Acute Illness and Outcomes in the Modern Cardiac ICU
What is the association of acute noncardiovascular illnesses with outcomes including length of stay (LOS), mortality, and hospital readmission in the cardiac intensive care unit (CICU)?
The investigators studied 1,042 admissions between October 12, 2013 and November 28, 2014 to the CICU at the University of Virginia Health System, a tertiary-care academic medical center. Through systematic inspection of individual charts, they identified primary and secondary diagnoses, vital sign measurements, LOS, hospital readmissions, and mortality. The authors used regression models to assess the association of variables on CICU LOS, hospital mortality, and 30-day readmission, adjusting for demographics, severity of illness, and common acute comorbid conditions.
The most common primary diagnosis was acute coronary syndrome (25%), consisting of both non-ST-segment elevation acute coronary syndrome (14%) and ST-segment elevation myocardial infarction (11%). Sepsis was the most frequent noncardiovascular primary diagnosis (5%), but occurred in 16% of all admissions. Acute kidney injury and acute respiratory failure each occurred in 30%. One-half of all admissions (n = 524; 50%) were marked by acute respiratory failure, acute kidney injury, or sepsis. Median LOS in the CICU and the hospital were 2 (interquartile range [IQR], 1-5) and 6 (IQR, 3-11) days. Mortality was 7% in the CICU and 12% in the hospital. Of the 920 patients who survived to hospital discharge, 171 (19%) were readmitted within 30 days. Sepsis, acute kidney injury, and acute respiratory failure were associated with mortality. Acute kidney injury, acute respiratory failure, and new-onset subclinical atrial fibrillation, which occurred in 8% of admissions, were all associated with CICU LOS.
The authors concluded that many patients in the modern CICU have acute noncardiovascular illnesses that are associated with mortality and increased LOS.
This study reports that although cardiovascular conditions, including ACS, remain common, acute noncardiovascular conditions are strongly associated with outcomes, including mortality and LOS. About 50% of all admissions were marked by either acute respiratory failure, acute kidney injury, or sepsis. It appears that clinicians caring for these patients increasingly need greater competency in treating complex comorbid noncardiovascular conditions, and optimum care for critically ill patients in the CCU may need cardiologists with specialized training in critical care.
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