Do Stable Non-ST Segment Elevation Acute Coronary Syndromes Require Admission to Coronary Care Units? American Heart Journal, January 23, 2016. Sean van Diepen, Meng Lin, Jeffrey A. Bakal, Finlay A. McAlister, Padma Kaul, Jason N. Katz, Christopher B. Fordyce, Danielle A. Southern, Michelle M. Graham, Stephen B. Wilton, L. Kristin Newby, Christopher B. Granger, Justin A. Ezekowitz.
Clinical practice guidelines recommend admitting patients with stable non-ST segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two thirds of patients are admitted to higher acuity critical care units (CCU). The outcomes of patients with stable NSTE ACS initially admitted to a CCU versus a cardiology ward with telemetry have not been described.
We used population-based data of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada between April 1, 2007 and Mar 31, 2013. We compared outcomes among patients initially admitted to a CCU (n=5141) with those admitted to cardiology telemetry wards (n=2728). Patients admitted to cardiology telemetry wards were older (median 69 vs 65 years, p<0.001), and more likely to be female (37.2% vs 32.1%, p<0.001) and have a prior myocardial infarction (14.3% vs 11.5%, p<0.001) compared with patients admitted to a CCU.
Patients admitted directly to cardiology telemetry wards had similar hospital stays (6.2 vs 5.7 days, p=0.29) and fewer cardiac procedures (40.3% vs 48.5%, p<0.001) compared with patients initially admitted to CCUs. There were no differences in the frequency of in-hospital mortality (1.3% vs 1.2%, adjusted odds ratio [aOR] 1.57; 95% CI, 0.98 to 2.52), cardiac arrest (0.7% vs 0.9%, aOR 1.37; 95% CI, 0.94 to 2.00), 30-day all-cause mortality (1.6% vs 1.5%, aOR 1.50; 95% CI 0.82 to 2.75), or 30-day all-cause post-discharge readmission (10.6% vs 10.8%, aOR 1.07; 95% CI 0.90 to 1.28) between cardiology telemetry ward and CCU patients. Results were similar across low, intermediate, and high risk Duke Jeopardy Scores, and in patients with non-ST segment myocardial infarction or unstable angina.
There were no differences in clinical outcomes observed between patients with NSTE ACS initially admitted to a ward or a CCU. These findings suggest that stable NSTE ACS may be managed appropriately on telemetry wards and presents an opportunity to reduce hospital costs and critical care capacity strain.