More ICU Use in Hospitals With Worse Quality of Care for Heart Failure or MI Interview with:

Thomas Valley, MD, MSc Fellow, Pulmonary and Critical Care University of Michigan Ann Arbor, MI 48109-2800

Dr. Thomas Valley

Thomas Valley, MD, MSc
Fellow, Pulmonary and Critical Care
University of Michigan
Ann Arbor, MI 48109-2800 What is the background for this study? What are the main findings?

Response: Hospitalizations for cardiovascular condition such as acute myocardial infarction (AMI) and heart failure (HF) are incredibly common and costly. Yet, about 20% of hospitalized patients with these conditions receive substandard care. We assessed whether there was an association between the quality of care a hospital provided for AMI or heart failure and how frequently a hospital used the ICU. We found that hospitals with the highest rates of ICU use for AMI or HF delivered worse quality of care and had higher 30-day mortality for these conditions. What should readers take away from your report?

Response: Wide variation in the use of the ICU has been previously noted for AMI and heart failure. There are many factors that contribute to how ICUs are used, such as how sick patients are at the hospital, how many beds are available, or what resources are available at the hospital. Our study demonstrates an association between a hospital’s quality of care for AMI or HF and ICU use. Hospitals with worse quality of care tended to use the ICU more frequently for AMI or HF.

By identifying hospitals that provide worse quality of care to patients, more resources may be devoted to recognizing gaps and enhancing care. Our study suggests that high ICU use hospitals could be targeted to improve care delivery. What recommendations do you have for future research as a result of this study?

Response: Further work is necessary to determine the mechanisms that underlie the relationship between quality of care and ICU use. Quality of care could play a key role in why hospitals use the ICU. For instance, hospitals could use the ICU proactively to prevent patient complications, or hospitals could use the ICU reactively after patients have already worsened. To improve overall quality of care, we must also assess other reasons why hospitals utilize the ICU. Thank you for your contribution to the community.


Intensive care use and quality of care for patients with myocardial infarction and heart failure
Thomas S. Valley, MD, MSc; Michael W. Sjoding, MD, MSc; Zachary D. Goldberger, MD, MS; Colin R. Cooke, MD, MSc, MS
Chest. 2016. doi:10.1016/j.chest.2016.05.034

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on June 29, 2016 by Marie Benz MD FAAD