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Intensive care not necessarily the answer for COPD and heart failure flare-ups

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Treatment in intensive care does not necessarily benefit patients experiencing chronic obstructive pulmonary disease or heart failure exacerbations, or even acute heart attacks, suggests a study.

Researchers decided to study how patients with the three conditions fared in ICU after finding in a previous study that patients admitted to critical care for pneumonia were more likely to survive.

“We found that the ICU may not always be the answer”

Thomas Valley

They noted that the three conditions frequently resulted in an ICU admission, but there was great variability across hospitals in the US.

They estimated that around one in six patients was admitted to the ICU, simply because of living nearest to a hospital that tended to place a high percentage of its patients in intensive care beds.

The researchers looked at 30-day mortality among more than 1.5 million patients admitted to hospital with a COPD exacerbation, a heart failure exacerbation or acute myocardial infarction.

Of these, 486,272 patients – representing around 31% – were admitted to intensive care.

The researchers found that ICU admission was not associated with significant differences in 30-day mortality for any condition.

Mortality during the next 30 days for those with COPD admitted to ICU was 11.5% compared to 7.8% for normal inpatient care.

For heart failure, 30-day mortality was 12.6% among those admitted to ICU and 10.8% for usual inpatient care, while for acute MI it was 15.4% compared with 17.2%.

Although they found no significant difference in outcome between patients treated in ICU or as regular inpatients, the cost of ICU care for the two heart conditions was significantly higher.

In addition, ICU patients are more likely to undergo invasive procedures and be exposed to dangerous infections.

The authors said: “ICU admission did not confer a survival benefit for patients with uncertain ICU needs hospitalized with COPD exacerbation, heart failure exacerbation, or acute MI – suggesting the ICU may be overused for some patients with these conditions.

“Identifying patients most likely to benefit from ICU admission may improve healthcare efficiency while reducing costs,” they said in the Annals of the American Thoracic Society.

Lead study author Dr Thomas Valley, from the University of Michigan, added: “We wanted to evaluate whether ICU care is always beneficial. ICU care can save lives, but it is also very costly.

“Our results highlight that there is a large group of patients who doctors have trouble figuring out whether or not the ICU will help them or not,” he said. “We found that the ICU may not always be the answer.”

He noted that researchers now needed to develop ways to help clinicians decide which patients needed to be in ICU and those that did not.

Dr Valley emphasised that the current study results did not apply to patients who clearly require intensive care, such as those who cannot breathe on their own.

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