Abstract 14539: Interhospital Differences in the Use of Critical Care Therapies in Coronary Intensive Care Units and Its Association With In-Hospital Mortality: Insights From the Critical Care Cardiology Trials Network

Abstract

Background: Previous studies have shown wide interhospital variation in cardiovascular intensive care unit (CICU) admission practices and use of critical care restricted therapies and monitoring (CCRx), but little is known about practice differences among tertiary and academic CICUs. Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter registry of tertiary and academic CICUs in the USA and Canada that contributed consecutive patient data in annual 2-month periods from 2017 to 2021. The analysis included 13,318 admissions across 28 sites and compared interhospital variability in CCRx and its association with in-hospital survival. Results: CCRx was provided to 61.4% (interhospital range 28.3 - 86.7%) of CICU patients. Admissions to CICUs in the highest tertile of CCRx utilization, compared with the lower tertile, had a greater burden of comorbidities; less frequently admitted patients with ACS (18.7% vs 35.8%); more frequently admitted cardiac arrest (4.9% vs 2.6%) or cardiogenic shock (5.8% vs 1.9%); and had higher median admission Sequential Organ Failure Assessment (SOFA) scores (5.0 vs 2.0), lactate (1.9 vs 1.8 mmol/L), and creatinine (1.3 vs 1.1 mg/dL) levels. Unadjusted in-hospital mortality varied widely between CICUs (median 12.6%; range 4.0-23.5%; p<0.001). After adjustment for patient differences, the correlation between CICU provision of CCRx and in-hospital mortality was weak (r=0.287, p<0.001). Conclusions: In a large registry of tertiary and academic CICUs, there was large interhospital variability in the provision of CCRx. The weak adjusted correlation with in-hospital mortality suggests that standardized CICU admission criteria could reduce disparities in admission practices and improve health-resource allocation. Figure 1: Unadjusted correlation between individual CICU utilization of critical care restricted therapies and in-hospital all-cause mortality