ICU-HEART: Using routine healthcare data to improve outcomes in ICU

We admit around 10,000 patients to Intensive Care Units (ICUs) in Scotland every year, with conditions such as sepsis, cardiac arrest and trauma. These patients are critically unwell, and despite best care, approximately 18% of patients admitted to ICU will die during their hospital admission. Significant amounts of data are collected on every patient admitted to the ICU including not only characteristics such as age, sex, and comorbidity, but also beat to beat information on heart rate, blood pressure and other markers of critical illness. This information helps us as clinicians in our diagnosis and management of each individual critically ill patient.

However, there are as yet unrealised potential uses for this data to improve outcomes for our whole population. Analysis of routine text healthcare data will enable us to characterise different healthcare phenotypes, identifying patients at risk of adverse events, or who may benefit from different interventions. Analysis of high-frequency physiological patient data could enable us to detect and potentially predict adverse events early and implement management changes quickly and effectively.

Collaboration between data scientists and clinicians using this routinely collected healthcare data could transform the way that patients are managed in the ICU and ultimately improve outcomes for this critically unwell population.

Annemarie Docherty is a Wellcome Clinical Research Development Fellow based in the Usher Institute, and Consultant in Critical Care at the Royal Infirmary Edinburgh. Her PhD, in myocardial injury in critically ill patients with co-existing cardiovascular disease (CVD), found that a quarter of patients with co-existing CVD have a heart attack in the first ten days of their ICU admission. Fewer than 5% of these heart attacks were diagnosed clinically, and these patients had greater mortality. She leads ICU-HEART (Intensive care - Cardiovascular disease: Use of HEAlthcare Routine data to inform Trial design), a programme of work that aims to improve outcomes for critically ill patients with co-existing cardiovascular disease using routine national healthcare data in Scotland and England.