ICU Admission for Patients With COPD May Not Improve Outcomes

Except in cases of critical illness, the intensive care unit (ICU) may not be the best place for patients experiencing a flare-up of heart failure or their chronic obstructive pulmonary disease (COPD) or even having a heart attack, according to a study published in the Annals of the American Thoracic Society.

The researchers sought to understand the relationship between ICU admission and outcomes for patients with acute myocardial infarction or exacerbation of COPD or heart failure. They analyzed acute are hospitalizations from 2010 to 2012 for Medicare beneficiaries age 65 or older who were admitted for one of those 3 reasons. These 3 conditions frequently result in an ICU admission, the authors noted.

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

Among the more than 1.5 million cases, 31% were admitted to the ICU and the analysis found that the admissions did not result in significant differences in 30-day mortality for any of the 3 conditions. In addition, ICU admission was associated with higher hospital costs for heart failure and acute myocardial infarction, but not for COPD.

According to Valley, doctors have trouble determining whether or not the ICU would help a large group of patients, and this study 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,” he said.

The study’s results would not apply to patients who require intensive care, such as those having trouble breathing on their own. Furthermore, since the study only included Medicare patients, the results may not apply to younger patients either. Additional research should better define which patients with COPD, heart failure, or acute myocardial infarction should be treated in the ICU and which can be treated elsewhere.

“These findings suggest that the ICU may be overused for some patients with these conditions,” the authors concluded. “Identifying patients most likely to benefit from ICU admission may improve healthcare efficiency while reducing costs.”