low-risk patients to a lower acuity unit. Methods: We created a modified best practice advisory (BPA) within the electronic health record (EHR) at a single institution. The BPA semi-automatically calculates the ACTION ICU score (5 elements automatically populate from the EHR and 4 are entered manually) and recommends a location for admission based on a 10% risk threshold for clinical deterioration over the course of admission. The BPA was triggered for all ED patients with serum 4 th generation troponin T above the local upper limit of normal. Physicians could temporarily hide the BPA, permanently cancel it if they felt the patient’s presentation was not primarily due to NSTEMI, or generate the ACTION ICU score. We measured how ED physicians used the BPA, and clinical and utilization outcomes for patients admitted through the ED with a discharge diagnosis of NSTEMI in the 12 months before and after BPA roll-out. Results: Between August 14, 2017 and August 13, 2018, the BPA triggered 972 times. It was hidden until the patient left the ED 230 times (23.7%) and canceled 561 times (57.7%). Providers opted to calculate a risk score 181 times (18.6%), and a score was successfully calculated 146 times. Among 135 patients for whom the BPA triggered that had a final hospital diagnosis of NSTEMI, the BPA was inappropriately canceled in 62 (45.9%) and hidden in 16 (11.9%). Overall, there were 190 NSTEMI admissions through the ED in the year after BPA integration into the EHR and 253 in the year prior. In the year after BPA integration 32.6% of the NSTEMI patients were admitted directly to the ICU compared with 37.5% admitted to ICU prior to BPA (p=0.32). No change was found in the distribution of ACTION ICU scores of NSTEMI patients admitted to the ICU prior to vs after BPA integration, as well as no differences in ICU length of stay (p=0.96), hospital length of stay (p=0.27), the proportion of patients transferred from the ward to the ICU (p=0.78), or in-hospital mortality (p=0.18). Conclusions: Embedding the ACTION ICU risk score into the EHR did not affect clinical or utilization outcomes for patients presenting to the ED with NSTEMI, but was limited by inappropriate cancellation of the risk score calculator. Better EHR mapping to enable risk calculation without the need for user input may be needed for successful deployment of predictive analytics in this patient population.

scholarly journals Analysis of the TIMI score in patients admitted with ST-segment elevation myocardial infarction in an intensive care unit

Critical Care ◽  
2007 ◽  
Vol 11 (Suppl 3) ◽  
pp. P50
Author(s):  
SLM Arruda ◽  
HJP Branisso ◽  
EC Figueiredo ◽  
VA Pereira ◽  
JA Luna ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Timi Score ◽  
St Segment

Clinical outcomes and need for intensive care after non-ST-segment-elevation myocardial infarction

2020 ◽  
Vol 76 ◽  
pp. 58-63 ◽  
Author(s):  
Patrícia O. Guimarães ◽  
Márcio C. Sampaio ◽  
Felipe L. Malafaia ◽  
Renato D. Lopes ◽  
Alexander C. Fanaroff ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals National trends in coronary intensive care unit admissions, resource utilization, and outcomes

2019 ◽  
Vol 9 (8) ◽  
pp. 923-930
Author(s):  
Sarah Woolridge ◽  
Wendimagegn Alemayehu ◽  
Padma Kaul ◽  
Christopher B Fordyce ◽  
Patrick R Lawler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Mortality Rates ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Emerging evidence suggests that coronary intensive care units are evolving into intensive care environments with an increasing burden of non-cardiovascular illness, but previous studies have been limited to older populations or single center experiences. Methods: Canadian national health-care data was used to identify all patients ≥18 years admitted to dedicated coronary intensive care units (2005–2015) and admissions were categorized as primary cardiac or non-cardiac. The outcomes of interest included longitudinal trends in admission diagnoses, critical care therapies, and all-cause in-hospital mortality. Results: Among the 373,992 patients admitted to a coronary intensive care unit, minimal changes in the proportion of patients admitted with a primary cardiac (88.2% to 86.9%; p<0.001) and non-cardiac diagnoses (11.8% to 13.1%; p<0.001) were observed. Among cardiac admissions, a temporal increase in the proportion of ST-segment elevation myocardial infarction (19.4% to 24.1%, p<0.001), non-ST-segment elevation myocardial infarction (14.6% to 16.2%, p<0.001), heart failure (7.3% to 8.4%, p<0.001), shock (4.9% to 5.7%, p<0.001), and decline in unstable angina (4.9% to 4.0%, p<0.001) and stable coronary diseases (21.3% to 12.4%, p<0.001) was observed. The proportion of patients requiring critical care therapies (57.8% to 63.5%, p<0.001) including mechanical ventilation (9.6% to 13.1%, p<0.001) increased. In-hospital mortality rates for patients with primary cardiac (4.9% to 4.4%; adjusted odds ratio 0.71, 95% confidence interval 0.63–0.79) and non-cardiac (17.8% to 16.1%; adjusted odds ratio 0.84, 0.73–0.97) declined; results were consistent when stratified by academic vs community hospital, and by the presence of on-site percutaneous coronary intervention. Conclusion: In a national dataset we observed a changing case-mix among patients admitted to a coronary intensive care unit, though the proportion of patients with a primary cardiac diagnosis remained stable. There was an increase in clinical acuity highlighted by critical care therapies, but in-hospital mortality rates for both primary cardiac and non-cardiac conditions declined across all hospitals. Our findings confirm the changing coronary intensive care unit case-mix and have implications for future coronary intensive care unit training and staffing.

