The necessity of conversion from coronary care unit to the cardiovascular intensive care unit required for cardiologists

Nonogi, Hiroshi

doi:10.1016/j.jjcc.2018.10.001

Cited by 5 publications

(4 citation statements)

References 66 publications

(82 reference statements)

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“…It is likely that the clinical pharmacy intervention is best implemented in the cardiology ward if the clinical pharmacist discusses the DRPs face-to-face with the physicians. A pharmacist's clinical services in the CCU allowed for significant estimated reductions in total drug costs[62][63][64].…”

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confidence: 99%

Pharmacists in Critical Care

Mohiuddin

2019

Innov Pharm

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The beginnings of caring for critically ill patients date back to Florence Nightingale’s work during the Crimean War in 1854, but the subspecialty of critical care medicine is relatively young. The first US multidisciplinary intensive care unit (ICU) was established in 1958, and the American Board of Medical Subspecialties first recognized the subspecialty of critical care medicine in 1986. Critical care pharmacy services began around the 1970s, growing in the intervening 40 years to become one of the largest practice areas for clinical pharmacists, with its own section in the SCCM, the largest international professional organization in the field. During the next decade, pharmacy services expanded to various ICU settings (both adult and pediatric), the operating room, and the emergency department. In these settings, pharmacists established clinical practices consisting of therapeutic drug monitoring, nutrition support, and participation in patient care rounds. Pharmacists also developed efficient and safe drug delivery systems with the evolution of critical care pharmacy satellites and other innovative programs. In the 1980s, critical care pharmacists designed specialized training programs and increased participation in critical care organizations. The number of critical care residencies and fellowships doubled between the early 1980s and the late 1990s. Standards for critical care residency were developed, and directories of residencies and fellowships were published. In 1989, the Clinical Pharmacy and Pharmacology Section was formed within the Society of Critical Care Medicine, the largest international, multidisciplinary, multispecialty critical care organization. This recognition acknowledged that pharmacists are necessary and valuable members of the physician-led multidisciplinary team. The Society of Critical Care Medicine Guidelines for Critical Care Services and Personnel deem that pharmacists are essential for the delivery of quality care to critically ill patients. These guidelines recommend that a pharmacist monitor drug regimen for dosing, adverse reactions, drug-drug interactions, and cost optimization for all hospitals providing critical care services. The guidelines also advocate that a specialized, decentralized pharmacist provide expertise in nutrition support, cardiorespiratory resuscitation, and clinical research in academic medical centers providing comprehensive critical care. Article Type: Commentary

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confidence: 99%

Pharmacists in Critical Care

Mohiuddin

2019

Innov Pharm

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“…CCU, which was initially established as a separate unit for the early detection and treatment of arrhythmias associated with acute myocardial infarction (AMI), 32 now provides the setting for monitoring and treating a wide variety of critical cardiovascular disease (CVD) states. 33 Jason N. Katz et al 32 reported a decreasing contemporary CCU and in-hospital mortality over time, although this decrease in odds was modest. Although mortality for AMI has steadily decreased among the patients admitted to CCU, 34,35 the prevalence of other cardiovascular diseases and critical illnesses seems to be increasing.…”

Section: Discussionmentioning

confidence: 99%

The Association Between High CHA₂DS₂-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients

