Changes in comorbidities, diagnoses, therapies and outcomes in a contemporary cardiac intensive care unit population

Jentzer, Jacob C.; Diepen, Sean van; Barsness, Gregory W.; Katz, Jason N.; Wiley, Brandon M.; Bennett, Courtney; Mankad, Sunil; Sinak, Lawrence J.; Best, Patricia J.M.; Herrmann, Joerg; Jaffe, Allan S.; Murphy, Joseph G.; Morrow, David A.; Wright, R. Scott; Bell, Malcolm R.; Anavekar, Nandan S.

doi:10.1016/j.ahj.2019.05.012

Cited by 92 publications

(69 citation statements)

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“…The adverse outcome associated with respiratory failure in cardiac patients is multifactorial, influenced by primary disease severity, noncardiac patient comorbidities ( 6 , 30 ), iatrogenic factors related to respiratory support such as sedation strategy and delirium ( 31 ), ventilator-induced lung injury ( 32 ), and other contributors. Our results should provide impetus to better identify causes and potential innovative treatments to reduce these adverse outcomes including minimizing preventable harm ( 33 ) through protocols specific to CICU patients.…”

Section: Discussionmentioning

confidence: 99%

“…Other knowledge gaps include the role of noninvasive respiratory support prior to intubation and after extubation in CICU patients, benchmark reintubation rates in medical cardiac patients, and the optimal use of hemodynamic monitoring strategies. Finally, available outcome data on respiratory failure in the CICU have limitations including retrospective design ( 5 ), single-center populations ( 6 ), and reliance on claims data, and focus on single cardiac disease states ( 3 , 4 , 7 ). An accounting of the diversity of cardiac pathologies treated with respiratory support is needed.…”

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confidence: 99%

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Advanced Respiratory Support in the Contemporary Cardiac ICU

Metkus

Miller

Alviar

et al. 2020

Critical Care Explorations

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Advanced Respiratory Support in the Contemporary Cardiac ICU

Metkus

Miller

Alviar

et al. 2020

Critical Care Explorations

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“…We retrospectively analysed a previously constructed database including data from the index CICU admission of consecutive unique adult patients aged ≥18 years admitted to the CICU at Mayo Clinic Hospital, St. Mary's Campus between 1 January 2007, and 31 December 2015. 1, [4][5][6]17,18,[20][21][22][23][24][25][26] To minimize bias associated with CICU readmission, only data from the first CICU admission during the study period were analysed.…”

Section: Study Populationmentioning

confidence: 99%

Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure

et al. 2020

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Aims Age is an important risk factor for mortality among patients with cardiogenic shock and heart failure (HF). We sought to assess the extent to which age modified the performance of the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage for in-hospital and 1 year mortality in cardiac intensive care unit (CICU) patients with and without HF. Methods and results We retrospectively reviewed unique admissions to the Mayo Clinic CICU during 2007-2015 and stratified patients by age and SCAI shock stage. The association between age and in-hospital mortality was analysed using multivariable logistic regression, and 1 year mortality was analysed using Cox proportional hazards analysis, both in the entire cohort and among patients with an admission diagnosis of HF or acute coronary syndrome (ACS). The final study population included 10 004 unique patients with a mean age of 67 ± 15 years, including 46.1% with HF and 43.1% with ACS. Older patients more frequently had HF and had more extensive co-morbidities, higher illness severity, more organ failure, and differential use of critical care therapies. The percentage of patients with SCAI shock stages A, B, C, D, and E were 46%, 30%, 16%, 7%, and 1%, respectively. Patients with HF were older, had greater severity of illness and higher SCAI shock stage, and had higher rates of death at all time points. In-hospital mortality occurred in 908 (9%) patients, including 549 (12%) patients with HF (61% of all hospital deaths). Age was independently associated with hospital mortality (adjusted odds ratio per 10 years 1.3, 95% confidence interval 1.2-1.4, P < 0.001) and 1 year mortality (adjusted hazard ratio per 10 years 1.2, 95% confidence interval 1.2-1.3, P < 0.001) in the overall cohort. The associations of age with both hospital mortality (adjusted odds ratio 1.6 vs. 1.3 per 10 years older) and 1 year mortality (adjusted hazard ratio 1.5 vs. 1.3 per 10 years older) were higher for patients with ACS compared with patients with HF. Older age was associated with higher adjusted hospital mortality and 1 year mortality in each SCAI shock stage (all P < 0.05). Additive increases in both hospital mortality and 1 year mortality were observed with increasing age and SCAI shock stage. Conclusions Age is an independent risk factor for mortality that modifies the relationship between the SCAI shock stage and mortality risk in CICU patients, providing robust risk stratification for in-hospital and 1 year mortality. Although patients with HF had a higher risk of dying, age was more strongly associated with mortality among patients with ACS.

