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

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.

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 Unstable angina and non-ST-segment elevation myocardial infarction: an analysis by TIMI score

Critical Care ◽  
2009 ◽  
Vol 13 (Suppl 3) ◽  
pp. P36
Author(s):  
SLM Arruda ◽  
PC Miranda ◽  
TPF Araújo ◽  
KO Teixeira ◽  
CS Souza ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Unstable Angina ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Timi Score ◽  
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.

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