Author + information
- Michael Yin-Cheung Tsang,
- Carolyn Taylor,
- Jennifer Rajala,
- Kevin Ong,
- Graham Wong,
- Annie Chou,
- Perminder S. Bains,
- Christopher Fordyce,
- Del Dorscheid and
- Krishnan Ramanathan
Patients (pts) admitted to coronary care units (CCU's) often develop anemia and receive blood transfusion (BT) therapy. However, the hemoglobin (Hb) threshold at which BT becomes necessary is unknown. We sought to prospectively examine the current practice of BT in 2 tertiary CCU's without a specific BT policy.
From July 2009 to November 2012, physicians were asked to document the baseline characteristics of their pts, primary reason for BT, and site of blood loss when BT was ordered. Information regarding length of hospitalization and in-hospital mortality was tracked.
Our prospective cohort consisted of 81 pts (mean age 70.5±11.8 years, 48 male). The primary diagnoses for CCU admission were acute coronary syndrome in 46 (56.8%) pts, arrhythmia in 9 (11.1%) pts, and decompensated heart failure in 8 (9.9%) pts. The average systolic blood pressure was 104.9±27.5 mmHg at the time of BT. Vasopressor or inotropic agents were being administered in 24.7% of pts, and left ventricular assist devices were present in 14.8% at the time of BT. Cardiac catheterization (49.4%) and coronary intervention (30.9%) were common before BT. The use of ASA, clopidogrel and heparin within 24 hours prior to BT was 87.7%, 60.5% and 74.1% respectively. The most common site of blood loss was the gastrointestinal (GI) system (35.8%), but the site was unknown in up to 22.2% of pts. “Low Hb” (37.0%) and “ongoing blood loss” (32.1%) were the leading reasons for BT, while only 11.1% of pts received BT for hemodynamic instability. The mean Hb at the time of BT was 8.0±1.4 g/dL, while it was 7.8±0.8 g/dL for pts with “low Hb” as the indication for BT. The median length of hospitalization was 13 days, and in-hospital mortality was 15.0% amongst pts who received BT.
Pts receiving BT in CCU often required left ventricular supportive therapy. “Low Hb level”, not “hemodynamic instability”, was the most common reason for BT in CCU. The most common site of blood loss was the GI system, but the site was unknown in many pts. Pts who received BT had a high rate of mortality. The current study highlights the heterogeneous practice of BT and the need to establish evidence-based practice guidelines for BT in pts with cardiac disease.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Improving Cardiovascular Health Services
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1201-108
- 2013 American College of Cardiology Foundation