Risk score to predict need for intensive care in initially hemodynamically stable adults with non-ST-segment-elevation myocardial infarction

Alexander C. Fanaroff, Anita Y. Chen, Laine E. Thomas, Karen S. Pieper, Kirk N. Garratt, Eric D. Peterson, L. Kristin Newby, James A. de Lemos, Mikhail N. Kosiborod, Ezra A Amsterdam, Tracy Y. Wang

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background--Intensive care unit (ICU) use for initially stable patients presenting with non-ST-segment-elevation myocardial infarction (NSTEMI) varies widely across hospitals and minimally correlates with severity of illness. We aimed to develop a bedside risk score to assist in identifying high-risk patients with NSTEMI for ICU admission. Methods and Results--Using the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry linked to Medicare data, we identified patients with NSTEMI aged ≥65 years without cardiogenic shock or cardiac arrest on presentation. Complications requiring ICU care were defined as subsequent development of cardiac arrest, shock, high-grade atrioventricular block, respiratory failure, stroke, or death during the index hospitalization. We developed and validated a model and integer risk score (Acute Coronary Treatment and Intervention Outcomes Network (ACTION) ICU risk score) that uses variables present at hospital admission to predict requirement for ICU care. Of 29 973 patients with NSTEMI, 4282 (14%) developed a complication requiring ICU-level care, yet 12 879 (43%) received care in an ICU. Signs or symptoms of heart failure, initial heart rate, initial systolic blood pressure, initial troponin, initial serum creatinine, prior revascularization, chronic lung disease, ST-segment depression, and age had statistically significant associations with requirement for ICU care after adjusting for other risk factors. The ACTION ICU risk score had a C-statistic of 0.72. It identified 11% of patients as having very high risk (> 30%) of developing complications requiring ICU care and 49% as having low likelihood (< 10%) of requiring an ICU. Conclusions--The ACTION ICU risk score quantifies the risk of initially stable patients with NSTEMI developing a complication requiring ICU care, and could be used to more effectively allocate limited ICU resources.

Original languageEnglish (US)
Article numbere008894
JournalJournal of the American Heart Association
Volume7
Issue number11
DOIs
StatePublished - Jun 1 2018

Fingerprint

Critical Care
Intensive Care Units
Non-ST Elevated Myocardial Infarction
Heart Arrest
Blood Pressure
Troponin
Cardiogenic Shock
Atrioventricular Block
Medicare
Respiratory Insufficiency
Lung Diseases
Signs and Symptoms
Registries
Shock
Creatinine
Hospitalization
Chronic Disease
Heart Failure
Heart Rate
Stroke

Keywords

  • Intensive care unit
  • Model
  • Non-ST-segment acute coronary syndrome
  • Risk prediction risk score
  • Risk score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Risk score to predict need for intensive care in initially hemodynamically stable adults with non-ST-segment-elevation myocardial infarction. / Fanaroff, Alexander C.; Chen, Anita Y.; Thomas, Laine E.; Pieper, Karen S.; Garratt, Kirk N.; Peterson, Eric D.; Newby, L. Kristin; de Lemos, James A.; Kosiborod, Mikhail N.; Amsterdam, Ezra A; Wang, Tracy Y.

In: Journal of the American Heart Association, Vol. 7, No. 11, e008894, 01.06.2018.

Research output: Contribution to journalArticle

Fanaroff, AC, Chen, AY, Thomas, LE, Pieper, KS, Garratt, KN, Peterson, ED, Newby, LK, de Lemos, JA, Kosiborod, MN, Amsterdam, EA & Wang, TY 2018, 'Risk score to predict need for intensive care in initially hemodynamically stable adults with non-ST-segment-elevation myocardial infarction', Journal of the American Heart Association, vol. 7, no. 11, e008894. https://doi.org/10.1161/JAHA.118.008894
Fanaroff, Alexander C. ; Chen, Anita Y. ; Thomas, Laine E. ; Pieper, Karen S. ; Garratt, Kirk N. ; Peterson, Eric D. ; Newby, L. Kristin ; de Lemos, James A. ; Kosiborod, Mikhail N. ; Amsterdam, Ezra A ; Wang, Tracy Y. / Risk score to predict need for intensive care in initially hemodynamically stable adults with non-ST-segment-elevation myocardial infarction. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 11.
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abstract = "Background--Intensive care unit (ICU) use for initially stable patients presenting with non-ST-segment-elevation myocardial infarction (NSTEMI) varies widely across hospitals and minimally correlates with severity of illness. We aimed to develop a bedside risk score to assist in identifying high-risk patients with NSTEMI for ICU admission. Methods and Results--Using the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry linked to Medicare data, we identified patients with NSTEMI aged ≥65 years without cardiogenic shock or cardiac arrest on presentation. Complications requiring ICU care were defined as subsequent development of cardiac arrest, shock, high-grade atrioventricular block, respiratory failure, stroke, or death during the index hospitalization. We developed and validated a model and integer risk score (Acute Coronary Treatment and Intervention Outcomes Network (ACTION) ICU risk score) that uses variables present at hospital admission to predict requirement for ICU care. Of 29 973 patients with NSTEMI, 4282 (14{\%}) developed a complication requiring ICU-level care, yet 12 879 (43{\%}) received care in an ICU. Signs or symptoms of heart failure, initial heart rate, initial systolic blood pressure, initial troponin, initial serum creatinine, prior revascularization, chronic lung disease, ST-segment depression, and age had statistically significant associations with requirement for ICU care after adjusting for other risk factors. The ACTION ICU risk score had a C-statistic of 0.72. It identified 11{\%} of patients as having very high risk (> 30{\%}) of developing complications requiring ICU care and 49{\%} as having low likelihood (< 10{\%}) of requiring an ICU. Conclusions--The ACTION ICU risk score quantifies the risk of initially stable patients with NSTEMI developing a complication requiring ICU care, and could be used to more effectively allocate limited ICU resources.",
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T1 - Risk score to predict need for intensive care in initially hemodynamically stable adults with non-ST-segment-elevation myocardial infarction

