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Full-Time Cardiac Intensive Care Unit Staffing by Heart Failure Specialists and its Association with Mortality Rates

Daniel B Sims1, Yekaterina Kim2, Aleksandr Kalininskiy2

  • 1Division of Cardiology.

Journal of Cardiac Failure
|October 11, 2021
PubMed

Insights

A dedicated heart failure (HF) specialist team in cardiac intensive care units (CICUs) is linked to reduced patient mortality. This change from an open unit to a closed unit model improved outcomes for complex cardiac patients.

Area of Science:

  • Cardiology
  • Intensive Care Medicine
  • Health Services Research

Background:

  • Cardiac intensive care units (CICUs) manage complex patients with multiorgan dysfunction.
  • The impact of dedicated heart failure (HF) specialist staffing on CICU mortality was previously unclear.

Purpose of the Study:

  • To investigate whether a CICU staffed full-time by HF specialists is associated with decreased patient mortality.
  • To compare mortality rates between an open CICU model and a closed CICU model managed by HF specialists.

Main Methods:

  • Retrospective review of CICU admissions from January 2012 to December 2016.
  • Comparison of mortality rates before (open unit) and after (closed unit with HF specialists) January 2014.
  • Multivariate regression analysis to ascertain mortality rates, adjusting for baseline severity of illness.

Main Results:

  • The closed/HF specialist CICU model had a higher baseline severity of illness (P<0.001).
  • Overall CICU mortality decreased from 8.5% in the open-unit model to 6.4% in the closed/HF specialist model (absolute risk reduction 2.1%, P=0.01).
  • The transition to a closed/HF specialist model was associated with significantly lower CICU mortality (OR 0.63; 95% CI 0.43-0.93).

Conclusions:

  • Transitioning to a closed CICU model staffed by dedicated HF specialists is associated with lower overall mortality.
  • This specialized staffing model may improve outcomes for critically ill cardiac patients.
  • Mechanical circulatory support use showed lower mortality in the closed/HF specialist model, indicating potential benefits for high-risk patients.
Abstract

Keywords:
Critical care cardiologyadvanced heart failuremechanical circulatory supportstaffing patterns

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