Elderly patients who survive ICU stay have high rate of death in following years

Mar 02, 2010

An analysis of Medicare data indicates that elderly patients who are hospitalized in an intensive care unit (ICU) and survive to be discharged from the hospital have a high rate of death in the following three years, and that, in particular, patients who receive mechanical ventilation have a substantially increased rate of death compared with both hospital and general population controls in the first several months after hospital discharge, according to a study in the March 3 issue of JAMA.

Although there has been a decrease over time in the risk of in-hospital death for patients who receive intensive care in the United States, little is known about subsequent outcomes for those discharged alive. "Patients older than 65 years now make up more than half of all ICU admissions," the authors write. "Information is needed to understand the patterns of mortality, morbidity, and health care resource use in the months and years that follow to allow for better targeting of follow-up care."

Hannah Wunsch, M.D., M.Sc., of Columbia University Medical Center and NewYork-Presbyterian Hospital/Columbia, New York, and colleagues examined the 3-year outcomes and health care resource use of ICU survivors, and identified subgroups of patients and periods in which patients are at highest risk of death, using a 5 percent sample of Medicare beneficiaries older than 65 years. A random half of all patients were selected who received intensive care and survived to in 2003 with 3-year follow-up through 2006. From the other half of the sample, 2 matched control groups were generated: hospitalized patients who survived to discharge (hospital controls) and the general population (general controls), individually matched on age, sex, race, and whether they had surgery (for hospital controls).

In the data analyzed for the study, 35,308 ICU patients survived to hospital discharge. The ICU survivors had a higher 3-year mortality (39.5 percent) than hospital controls (34.5 percent) and general controls (14.9 percent). The ICU survivors who did not receive had minimal increased risk compared with hospital controls (3-year mortality, 38.3 percent vs. 34.6 percent).

"However, mortality for those who received mechanical ventilation was substantially higher than for the corresponding hospital controls (3-year mortality: 57.6 percent vs. 32.8 percent, respectively). This difference was primarily due to mortality during the first 2 quarters following hospital discharge (6-month mortality: 30.1 percent for ICU survivors vs. 9.6 percent for hospital controls)," the authors write.

Discharge to a skilled care facility for ICU survivors (33.0 percent) and hospital controls (26.4 percent) also was associated with high 6-month mortality (24.1 percent for ICU survivors and hospital controls discharged to a skilled care facility vs. 7.5 percent for ICU survivors and hospital controls discharged home).

"The magnitude of the postdischarge use of skilled care facilities for both ICU survivors and hospital controls and the high long-term mortality for all of these patients call into question whether discharge to skilled care facilities is merely a marker for higher severity of illness with appropriate delivery of care. These patients could have been discharged prematurely from acute care hospitals, and needed a higher level of care than they received. It also is possible that these patients could have had better outcomes if discharged home, but were not able to be sent there due to lack of sufficient support from family or friends to act as caregivers. These findings highlight the need for a much more detailed understanding of the long-term care needs of these patients," the authors conclude.

Explore further: AbbVie to pay Shire $1.64B fee over nixed merger

More information: JAMA. 2010;303[9]:849-856.

add to favorites email to friend print save as pdf

Related Stories

Heart attack not a death sentence

Jul 18, 2008

Survivors of cardiac arrest who received intensive care can expect long-term quality of life at reasonable expense to the health care system. Research published today in BioMed Central's open access journal Critical Care is the ...

Low blood sugar in hospital linked to higher death risk

Jun 29, 2009

(PhysOrg.com) -- Harvard researchers at Brigham and Women’s Hospital (BWH) found that diabetics hospitalized for noncritical illnesses who develop hypoglycemia (low blood sugar) during hospitalization have ...

Recommended for you

New MCAT shifts focus, will include humanities

12 hours ago

(HealthDay)—The Medical College Admission Test (MCAT) has been revised, and the latest changes, including more humanities such as social sciences, are due to be implemented next April, according to a report ...

Using feminist theory to understand male rape

23 hours ago

Decades of feminist research have framed rape and sexual assault as a 'women's issue', leaving little room for the experiences of male victims. But a new study published in the Journal of Gender Studies suggests that feminist ...

Simulation-based training improves endoscopy execution

Oct 18, 2014

(HealthDay)—Simulation-based training (SBT) improves clinicians' performance of gastrointestinal endoscopy in both test settings and clinical practice, according to research published in the October issue ...

User comments : 0