Association between early intensive care or coronary care unit admission and post-discharge performance of activities of daily living in patients with acute decompensated heart failure.

Masato Kanda,Atsushi Nakagomi,Yoshio Kobayashi,Takahiro Inoue,Hiroyo Kuwabara,Togo Iwahana,Sho Okada,Kazuya Tateishi,Corstiaan Den Uil

doi:10.1371/journal.pone.0251505

Masato Kanda, Atsushi Nakagomi + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0251505

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Abstract

The management of acute decompensated heart failure often requires intensive care. However, the effects of early intensive care unit/coronary care unit admission on activities of daily living (ADL) in acute decompensated heart failure patients have not been precisely evaluated. Thus, we retrospectively assessed the association between early intensive care unit admission and post-discharge ADL performance in these patients. Acute decompensated heart failure patients (New York Heart Association I–III) admitted on emergency between April 1, 2014, and December 31, 2018, were selected from the Diagnosis Procedure Combination database and divided into intensive care unit/coronary care unit (ICU) and general ward (GW) groups according to the hospitalization type on admission day 1. The propensity score was calculated to create matched cohorts where admission style (intensive care unit/coronary care unit admission) was independent of measured baseline confounding factors, including ADL at admission. The primary outcome was ADL performance level at discharge (post-ADL) defined according to the Barthel index. Secondary outcomes included length of stay and total hospitalization cost (expense). Overall, 12231 patients were eligible, and propensity score matching created 2985 pairs. After matching, post-ADL was significantly higher in the ICU group than in the GW group [mean (standard deviation), GW vs. ICU: 71.5 (35.3) vs. 78.2 (31.2) points, P<0.001; mean difference: 6.7 (95% confidence interval, 5.1–8.4) points]. After matching, length of stay was significantly shorter and expenses were significantly higher in the ICU group than in the GW group. Stratified analysis showed that the patients with low ADL at admission (Barthel index score <60) were the most benefited from early intensive care unit/coronary care unit admission. Thus, early intensive care unit/coronary care unit admission was associated with improved post-ADL in patients with emergency acute decompensated heart failure admission.

Highlights

Heart failure is a common cause of mortality and morbidity [1, 2] and acute decompensated heart failure (ADHF) is one of the common reasons for emergency department (ED) visits [2]
In many cases of severe ADHF, the rapid initiation of intense invasive treatments, such as mechanical respiration, hemodialysis, intra-artery balloon pumping (IABP), or extracorporeal membrane oxygenation (ECMO), is required, and these treatments are best performed in intensive care unit (ICU) settings [3, 6]
The European Society of Cardiology 2016 guidelines recommended that ADHF patients with signs or symptoms of hypoperfusion, significant vital instability, or need for intubation should be considered for ICU or coronary care unit (CCU) admission [3, 7]

Summary

Introduction

The underlying heart diseases, comorbidities, causes of worsening conditions, and clinical pathology of ADHF are diverse [3]; the management of heart failure requires various treatment modalities, including intensive care which is limited in resources and puts a burden on the medical economy [4, 5]. The European Society of Cardiology 2016 guidelines recommended that ADHF patients with signs or symptoms of hypoperfusion, significant vital instability, or need for intubation should be considered for ICU or coronary care unit (CCU) admission [3, 7]. A patient’s vital signs may be normal; several worsening stages could require urgent definitive intervention [6, 8], in which the ICU/CCU are probable places for admission. The definite criterion for ICU/CCU admission is still a matter of conflict, and there are wide regional and international variations in the admission rates to ICU for ADHF patients[6, 9]

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