Abstract 15864: Patients With Acute Coronary Syndromes and Heart Failure Admitted to Critical Care Units in Teaching Hospitals Have Lower Observed In-hospital Mortality and 30-day Readmission Rates
Background: Acute coronary syndromes (ACS) and heart failure (HF) are leading diagnoses in patients admitted to coronary care units (CCU). However, it is unknown if the hospital type, including size and community or teaching focus, has clinical implications.
Hypothesis: We evaluated rates of CCU admission, therapies, resource utilization, and clinical outcomes across teaching and community hospitals.
Methods: Canadian Institute for Health Information data was used to identify patients aged ≥ 18 years hospitalized in with a primary diagnosis of an ACS (STEMI, NSTEMI, UA) or HF in 9 Canadian provinces between 2007 and 2013. CCUs were categorized by hospital type as follows: teaching (any size), large (≥200 beds), medium (50-199 beds), and small (1-49 beds) community hospitals. The outcomes were CCU admission rates, critical care therapy/procedure use, in-hospital mortality and 30-day post-discharge all-cause readmission rates.
Results: Among the 220,759 hospitalized patients, 73,338 (33.2%) were admitted to a CCU. The proportion of patients admitted to a CCU varied across hospital types: 20,963 (41.0%) in teaching, 31,110 (29.9%) in large, 18,125 (42.6%) in medium, and 3,140 (13.7%) in small community hospitals. Patients receiving critical care therapies in teaching, large, medium and small hospitals were 73.6%, 50.9%, 24.6%, and 8.8% (p<0.0001), respectively. Patients admitted to CCUs in community hospitals had higher in-hospital mortality rates compared to teaching hospitals (Table). Similar findings were observed for 30-day all-cause readmission in patients with STEMI and NSTEMI patients.
Conclusions: Patients admitted with ACS or HF to teaching hospital CCUs had a higher use of CCU therapies, and lower adjusted mortality and 30-day re-admission rates compared to community hospitals. These differences highlight differences and potential disparities in CCU admission practices, resource utilization, and outcomes across hospitals types in Canada.
Author Disclosures: S. Verma: None. P. Kaul: None. M. Lin: None. J.A. Ezekowitz: Consultant/Advisory Board; Modest; Pfizer/Bristol-Myers Squibb, Bayer. D. Zygun: None. F. McAlister: None. S. van Diepen: None.
- © 2016 by American Heart Association, Inc.