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    Patent Pending

    ACTION ICU Score for Intensive Care in NSTEMI

    Predicts risk of NSTEMI complications requiring ICU care.
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    IMPORTANT

    This calculator is not externally validated, and as such, should be used with caution.

    INSTRUCTIONS

    Use in emergency patients with NSTEMI.

    When to Use
    Pearls/Pitfalls
    Why Use

    • Emergency patients with NSTEMI, to predict likelihood of complications requiring ICU care for patients with NSTEMI.

    • Should not be used in patients with STEMI, cardiogenic shock, or cardiac arrest.

    • Derived in patients ≥65 years old, and may not apply to younger patients.

    • Different institutions may use different thresholds for ICU admission.

    • Not yet prospectively validated.

    Helps identify patients who are initially stable but may later develop complications requiring a higher level of care, and may therefore help with disposition and avoiding failure to rescue.

    <70
    0
    ≥70
    +1
    <1.1
    0
    ≥1.1
    +1
    <85
    0
    85-100
    +1
    ≥100
    +3
    ≥145
    0
    125-145
    +1
    <125
    +3
    <12
    0
    ≥12
    +2
    No
    0
    Yes
    +5
    No
    0
    Yes
    +1
    Yes
    0
    No
    +1
    No
    0
    Yes
    +2

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    • Patients with low risk for complications requiring ICU care may be considered for admission outside of an ICU setting.

    • Patients with high risk for complications requiring ICU care may benefit from early admission to the ICU.  

    Management

    • Hospital systems should define their own threshold for ICU admission, based on ICU capacity, non-ICU resource availability, etc.

    • For example, an ACTION ICU threshold of 5 might triage 50% of patients to the ICU, with an expected complication rate of <10% for non-ICU patients, while an ACTION ICU threshold of 12 might triage 50% of only very high risk patients to the ICU.

    Critical Actions

    This predictive tool should not replace clinical judgment. Not all factors benefiting from ICU care can be accounted for in this score.

    Formula

    0 points

    1 point

    2 points

    3 points

    5 points

    Age, years

    <70

    ≥70

    --

    --

    --

    Serum creatinine, mg/dL

    <1.1

    ≥1.1

    --

    --

    --

    Heart rate, bpm

    <85

    85-100

    --

    ≥100

    --

    Systolic blood pressure, mmHg

    ≥145

    125-145

    --

    <125

    --

    Initial troponin, times above upper limit of normal

    <12

    --

    ≥12

    --

    --

    Heart failure signs or symptoms

    No

    --

    --

    --

    Yes

    ST depression on EKG

    No

    Yes

    --

    --

    --

    Prior revascularization

    Yes

    No

    --

    --

    --

    Chronic lung disease

    No

    --

    Yes

    --

    --

    Facts & Figures

    Interpretation:

    ACTION ICU Score

    Risk of complications requiring ICU care among initially uncomplicated patients with NSTEMI*

    ≤1

    3.4%

    2

    4.9%

    3

    5.5%

    4

    6.9%

    5

    9.3%

    6

    12%

    7

    14.6%

    8

    17.4%

    9

    20.8%

    10

    23.3%

    11

    27.7%

    12

    31%

    13

    31.5%

    14

    39.3%

    >14

    >39.3%

    *Cardiac arrest, shock, high-grade atrioventricular block, respiratory failure, stroke, or death during index admission. 

     

    Evidence Appraisal

    The ACTION ICU Score was developed retrospectively from 29,973 patients in the ACTION registry, with an overall ICU complication rate of 14.3%. In the derivation cohort, the score performed with R2 = 0.94, C-statistic 0.73 (95% CI 0.72-0.74). It has not yet been prospectively validated in a separate population.

    Literature

    Other References

    Research PaperChin CT, Chen AY, Wang TY, et al. Risk adjustment for in-hospital mortality of contemporary patients with acute myocardial infarction: the acute coronary treatment and intervention outcomes network (ACTION) registry-get with the guidelines (GWTG) acute myocardial infarction mortality model and risk score. Am Heart J. 2011;161(1):113-122.e2.Research PaperNational Clinical Guidelines Centre (UK). Stable Angina: Methods, Evidence & Guidance [Internet]. London: Royal College of Physicians (UK); 2011 Jul. (NICE Clinical Guidelines, No. 126.) 14, Risk scores. Available from: https://www.ncbi.nlm.nih.gov/books/NBK83609/.Research PaperFanaroff AC, Peterson ED, Chen AY, et al. Intensive Care Unit Utilization and Mortality Among Medicare Patients Hospitalized with Non-ST-Segment Elevation Myocardial Infarction. JAMA Cardiol. 2017;2(1):36-44.
    Dr. Alexander C. Fanaroff

    About the Creator

    Alexander C. Fanaroff, MD, is a cardiologist and chief fellow at the Duke Clinical Research Institute. He is a recipient of the American Heart Association (AHA) Fellow-to-Faculty Transition Award. Dr. Fanaroff’s primary research interests are in interventional cardiology and course of care for patients with cardiovascular illnesses.

    To view Dr. Alexander C. Fanaroff's publications, visit PubMed

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