AU - Fanaroff, Alexander C.

AU - Chen, Anita Y.

AU - Thomas, Laine E.

AU - Pieper, Karen S.

AU - Garratt, Kirk N.

AU - Peterson, Eric D.

AU - Newby, L. Kristin

AU - de Lemos, James A.

AU - Kosiborod, Mikhail N.

AU - Amsterdam, Ezra A

AU - Wang, Tracy Y.

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N2 - Background--Intensive care unit (ICU) use for initially stable patients presenting with non-ST-segment-elevation myocardial infarction (NSTEMI) varies widely across hospitals and minimally correlates with severity of illness. We aimed to develop a bedside risk score to assist in identifying high-risk patients with NSTEMI for ICU admission. Methods and Results--Using the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry linked to Medicare data, we identified patients with NSTEMI aged ≥65 years without cardiogenic shock or cardiac arrest on presentation. Complications requiring ICU care were defined as subsequent development of cardiac arrest, shock, high-grade atrioventricular block, respiratory failure, stroke, or death during the index hospitalization. We developed and validated a model and integer risk score (Acute Coronary Treatment and Intervention Outcomes Network (ACTION) ICU risk score) that uses variables present at hospital admission to predict requirement for ICU care. Of 29 973 patients with NSTEMI, 4282 (14%) developed a complication requiring ICU-level care, yet 12 879 (43%) received care in an ICU. Signs or symptoms of heart failure, initial heart rate, initial systolic blood pressure, initial troponin, initial serum creatinine, prior revascularization, chronic lung disease, ST-segment depression, and age had statistically significant associations with requirement for ICU care after adjusting for other risk factors. The ACTION ICU risk score had a C-statistic of 0.72. It identified 11% of patients as having very high risk (> 30%) of developing complications requiring ICU care and 49% as having low likelihood (< 10%) of requiring an ICU. Conclusions--The ACTION ICU risk score quantifies the risk of initially stable patients with NSTEMI developing a complication requiring ICU care, and could be used to more effectively allocate limited ICU resources.

AB - Background--Intensive care unit (ICU) use for initially stable patients presenting with non-ST-segment-elevation myocardial infarction (NSTEMI) varies widely across hospitals and minimally correlates with severity of illness. We aimed to develop a bedside risk score to assist in identifying high-risk patients with NSTEMI for ICU admission. Methods and Results--Using the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry linked to Medicare data, we identified patients with NSTEMI aged ≥65 years without cardiogenic shock or cardiac arrest on presentation. Complications requiring ICU care were defined as subsequent development of cardiac arrest, shock, high-grade atrioventricular block, respiratory failure, stroke, or death during the index hospitalization. We developed and validated a model and integer risk score (Acute Coronary Treatment and Intervention Outcomes Network (ACTION) ICU risk score) that uses variables present at hospital admission to predict requirement for ICU care. Of 29 973 patients with NSTEMI, 4282 (14%) developed a complication requiring ICU-level care, yet 12 879 (43%) received care in an ICU. Signs or symptoms of heart failure, initial heart rate, initial systolic blood pressure, initial troponin, initial serum creatinine, prior revascularization, chronic lung disease, ST-segment depression, and age had statistically significant associations with requirement for ICU care after adjusting for other risk factors. The ACTION ICU risk score had a C-statistic of 0.72. It identified 11% of patients as having very high risk (> 30%) of developing complications requiring ICU care and 49% as having low likelihood (< 10%) of requiring an ICU. Conclusions--The ACTION ICU risk score quantifies the risk of initially stable patients with NSTEMI developing a complication requiring ICU care, and could be used to more effectively allocate limited ICU resources.

KW - Intensive care unit

KW - Model

KW - Non-ST-segment acute coronary syndrome

KW - Risk prediction risk score

KW - Risk score

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