Acute decompensated heart failure patients admitted to critical care units: insights from ASCEND-HF

Sean van Diepen; Mohua Podder; Adrian F Hernandez; Cynthia M Westerhout; Paul W Armstong; John J V McMurray; Zubin J Eapen; Robert M Califf; Randall C Starling; Christopher M O'Connor; Justin A Ezekowitz

doi:10.1016/j.ijcard.2014.11.007

Acute decompensated heart failure patients admitted to critical care units: insights from ASCEND-HF

Int J Cardiol. 2014 Dec 20;177(3):840-6. doi: 10.1016/j.ijcard.2014.11.007. Epub 2014 Nov 4.

Affiliations

¹ Divisions of Critical Care and Cardiology, University of Alberta, Edmonton, Alberta, Canada; Canadian Vigour Center, Edmonton, Alberta, Canada. Electronic address: sv9@ualberta.ca.
² Canadian Vigour Center, Edmonton, Alberta, Canada.
³ Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
⁴ Canadian Vigour Center, Edmonton, Alberta, Canada; Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
⁵ Western Infirmary, University of Glasgow, Glasgow, Scotland, United Kingdom.
⁶ Cleveland Clinic, OH, USA.

PMID: 25465830
DOI: 10.1016/j.ijcard.2014.11.007

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 a ward, 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). Compared with 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), and WE (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: Coronary care unit; Critical care; Heart failure; Intensive care unit; Outcomes.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Aged
Critical Care / methods
Critical Care / trends*
Double-Blind Method
Female
Heart Failure / diagnosis*
Heart Failure / mortality*
Heart Failure / therapy
Humans
Intensive Care Units / trends*
Male
Middle Aged
Patient Admission / trends*
Patient Readmission / trends