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

Jacob C Jentzer1, Sean van Diepen2, Gregory W Barsness3

  • 1Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN.

American Heart Journal
|July 2, 2019
PubMed

Insights

Cardiac intensive care unit (CICU) admissions show increasing critical care diagnoses and therapies. This evolution in patient care is associated with a significant decrease in adjusted hospital mortality over time.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Health Services Research

Background:

  • The patient population in cardiac intensive care units (CICUs) has been observed to change over time.
  • Understanding these temporal shifts is crucial for adapting care strategies.

Purpose of the Study:

  • To describe temporal changes in comorbidities, illness severity, diagnoses, and procedures within a CICU.
  • To assess trends in adjusted mortality for CICU patients over a defined period.

Main Methods:

  • Retrospective review of 12,418 unique CICU admissions at Mayo Clinic (January 2007 - April 2018).
  • Analysis of comorbidities, severity of illness, discharge diagnoses, and procedures.
  • Temporal trends assessed using linear regression and Cochran-Armitage tests.
  • Adjusted hospital mortality trends evaluated using multivariable logistic regression.

Main Results:

  • Increased prevalence of non-coronary cardiovascular diseases, critical care diagnoses, and organ failure (P < .05).
  • Increased utilization of mechanical ventilation, invasive lines, and vasoactive drugs (P < .05).
  • A temporal decrease in adjusted hospital mortality was observed for patients with and without critical care discharge diagnoses.

Conclusions:

  • The CICU patient cohort exhibits an increasing prevalence of critical care and organ failure diagnoses.
  • There is a corresponding rise in the utilization of critical care therapies.
  • These changes are associated with a reduction in risk-adjusted hospital mortality over time.

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