Utilization of Intensive Care Units and Outcomes Based on Admission Wards in Cardiovascular Emergencies

Cardiovascular emergencies often require intensive care unit (ICU) management, but there is limited data comparing outcomes based on the admission ward.

We analyzed data from the Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination (JROAD-DPC) database (2016-2020) for 715,054 patients (mean age, 75.4±14.2 years, 58.4% male) admitted with acute myocardial infarction (N=175,974), unstable angina (N=45,308), acute heart failure (N=179,871), acute aortic dissection (N=58,597), pulmonary embolism (N=17,009), or post-cardiac arrest (N=184,701). Patients were categorized into 4 groups: intensive care add-ons 1/2, 3/4 (ICU 1/2, 3/4), high-care unit (HCU), and general wards. Comparisons included patient characteristics, hospitalization duration, mortality rates, and rates of defibrillation or cardiopulmonary resuscitation (CPR) defined by chest compression. General ward patients were the oldest and with shortest hospitalization durations. Additionally, mortality rates were the highest in general wards for acute heart failure, myocardial infarction, and aortic dissection. Defibrillation rates were 7.0%, 5.6%, 3.1%, and 4.3%, for ICU 1/2, 3/4, HCU, and general ward, respectively, with corresponding mortality rates of 40.4%, 44.1%, 44.6%, and 79.3%. CPR rates were 10.1%, 9.5%, 6.2%, and 30.8%, with mortality rates of 71.0%, 73.9%, 78.4%, and 97.7%, respectively.

High mortality rates in general wards highlight the importance of ICU management, particularly for acute myocardial infarction and aortic emergencies. These findings support prioritizing ICU admission for these critical conditions.