Although cardiac intensive care units (CICU) have evolved substantially in terms of the patient population, comorbidities and diagnoses, there has been a lag in the generation of high-quality evidence to manage these critically ill patients, according to a JACC Expert Panel article published Dec. 4 in JACC.

P. Elliott Miller, MD, MHS, et al., writing on behalf of ACC's Critical Cardiology Member Section and ESC's Association for Acute CardioVascular Care, describe in their multinational perspective key areas of CICU-specific research in critical care cardiology research, current challenges for clinical and translational investigation in the CICU, and essential elements of a path forward for the field.

The authors note that beyond the difficulties of studying critically ill patients, there are unique barriers to research in critical care cardiology, such as equipoise, issues with informed consent, heterogeneity of many of the clinical syndromes, and limited resources. Additionally, "wide variation in practice patterns for management of common CICU disorders reflect the absence of evidence-based professional society guidelines for many of the most common and morbid syndromes cared for in CICUs."

They conclude that overcoming these barriers will require collaboration across disciplines as well as novel research designs, stating that "understanding the epidemiology of critical care cardiology and variations in practice is foundational to identifying key areas of research" and "more comprehensive phenotyping will allow for more tailored patient selection for clinical trials and better targeting of therapies."

Keywords: Critical Illness, Research Design, Intensive Care Units, Critical Care