scholarly journals Impact of the 2019 Novel Coronavirus Disease Pandemic on the Performance of a Cardiovascular Department in a Non-epidemic Center in Beijing, China

2021 ◽  
Vol 8 ◽  
Author(s):  
Jing Nan ◽  
Tong Zhang ◽  
Yali Tian ◽  
Ke Song ◽  
Qun Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care ◽  
Clinic Attendance ◽  
Cardiac Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Emergency Medical ◽  
St Segment ◽  
Number Of Patients ◽  
Novel Coronavirus

Background: Knowledge of the impact of the 2019 novel coronavirus disease (COVID-19) pandemic on the performance of a cardiovascular department in a medical referral hub center from a non-epidemic area of China is limited.Method: The data on the total number of non-emergency medical cares (including the number of out-patient clinic attendances, the number of patients who were hospitalized in non-intensive care wards, and patients who underwent elective cardiac intervention procedures) and emergency medical cares [including the number of emergency department (ED attendances) and chest pain center (CPC attendances), as well as the number of patients who were hospitalized in coronary care unit (CCU) and the number of patients who underwent emergency cardiac intervention procedures] before and during the pandemic (time before the pandemic: 20th January 2019 to 31st March 2019 and time during the pandemic: 20th January 2020 to 31st March 2020) in the Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University were collected and compared.Results: Both the non-emergency medical and emergency medical cares were affected by the pandemic. The total number of out-patient clinic attendance decreased by 44.8% and the total number of patients who were hospitalized in non-intensive care wards decreased by 56.4%. Pearson correlation analysis showed that the number of out-patient clinic attendance per day was not associated with the number of new confirmed COVID-19 cases and the cumulative number of confirmed COVID-19 patients in Beijing (r = −0.080, p = 0.506 and r = −0.071, p = 0.552, respectively). The total number of patients who underwent non-emergency cardiac intervention procedures decreased during the pandemic, although there were no statistically significant differences except for patent foramen ovale (PFO) occlusion (1.7 ± 2.9 vs. 8.3 ± 2.3, p = 0.035). As for the emergency medical cares, the ED attendances decreased by 22.4%, the total number of CPC attendances increased by 10.3%, and the number of patients who were hospitalized in CCU increased by 8.9%: these differences were not statistically significant. During the pandemic, the proportion of hospitalized patients with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) significantly increased (19.0 vs. 8.7%, p &lt; 0.001; 28.8 vs. 18.0%, p &lt; 0.001, respectively); also, the number of primary percutaneous coronary intervention (PCI) increased by 10.3%. There was no significant difference between patients before and during the pandemic regarding the age, gender, baseline and discharge medication therapy, as well as length of stay and in-hospital mortality.Conclusions: Our preliminary results demonstrate that both the non-emergency and emergency medical cares were affected by the COVID-19 pandemic even in a referral medical center with low cross-infection risk. The number of the out-patient clinic attendances not associated with the number of confirmed COVID-19 cases could be due to different factors, such as the local government contamination measures. The proportion of hospitalized patients with acute myocardial infarction increased in our center during the pandemic since other hospitals stopped performing primary angioplasty. A hub-and-spoke model could be effective in limiting the collateral damage for patients affected by cardiovascular diseases when the medical system is stressed by disasters, such as COVID-19 pandemic.

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