Variation in risk-adjusted cardiac intensive care unit (CICU) length of stay and the association with in-hospital...

Area of Science:

• Cardiology
• Critical Care Medicine
• Health Services Research

Background:

• Cardiac intensive care unit (CICU) length of stay (LOS) shows significant variability.
• Previous studies lacked detailed risk assessment, limiting understanding of LOS variability.
• Inter-hospital differences in CICU LOS and its association with mortality require further investigation.

Purpose of the Study:

• To evaluate inter-hospital differences in CICU LOS.
• To assess the association between CICU LOS and in-hospital mortality.
• To inform CICU resource utilization and risk prognostication.

Main Methods:

• Utilized data from the Critical Care Cardiology Trials Network (CCCTN) registry (22,862 admissions, 2017-2022).
• Included 35 tertiary and quaternary CICUs with consecutive admissions snapshots.
• Employed Fine and Gray competing risk model to analyze LOS and mortality association.

Main Results:

• Median CICU LOS was 2.2 days; median hospital LOS was 5.9 days.
• Longer LOS associated with younger patients, more comorbidities, higher SOFA scores, and increased need for mechanical ventilation/support.
• Higher CICU LOS tertiles showed increased unadjusted in-hospital mortality (9.3% to 13.4%).
• Individual patient CICU LOS correlated with higher 30-day in-hospital mortality risk (r² = 0.31), significant across heart failure and myocardial infarction subtypes.

Conclusions:

• Significant variation in CICU LOS observed across academic centers.
• CICU LOS is independently associated with all-cause in-hospital mortality.
• Findings support improved CICU resource planning and risk stratification for critically ill cardiovascular patients.