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“…The contemporary cardiac intensive care unit (CICU) serves an increasingly complex patient population with acute and chronic multiorgan dysfunction and superimposed cardiac pathology . Acute cardiovascular diseases remain an important focus of CICU care, yet noncardiovascular disease processes including extracardiac organ failure are becoming more prevalent in CICU patients . Organ failure, particularly multiorgan failure, is a final common pathway of critical illness and an important driver of mortality among CICU patients.…”

Section: Introductionmentioning

confidence: 99%

“…Organ failure, particularly multiorgan failure, is a final common pathway of critical illness and an important driver of mortality among CICU patients. In particular, acute kidney injury, and acute respiratory failure are increasingly prevalent and have been associated with higher mortality in CICU populations, emphasizing the importance of early recognition and management of these concomitant acute noncardiovascular illnesses …”

Section: Introductionmentioning

confidence: 99%

Early noncardiovascular organ failure and mortality in the cardiac intensive care unit

Jentzer

Wiley

Bennett

et al. 2020

Clinical Cardiology

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Background: Noncardiac organ failure has been associated with worse outcomes among a cardiac intensive care unit (CICU) population.Hypothesis: We hypothesized that early organ failure based on the sequential organ failure assessment (SOFA) score would be associated with mortality in CICU patients.Methods: Adult CICU patients from 2007 to 2015 were reviewed. Organ failure was defined as any SOFA organ subscore ≥3 on the first CICU day. Organ failure was evaluated as a predictor of hospital mortality and postdischarge survival after adjustment for illness severity and comorbidities.Results: We included 10 004 patients with a mean age of 67 ± 15 years (37% female). Admission diagnoses included acute coronary syndrome in 43%, heart failure in 46%, cardiac arrest in 12%, and cardiogenic shock in 11%. Organ failure was present in 31%, including multiorgan failure in 12%. Hospital mortality was higher in patients with organ failure (22% vs 3%, adjusted OR 3.0, 95% CI 2.5-3.7, P < .001).After adjustment, each failing organ system predicted twofold higher odds of hospital mortality (adjusted OR 1.9, 95% CI 1.1-2.1, P < .001). Mortality risk was highest with cardiovascular, coagulation and liver failure. Among hospital survivors, organ failure was associated with higher adjusted postdischarge mortality risk (P < .001); multiorgan failure did not confer added long-term mortality risk.Conclusions: Early noncardiovascular organ failure, especially multiorgan failure, is associated with increased hospital mortality in CICU patients, and this risk continues Abbreviations: APACHE, acute physiology and chronic health evaluation; BMI, body mass index; CCI, Charlson comorbidity index; CI, confidence interval; CICU, cardiac intensive care unit; IABP, intra-aortic balloon pump; LOS, length of stay; OASIS, Oxford Acute Severity of Illness Score; OR, odds ratio; PAC, pulmonary artery catheter; PCI, percutaneous coronary intervention; SOFA, sequential organ failure assessment.

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Changes in comorbidities, diagnoses, therapies and outcomes in a contemporary cardiac intensive care unit population

Cited by 92 publications

References 17 publications

Advanced Respiratory Support in the Contemporary Cardiac ICU

Advanced Respiratory Support in the Contemporary Cardiac ICU

Age and shock severity predict mortality in cardiac intensive care unit patients with and without heart failure

Early noncardiovascular organ failure and mortality in the cardiac intensive care unit

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