Acute Decompensated HF Is Safely Managed in the Intermediate Care Unit

Patients with acute decompensated heart failure (ADHF) can be safely managed in the Medical Intermediate Care (MIMC) unit compared with the general ward, according to new research presented at CHEST Annual Meeting 2018.

The report, authored by Dr Muhammad Hashmi and colleagues, will be presented on Tuesday, October 9, at CHEST 2018 in San Antonio. 

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For their study, Hashmi and colleagues retrospectively evaluated all patients with ADHF admitted to the MIMC in their institution between October 2016 and June 2017.

The researchers recorded demographics, comorbidities, illness severity, in-hospital mortality, and up-triage rates. Up-triage was defined as a transfer to the intensive care unit for any reason within 48 hours of admittance.

A total of 165 patients were included in the final analysis.

Overall, 1.8% of patients had died in the MIMC, and 7.9% of patients had died in the hospital. The up-triage rate was 13.3%.

After secondary analysis, the researchers found no significant factors associated with up-triage rate. However, for each point decrease in Glasgow Coma Scale, the risk for in-hospital death increased by a factor of 1.7. For each decrease in sodium level, the risk for death increased by a factor of 1.1.

“Despite high up-triage rates, mortality associated with ADHF was low in the MIMC,” the researchers wrote.

“Mental status and sodium levels are well known markers associated with mortality in ADHF. Patients with ADHF requiring [noninvasive positive pressure ventilation (NIPPV)] can be safely managed and monitored in a MIMC.”

—Amanda Balbi

Reference:

Hashmi M, Ohri C, Jakharia K, Chan C. Acute decompensated heart failure outcomes in the medical intermediate care (MIMC) unit. Paper presented at: CHEST Annual Meeting 2018; October 6-10, 2018; San Antonio, TX. https://journal.chestnet.org/article/S0012-3692(18)31268-6/fulltext. Accessed October 5, 2018.