Acute Coronary Syndromes and Heart Failure Critical Care Units Utilization and Outcomes in Teaching and Community Hospitals: A National Population-Based Analysis

Abstract Acute coronary syndromes (ACS) and heart failure (HF) are the leading diagnoses in patients admitted to critical care units (CCU). Little is known about the differences between CCU resource utilization and outcomes across hospital types. The Canadian Institute for Health Information was used to identify patients hospitalized with a primary diagnosis of an ACS or HF. CCUs were categorized as teaching, large community, medium community, and small community hospitals. Outcomes included CCU admission rates, critical care therapy/procedure use, and in-hospital mortality. Among 204,900 patients hospitalized with ACS or HF, 73,338 (35.8%, hospital range 0-81.4%) were admitted to a CCU and it varied across hospital types: 41.0% in teaching, 30.0% in large, 45.4% in medium, and 30.9% in small community hospitals (p In the pre-reperfusion era critical care units (CCUs) provided continuous electrographic monitoring and resuscitative technologies and were associated with improved survival in patients with acute coronary syndromes (ACS). Therapeutic advances that have reduced in-hospital mortality along with telemetry equipped hospital ward beds have led to contemporary guidelines recommending admitting uncomplicated patients with ACS and HF to a non-CCU telemetry ward. Nonetheless, North American and European registries have reported wide variation in CCU admission rates for patients admitted with ACS (50 –79%) or HF (10–51%).[1-4] Although some of the variability in CCU admission and resource utilization rates has been attributed to differences in individual patient and socio-economic characteristics, admission diagnosis, physician specialty, and annual volume, the reasons underpinning these disparities are incompletely understood.[5] Previous studies have reported that teaching hospitals have better adherence to practice guidelines and outcomes in patients admitted with pneumonia, stroke, acute myocardial infarctions, and HF, but little is known about the associations between hospital type, resource utilization, and clinical outcomes among patients admitted to CCUs with ACS or HF. Accordingly, the purpose of this study was to examine differences in CCU admission rates, utilization of critical care therapies, and clinical outcomes among patients with ACS or HF admitted teaching, large, medium, and small community hospitals with CCUs.