Incremental costs of high intensive care utilisation in patients hospitalised with heart failure

European Heart Journal: Acute Cardiovascular Care - Tập 8 Số 7 - Trang 660-666 - 2019
Sean van Diepen1,2,3, Dat T. Tran1, Justin A. Ezekowitz1,3, Gregory Schnell4, Brandon M. Wiley5, David A. Morrow6, Finlay A. McAlister1,7, Padma Kaul1,3
1Canadian VIGOUR Center, University of Alberta, Canada
2Department of Critical Care, University of Alberta, Canada
3Division of Cardiology, University of Alberta, Canada
4Libin Cardiovascular Institute of Alberta, University of Calgary, Canada
5Department of Cardiovascular Medicine and Critical Care Independent Multidisciplinary Program, Mayo Clinic, USA
6Brigham and Women's Hospital and Harvard Medical School, USA
7Division of General Internal Medicine, University of Alberta, Canada

Tóm tắt

Aims: Registries have reported large inter-hospital differences in intensive care unit admission rates for patients with acute heart failure, but little is known about the potential economic impact of over-admission of low-risk patients with heart failure to higher cost intensive care units. We described the variability in intensive care unit admission practices, the provision of critical care therapies, and estimated the potential national cost savings if all hospitals adopted low intensive care unit admission practices for patients admitted with heart failure. Methods: Using a national population health dataset, we identified 349,693 heart failure admission hospitalisations with a primary diagnosis of heart failure between 2007 and 2016. Hospitals were categorised as low (first quartile), medium (second and third quartile) and high (fourth quartiles) intensive care unit utilisation. Results: The mean intensive care unit admission rate was 16.4% (inter-hospital range 0.3–51%) including 5.4% in low, 14.5% in medium and 30% in high utilisation hospitals. Intensive care unit therapies in low, medium and high intensive care unit utilisation hospitals were 54.5%, 45.1% and 24.1% ( P<0.001), respectively and the inhospital mortality rate was not significantly different. The proportion of hospital costs incurred by intensive care unit care was 7.8% in low, 19.8% in medium and 28.2% in high ( P<0.001) admission hospitals. The potential cost savings of altering intensive care unit utilisation practices for patients with heart failure was CAN$234.8m over the study period. Conclusions: In a national cohort of patients hospitalised with heart failure, we observed that low intensive care unit utilisation centres had lower hospital costs with no differences in mortality rates. The development of standardised admission criteria for high-cost and high acuity intensive care unit beds could reduce costs to the healthcare system.

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Thông tin
Thông tin xuất bản

European Heart Journal: Acute Cardiovascular Care

Tập 8 Số 7

660-666

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