Cheng

Kang

Lin

et al. 2022

Clin Appl Thromb Hemost

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Background The CHA2DS2-VASc score has been associated with the prognosis of cardiovascular diseases. This study aimed to explore the association between the CHA2DS2-VASc score and all-cause mortality in coronary care unit (CCU) patients. Methods The study was based on the Medical Information Mart for Intensive Care (MIMIC) III database. CCU patients were divided into two groups according to CHA2DS2-VASc score: 0-3 (low risk)，4-9 (intermediate and high risk). The primary outcome was 30-day mortality, and the secondary endpoints included in-hospital, 1-year, and 5-year mortality. Propensity score matching (PSM) and sensitivity analyzes for the confounders were also performed. The restricted cubic splines flexibility model was used to demonstrate the relation between red blood cell volume distribution width (RDW), blood urea nitrogen (BUN), platelet, white blood cell (WBC), hemoglobin, phosphorus, glucose, potassium, sodium and 30-day mortality in the 0-3 score versus the 4-9 score groups after PSM. Results Among 4491 eligible patients, 988 patients with low CHA2DS2-VASc scores and 988 patients with intermediate and high CHA2DS2-VASc scores had similar propensity scores and were included in the analyzes. In the survival analysis, the patients with intermediate and high CHA2DS2-VASc scores were associated with higher 30-day mortality [hazard ratio (HR): 1.11; 95% confidence interval (CI), 1.02–1.20, P = .014], 1-year mortality [HR: 1.13; 95%CI, 1.06–1.19, P < .001], and 5-year mortality [HR: 1.13; 95%CI, 1.07–1.18, P < .001]. The interaction for 30-day mortality among subgroups was not significant between the 0-3 score versus the 4-9 score groups. The restricted cubic splines for 30-day mortality demonstrated an L-shaped trajectory for platelets and hemoglobin, a J-shaped trajectory for WBC, glucose and potassium, and a U-shaped trajectory for sodium, respectively (all nonlinear P <.001). Conclusions A high CHA2DS2-VASc score was an independent risk for 30-day, 1-year, and 5-year mortality for CCU patients.

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“…A previous study revealed that AMI patients admitted to the intensive care unit had significantly lower 30-day mortality than those who were not [9] . In addition, Nonogi discussed the necessity for conversion from the CCU to the CICU in Japan [10] . However, fundamental data on contemporary CICUs related to patient characteristics, disease diversity, disease severity, length of stay (LOS), in-hospital mortality, and re-admission are extremely limited in Japan.…”

Section: Introductionmentioning

confidence: 99%

Non-cardiovascular disorders in a contemporary cardiovascular intensive care unit in Japan

Kadooka

Miyachi

Kimura

et al. 2021

Journal of Cardiology

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Background: In the modern US cardiovascular intensive care unit (CICU), the incidence of noncardiovascular disorders has increased and non-cardiovascular disorders are associated with an increase in morbidity and mortality. In Japan, however, data regarding the association between non-cardiovascular disorders and outcomes in the CICU are limited.Methods: This study examined 490 consecutive admissions to a closed CICU at the Nippon Medical School Hospital from January to December 2017. Characteristics, diagnoses, treatments, and outcomes of admitted patients were identified. Results:The most common primary diagnosis was acute coronary syndrome (50.4%), followed by acute heart failure (20.0%), arrhythmia (6.7%), and non-cardiovascular diseases (3.7%). The mortality rate and median length of stay (LOS) in the CICU were 4.7% and 4 (interquartile range, 2-8) days, respectively. Of all patients, 42.2% ( n = 207) developed non-cardiovascular complications such as acute respiratory failure, acute kidney injury, or sepsis during CICU stay. Multivariate logistic regression analysis revealed that acute respiratory failure and sepsis were significantly associated with mortality in the CICU (odds ratio, 11.014 and 25.678, respectively; both p < 0.05). The multiple linear regression analysis showed that acute kidney injury was significantly associated with LOS in the CICU ( β= 0.144, p = 0.002). Conclusions:Approximately half of patients admitted to the CICU had non-cardiovascular disorders including non-cardiovascular disease and non-cardiovascular complications, which were significantly associated with mortality and LOS in the CICU.

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The necessity of conversion from coronary care unit to the cardiovascular intensive care unit required for cardiologists

Cited by 5 publications

References 66 publications

Pharmacists in Critical Care

Pharmacists in Critical Care

The Association Between High CHA₂DS₂-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients

Non-cardiovascular disorders in a contemporary cardiovascular intensive care unit in Japan

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The necessity of conversion from coronary care unit to the cardiovascular intensive care unit required for cardiologists

Cited by 5 publications

References 66 publications

Pharmacists in Critical Care

Pharmacists in Critical Care

The Association Between High CHA2DS2-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients

Non-cardiovascular disorders in a contemporary cardiovascular intensive care unit in Japan

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The Association Between High CHA₂DS₂-VASc Scores and Short and Long-Term Mortality for Coronary Care Unit Patients