ICU QUALITY MEASURE EASILY BIASEDNew research suggests that the standardized mortality ratio (SMR), the outcome-based measure of intensive care unit (ICU) performance, may be easily biased. Overall, an SMR greater than one indicates a higher than expected mortality and less than one indicates a lower than expected mortality. However, researchers from the University of Washington in Seattle speculated how hospital transfers might affect the SMR. A baseline SMR of 1.06 ± 0.19 was calculated for 85 ICUs and compared with an adjusted SMR that was based on a simulation of a set number of patients being transferred out of the ICU alive. In the simulation, increasing the number of transfers by 2 percent and 6 percent over baseline decreased the SMR by 0.10 ± 0.03 and 0.14 ± 0.03, respectively. In addition, results showed that transferring as few as one patient out of the ICU per month can create a bias greater than 0.1 in 27 ICUs. Researchers conclude that a greater understanding of the factors affecting the SMR is needed before it should be widely used to benchmark ICU outcomes. This study appears in the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
SLEEP APNEA LINKED TO FAMILY HISTORY OF DEATH FROM HEART DISEASEA new study shows that patients with obstructive sleep apnea (OSA) are more likely than those without OSA to have a family history of premature death due to coronary artery disease (CAD). Researchers from Mayo Clinic College of Medicine in Rochester, MN, analyzed the relationship between OSA and premature death due to CAD by comparing the personal and family histories of 316 patients with OSA and 202 patients without OSA. Regardless of the patient's own CAD status, there was a significant and independent association between OSA and family history of premature CAD mortality. This study appears in the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
BETA BLOCKERS REDUCE SEVERITY OF CENTRAL SLEEP APNEABeta blockers, commonly used to treat high blood pressure and other heart conditions, may help to control central sleep apnea (CSA) in patients with congestive heart failure (CHF). Japanese researchers examined the relationship between use of beta blockers and severity of CSA in 45 patients with CHF and CSA. Results showed that patients using beta blockers (n=27) had lower apnea-hypopnea index (AHI) and central apnea index (CAI) scores than those not using beta blockers (n=18). AHI and CAI were also negatively correlated with the dose of the beta blocker carvedilol. In addition, no use of beta blockers was independently associated with CAI. Researchers conclude that beta blocker therapy may dose-dependently suppress CSA in patients with CHF. This study appears in the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
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