Do stable non-ST-segment elevation acute coronary syndromes require admission to coronary care units?

Sean van Diepen; Meng Lin; Jeffrey A Bakal; Finlay A McAlister; Padma Kaul; Jason N Katz; Christopher B Fordyce; Danielle A Southern; Michelle M Graham; Stephen B Wilton; L Kristin Newby; Christopher B Granger; Justin A Ezekowitz

doi:10.1016/j.ahj.2015.11.020

Do stable non-ST-segment elevation acute coronary syndromes require admission to coronary care units?

Am Heart J. 2016 May:175:184-92. doi: 10.1016/j.ahj.2015.11.020. Epub 2016 Jan 23.

Authors

Affiliations

¹ Divisions of Critical Care and Cardiology, University of Alberta, Edmonton, AB, Canada; Canadian Vigour Center, Edmonton, AB, Canada. Electronic address: sv9@ualberta.ca.
² Alberta SPOR Support Unit, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
³ Canadian Vigour Center, Edmonton, AB, Canada; Alberta SPOR Support Unit, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
⁴ Canadian Vigour Center, Edmonton, AB, Canada; Alberta SPOR Support Unit, Department of Medicine, University of Alberta, Edmonton, AB, Canada; Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
⁵ Canadian Vigour Center, Edmonton, AB, Canada.
⁶ Divisions of Cardiology and Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC.
⁷ Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
⁸ O'Brien Institute for Public Health and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
⁹ Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
¹⁰ Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
¹¹ Canadian Vigour Center, Edmonton, AB, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.

PMID: 27179739
DOI: 10.1016/j.ahj.2015.11.020

Abstract

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 higher-acuity critical care units (CCUs). The outcomes of patients with stable NSTE ACS initially admitted to a CCU vs a cardiology ward with telemetry have not been described.

Methods: We used population-based data of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada, between April 1, 2007, and March 31, 2013. We compared outcomes among patients initially admitted to a CCU (n=5,141) with those admitted to cardiology telemetry wards (n=2,728).

Results: Patients admitted to cardiology telemetry wards were older (median 69 vs 65years, P<.001) and more likely to be female (37.2% vs 32.1%, P<.001) and have a prior myocardial infarction (14.3% vs 11.5%, P<.001) compared with patients admitted to a CCU. Patients admitted directly to cardiology telemetry wards had similar hospital stays (6.2 vs 5.7days, P=.29) and fewer cardiac procedures (40.3% vs 48.5%, P<.001) compared with patients initially admitted to CCUs. There were no differences in the frequency of in-hospital mortality (1.3% vs 1.2%, adjusted odds ratio [aOR] 1.57, 95% CI 0.98-2.52), cardiac arrest (0.7% vs 0.9%, aOR 1.37, 95% CI 0.94-2.00), 30-day all-cause mortality (1.6% vs 1.5%, aOR 1.50, 95% CI 0.82-2.75), or 30-day all-cause postdischarge readmission (10.6% vs 10.8%, aOR 1.07, 95% CI 0.90-1.28) between cardiology telemetry ward and CCU patients. Results were similar across low-, intermediate-, and high-risk Duke Jeopardy Scores, and in patients with non-ST-segment myocardial infarction or unstable angina.

Conclusions: There were no differences in clinical outcomes observed between patients with NSTE ACS initially admitted to a ward or a CCU. These findings suggest that stable NSTE ACS may be managed appropriately on telemetry wards and presents an opportunity to reduce hospital costs and critical care capacity strain.

MeSH terms

Aged
Canada
Coronary Care Units* / economics
Coronary Care Units* / methods
Coronary Care Units* / statistics & numerical data
Costs and Cost Analysis
Disease Management
Electrocardiography / methods
Female
Hospital Mortality
Humans
Length of Stay
Male
Middle Aged
Non-ST Elevated Myocardial Infarction* / diagnosis
Non-ST Elevated Myocardial Infarction* / economics
Non-ST Elevated Myocardial Infarction* / physiopathology
Non-ST Elevated Myocardial Infarction* / therapy
Outcome and Process Assessment, Health Care
Patient Acuity
Patient Admission / standards