Evidence map›Paper›PMID 31164326›Full record

ArticleBMJ (Clinical research ed.)2019

Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study.

Thomas S Valley, Theodore J Iwashyna, Colin R Cooke, Shashank S Sinha, Andrew M Ryan, Robert W Yeh, Brahmajee K Nallamothu

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Thomas S ValleyDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.ORCID 0000-0002-5766-4970
Theodore J IwashynaDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Colin R CookeDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Shashank S SinhaCardiac Intensive Care Unit, Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, VA, USA.
Andrew M RyanInstitute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Robert W YehRichard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Brahmajee K NallamothuInstitute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.

Funding

Strategies to Enhance Pneumonia Care via Intermediate Intensive Care (STEP IN)R01HL137816 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI COOKE, COLIN · 2017 to 2021
$3.2M
Preventing avoidable deaths from pneumonia by improving use of intensive careK23HL140165 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI VALLEY, THOMAS SEBASTIAN · 2018 to 2022
$915k
NHLBI NIH HHS K23 HL140165NHLBI NIH HHS L30 HL133988NHLBI NIH HHS R01 HL137816
6 · The paper itself

Abstract

objectiveTo evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).

designRetrospective cohort study.

setting1727 acute care hospitals in the United States.

participantsMedicare beneficiaries (aged 65 years or older) admitted with STEMI to either an ICU or a non-ICU unit (general/telemetry ward or intermediate care) between January 2014 and October 2015.

main outcome measure30 day mortality. An instrumental variable analysis was done to account for confounding, using as an instrument the additional distance that a patient with STEMI would need to travel beyond the closest hospital to arrive at a hospital in the top quarter of ICU admission rates for STEMI.

resultsThe analysis included 109 375 patients admitted to hospital with STEMI. Hospitals in the top quarter of ICU admission rates admitted 85% or more of STEMI patients to an ICU. Among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates, ICU admission was associated with lower 30 day mortality than non-ICU admission (absolute decrease 6.1 (95% confidence interval -11.9 to -0.3) percentage points). In a separate analysis among patients with non-STEMI, a group for whom evidence suggests that routine ICU care does not improve outcomes, ICU admission was not associated with differences in mortality (absolute increase 1.3 (-0.9 to 3.4) percentage points).

conclusionsICU care for STEMI is associated with improved mortality among patients who could be treated in an ICU or non-ICU unit. An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial.

Indexed as

Critical CareHospital MortalityST Elevation Myocardial InfarctionAgedFemaleHealth Services AccessibilityHospitalizationHumansIntensive Care UnitsMaleMedicareMortalityNeeds AssessmentOutcome and Process Assessment, Health CareUnited States

Identifiers

PMID31164326
PMCPMC6547840

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.