Causes of mortality in a department of cardiology over a 15-year period

Abstract

Aims Over the last four decades, in-hospital mortality from acute coronary syndromes (ACS) has declined. We characterized the patients who died in our cardiovascular intensive care unit (CICU) over a 15-year period. Based on these data, we described the changing patient population in the CICU. Methods This retrospective study compared characteristics of patients who died in our CICU in 2005–6, 2013–4 and 2019. During these 5 years, 13,931 patients were hospitalized; 251 (1.8%) died. The mean age of the patients who died was 76 years, 144 (57%) were men. ACS was the leading cause of admission (93 patients, 37%), and 145 (58%) patients had a history of heart failure prior to hospitalization. The leading cause of death was cardiogenic shock in 104 (41%) patients, septic shock in 48 (19%) patients, and combined cardiogenic and septic shock in 31 (12%). Patients hospitalized in the later years of the study were significantly older (67.7, 69.0 and 70.5 years, 2005–6, 2013–4 and 2019, respectively, p < 0.02) but their medical characteristics did not differ significantly between the years examined. Conclusions The profile of the patients who died did not change significantly over the 15-year study period. Age of admitted patients was higher in later years of the study. The leading cause of admission was ACS and the leading causes of death were cardiogenic and septic shock. Based on our observations, additional skills should be added to the curriculum of cardiology, including the management of patients with multiorgan failure.

How to talk with the family of a dying patient: anger to understanding, rage to compassion, loss to acceptance

“…Unlike other methods such as CLASS and SPIKE, the following roles are directed to families of the acutely ill, 1 2 8 mostly patients without cancer, many of whom are elderly patients with multiple comorbidities. 9 The situation of patients with comorbidities or acute illness can deteriorate rapidly and the family finds itself in the waiting room or corridor of an intensive care unit unprepared and deprived of communication with the patients and the treating team. 10 Such an unfortunate situation, if not managed properly, can lead to severe grief and post-traumatic stress disorder.…”