Demographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units

Abstract

; for the Critical Care Cardiology Trials Network IMPORTANCE Single-center and claims-based studies have described substantial changes in the landscape of care in the cardiac intensive care unit (CICU). Professional societies have recommended research to guide evidence-based CICU redesigns. OBJECTIVE To characterize patients admitted to contemporary, advanced CICUs. DESIGN, SETTING, AND PARTICIPANTS This study established the Critical Care Cardiology Trials Network (CCCTN), an investigator-initiated multicenter network of 16 advanced, tertiary CICUs in the United States and Canada. For 2 months in each CICU, data for consecutive admissions were submitted to the central data coordinating center (TIMI Study Group). The data were collected and analyzed between September 2017 and 2018. MAIN OUTCOMES AND MEASURES Demographics, diagnoses, management, and outcomes. RESULTS Of 3049 participants, 1132 (37.1%) were women, 797 (31.4%) were individuals of color, and the median age was 65 years (25th and 75th percentiles, 55-75 years). Between September 2017 and September 2018, 3310 admissions were included, among which 2557 (77.3%) were for primary cardiac problems, 337 (10.2%) for postprocedural care, 253 (7.7%) for mixed general and cardiac problems, and 163 (4.9%) for overflow from general medical ICUs. When restricted to the initial 2 months of medical CICU admissions for each site, the primary analysis population included 3049 admissions with a high burden of noncardiovascular comorbidities. The top 2 CICU admission diagnoses were acute coronary syndrome (969 [31.8%]) and heart failure (567 [18.6%]); however, the proportion of acute coronary syndrome was highly variable across centers (15%-57%). The primary indications for CICU care included respiratory insufficiency (814 [26.7%]), shock (643 [21.1%]), unstable arrhythmia (521 [17.1%]), and cardiac arrest (265 [8.7%]). Advanced CICU therapies or monitoring were required for 1776 patients (58.2%), including intravenous vasoactive medications (1105 [36.2%]), invasive hemodynamic monitoring (938 [30.8%]), and mechanical ventilation (652 [21.4%]). The overall CICU mortality rate was 8.3% (95% CI, 7.3%-9.3%). The CICU indications that were associated with the highest mortality rates were cardiac arrest (101 [38.1%]), cardiogenic shock (140 [30.6%]), and the need for renal replacement therapy (51 [34.5%]). Notably, patients admitted solely for postprocedural observation or frequent monitoring had a mortality rate of 0.2% to 0.4%. CONCLUSIONS AND RELEVANCE In a contemporary network of tertiary care CICUs, respiratory failure and shock predominated indications for admission and carried a poor prognosis. While patterns of practice varied considerably between centers, a substantial, low-risk population was identified. Multicenter collaborative networks, such as the CCCTN, could be used to help redesign cardiac critical care and to test new therapeutic strategies.

Organization of intensive cardiac care units in Europe: Results of a multinational survey

“…The over-qualification of care and the overuse of resources has also been documented in a recent US report. 19 Level 1 ICCU mismatches included the admission of patients with high illness severity to low-level ICCUs, which might be clinically more relevant. One explanation is the absence of high-level ICCUs in the studied hospitals.…”

National Interhospital Transfer for Patients With Acute Cardiovascular Conditions

“…A recent study of contemporary North American tertiary and quaternary CICUs showed that HF is the second most common reason for admission after ACS but represents the longest LOS and most frequent indication for CICU therapies. 19 Moreover, HF was the second leading cause of CICU mortality, with an incidence of 12.0%. In a large retrospective analysis of 3.2 million HF hospitalizations in the United States between 2005 and 2015, all of which were patients 65 years and older, Wadhera et al.…”

Epidemiology of a National Reference Cardiovascular Intensive Care Unit

“…El factor de riesgo cardiovascular más prevalente en los pacientes fue la hipertensión arterial seguido de la diabetes mellitus tipo 2, patrón semejante a reportes internacionales. 5,13,16 La presencia de comorbilidades como enfermedades pulmonares obstructivas crónicas (EPOC) e insuficiencia renal crónica se encuentra por debajo de los niveles reportados en registros europeos 5,15 mientras que los antecedentes cardiovasculares más frecuentes fueron enfermedad coronaria y falla cardíaca crónica similar a lo reportado por Gagliardi et al 18 Aunque se ha registrado un cambio epidemiológico en los pacientes admitidos en las UCIC a nivel mundial, el síndrome coronario agudo, principalmente con elevación del segmento ST, sigue siendo la primera causa de admisión a las unidades críticas cardíacas lo que se refleja en nuestra población (28.6%) semejante a lo ocurrido en los registros italiano, alemán, argentino y norteamericano (63.8%, 43.6%, 24.9% y 31.8% respectivamente) [14][15][16]18 .…”

“…La mortalidad en la UCC reportada en diversos registros varía entre 3.3 y 27.8% 5,[14][15][16]19 La mortalidad por falla cardíaca agudamente descompensada, la segunda causa de admisión a UCIC INCOR, fue similar a la observada en registros mencionados. 5,14,19 El grupo de mayor riesgo fue aquel que ingresó a UCIC proveniente de UCIN y hospitalización, los que presentaron una alta tasa de mortalidad (12.5%) la cual duplica la mortalidad de UCIC; este hallazgo no ha sido reportado por otros registros.…”