Loading...
Acute decompensated heart failure patients admitted to critical care units: Insights from ASCEND-HF
Van Diepen, Sean Podder, Mohua Hernandez, Adrian F. Westerhout, Cynthia M. Armstong, Paul W. McMurray, John J.V. Eapen, Zubin J. Califf, Robert M. Starling, Randall C. O'Connor, Christopher M.
Van Diepen, Sean
Podder, Mohua
Hernandez, Adrian F.
Westerhout, Cynthia M.
Armstong, Paul W.
McMurray, John J.V.
Eapen, Zubin J.
Califf, Robert M.
Starling, Randall C.
O'Connor, Christopher M.
Abstract
Background: Little is known about global patterns of critical care unit (CCU) care and the relationship with outcomes in patients with acute decompensated heart failure (ADHF). Whether a ward or a CCU admission is associated with better outcomes is unclear. Methods: Patients in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND- HF) trial were initially hospitalized in a ward or CCU (coronary or intensive care unit). Sites were geographically classified: Asia-Pacific (AP), Central Europe (CE), Latin America (LA), North America (NA), and Western-Europe (WE). The primary outcome of 30-day all-cause mortality or all-cause hospital readmission was adjusted using a two-stage multivariable logistic regression model with a generalized estimated equation that took sites within each country as a nested random factor. Results: Overall, 1944 (38.2%) patients were admitted to a CCU and 3150 (61.8%) to award, and this varied by region: 50.6% AP, 63.3% CE, 60.7% WE, 22.1% LA, and 28.6% NA. The 30-day death or readmission rate was 15.2% in ward patients and 17.0% in CCU patients (risk-adjusted Odds Ratio [OR] 1.44: 95% CI, 1.14–1.82). Comparedwith CCU patients in NA (24.1% 30-day event rate), the primary outcomes were: AP (10.4%, Odds Ratio [OR] 0.63; 95% confidence Interval [CI], 0.35 to 1.15), CE (10.4%, OR 0.56: 95% CI, 0.31 to 1.02), LA (22.4%, OR 0.60: 95% CI, 0.11 to 3.32), andWE (11.2%, OR 0.63, 95% CI, 0.25 to 1.56). No regional differences in 30-day mortality were observed; however, 30-day readmission rates were highest in NA sites. Conclusions: Management of patients with ADHF varies significantly, and after adjustment, CCU care was associated with higher risk of early mortality, not explained by international differences. These findings may help to improve the early decisions regarding risk stratification of patients hospitalized with ADHF
Keywords
Heart failure, Critical care, Coronary care unit, Intensive care unit, Outcomes
Date
2014
Type
Journal article
Journal
International Journal of Cardiology
Book
Volume
177
Issue
3
Page Range
840-846
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled