NYMC Faculty Publications

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

Sarah Donnelly, Division of General Internal Medicine, Department of Medicine (S.D.), University of Alberta, Edmonton, Canada.
Christopher F. Barnett, Division of Cardiology, Department of Medicine, University of California, San Francisco (C.F.B., C.G.O.).
Erin A. Bohula, 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.).
Sunit-Preet Chaudhry, Division of Cardiology, Ascension St. Vincent Heart Center, Indianapolis, IN (S.-P.C.).
Meshe D. Chonde, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA (M.D.C.).
Howard A. Cooper, Westchester Medical Center and New York Medical College, Valhalla (H.A.C.).
Lori B. Daniels, Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla (L.B.D.).
Mark W. Dodson, Department of Medicine, Intermountain Medical Center, Murray, UT (M.W.D.).
Daniel Gerber, Division of Cardiovascular Medicine, Department of Medicine, Stanford University, CA (D.G.).
Michael J. Goldfarb, Division of Cardiology, Jewish General Hospital, Montreal, QC, Canada (M.J.G).
Jianping Guo, 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.).
Michael C. Kontos, Division of Cardiology, Virginia Commonwealth University, Richmond (M.C.K.).
Shuangbo Liu, Max Rady College of Medicine, St. Boniface Hospital, Winnipeg, MB, Canada (S.L.).
Adriana C. Luk, 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.).
Venu Menon, Cardiovascular Medicine, Cleveland Clinic Foundation, OH (V.M.).
Connor G. O'Brien, Division of Cardiology, Department of Medicine, University of California, San Francisco (C.F.B., C.G.O.).
Alexander I. Papolos, Division of Cardiology, Department of Critical Care, MedStar Washington Hospital Center, DC (A.I.P.).
Barbara A. Pisani, Atrium Wake Forest Baptist, Winston-Salem, NC (B.A.P.).
Brian J. Potter, Centre Hospitalier de l'Université de Montréal Research Center and Cardiovascular Center, QC, Canada (B.J.P.).
Rajnish Prasad, Wellstar Health System, Marietta, GA (R.P.).
Gregory Schnell, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (G.S.).
Kevin S. Shah, University of Utah Health Sciences Center, Salt Lake City (K.S.S.).
Lakshmi Sridharan, Division of Cardiology, Emory University, Atlanta, GA (L.S.).
Derek Y. So, University of Ottawa Heart Institute, ON, Canada (D.Y.F.S.).
Jeffrey J. Teuteberg
Wayne J. Tymchak, Department of Critical Care Medicine (W.J.T.), University of Alberta, Edmonton, Canada.
Sammy Zakaria, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (S.Z.).
Jason N. Katz, Duke University, Durham, NC (J.N.K.).
David A. Morrow, 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.).
Sean van Diepen

Author Type(s)

Faculty

Journal Title

Circulation. Cardiovascular Quality and Outcomes

First Page

e010092

Document Type

Article

Publication Date

1-1-2024

Department

Medicine

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.

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