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ICUs Might Be Overused – At High Cost -- for Patients with Common Conditions

ANN ARBOR, MI – The ICU is the best place for patients with flare-ups of chronic obstructive pulmonary disease (COPD) or heart failure, as well as those suffering acute myocardial infarction (AMI). Right?

Whether you believe that probably has a lot to do with your hospital’s culture. Furthermore, a study published online by the Annals of American Thoracic Society suggests that is not always true.

In fact, University of Michigan researchers argue that, unless patients are critically ill, they might be better off staying out of the ICU.

Using 1.5 million Medicare records, the study team analyzed ICU outcomes for patients admitted for the three conditions. With a primary outcome of 30-day mortality, secondary outcomes included hospital costs.

While 31% of Medicare beneficiaries with COPD exacerbation, HF exacerbation, or AMI were admitted to an ICU, results indicate that the higher-level unit was not associated with significant differences in 30-day mortality for any condition. ICU admission was associated with significantly greater hospital costs, however, for heart failure ($11,793 vs. $9,185) and AMI ($19,513 vs. $14,590), but not for COPD.

"We wanted to evaluate whether ICU care is always beneficial," explained lead author Thomas Valley, MD, MSc, a pulmonary and critical care researcher at the University of Michigan Medical School. "ICU care can save lives, but it is also very costly."

Valley pointed out that, in addition to being considerably more expensive, ICUs are more likely to expose patients to dangerous infections and to use more invasive procedures than regular hospital units.

Study authors also note great variability among hospitals in use of ICUs for these conditions. Surprisingly, they estimate that one in six patients was admitted to the ICU only because they lived closest to a hospital that places a high percentage of its patients in ICU beds.

“ICU admission did not confer a survival benefit for patients with uncertain ICU needs hospitalized with COPD exacerbation, HF exacerbation, or AMI,” the researchers concluded. “These findings suggest that 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.”

"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," Valley added. "We found that the ICU may not always be the answer. Now, we need to help doctors decide who needs the ICU and who doesn't."