Abstract 17437: Do Patients With Uncomplicated Non-ST Segment Acute Coronary Syndromes Require Admission to Critical Care Units?
Background: Clinical practice guidelines recommend admitting patients with stable non-ST segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two thirds of patients are admitted to critical care units (CCU). The outcomes of patients with stable NSTE ACS initially admitted to a CCU versus a cardiology ward with telemetry have not yet been described.
Methods: We used a population-based dataset of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada between April 1, 2007 and Mar 31, 2013 and excluded patients (n=589) who received CCU procedures or therapies on the day of admission. We compared outcomes among patients initially admitted to a CCU (n=5141) with those admitted to cardiology telemetry wards (n=2728).
Results: Patients admitted to cardiology telemetry wards were older (median 69 vs 65 years, p<0.001), and more likely to be female (37.2% vs 32.1%, p<0.001) and have a history of prior myocardial infarction (14.3% vs 11.5%, p<0.001). Patients admitted directly to cardiology telemetry wards had similar hospital stays (6.2 vs 5.7 days, p=0.29), fewer cardiac procedures (39.1% vs 45.8%, p<0.001) and higher mean Charleston scores (1.3 vs 1.0, p<0.001) compared with patients initially admitted to CCUs. There were no differences in the frequency of cardiac arrest (0.7% vs 0.9%, p=0.51), in-hospital mortality (1.3% vs 1.2%, adjusted odds ratio (aOR) 1.57; 95% CI, 0.98 to 2.52), 30-day all-cause mortality (1.6% vs 1.5%, aOR 1.50; 95% CI 0.82 to 2.75), or 30-day all-cause post-discharge readmission (10.6% vs 10.8%, aOR 1.07; 95% CI 0.90 to 1.28) between cardiology telemetry ward and CCU patients. Results were similar across low, intermediate, and high risk NSTE ACS Charleston subgroups and in patients with non-ST segment myocardial infarction or unstable angina.
Conclusions: No differences in clinically important outcomes were observed between patients with NSTE ACS initially admitted to wards or CCUs. These findings suggest that stable NSTE ACS can be managed appropriately in telemetry wards and present an opportunity to reduce hospital costs and critical care capacity strain.
Author Disclosures: S. van Diepen: Research Grant; Modest; Heart and Stroke Foundation. M. Lin: None. J.A. Bakal: None. F.A. McAlister: None. P. Kaul: None. J.N. Katz: None. C.B. Fordynce: None. D.A. Southern: None. M.M. Graham: None. S.B. Wilton: None. L.K. Newby: None. C.B. Granger: None. J.A. Ezekowitz: None.
- © 2015 by American Heart Association, Inc.