Highlights
- •Patients admitted to cardiac intensive care units (CICUs) have complex multiorgan dysfunction.
- •There is a shortage of dual-certified critical care cardiologists; therefore, new CICU models are needed.
- •A closed CICU model staffed by a heart failure specialist is associated with lower mortality in CICUs.
ABSTRACT
Background
Cardiac intensive care units (CICUs) serve medically complex patients with multiorgan
dysfunction. Whether a CICU that is staffed full time by heart failure (HF) specialists
is associated with decreased mortality is unclear.
Methods and Results
A retrospective review of consecutive CICU admissions from January 1, 2012, to December
31, 2016, was performed. In January 2014, the CICU changed from an open unit staffed
by any cardiologist to a closed unit managed by HF specialists. Patients’ baseline
characteristics were determined, and a multivariate regression analysis was performed
to ascertain mortality rates in the CICU. Baseline severity of illness was higher
in the closed/HF specialist CICU model (P< 0.001). Death occurred in 101 of 1185 patients admitted to the CICU (8.5%) in the
open-unit model and in 139 of 2163 patients (6.4%) admitted to the closed/HF specialist
model (absolute risk reduction 2.1%, 95% confidence interval [CI] 0.1–4.0%; P = 0.01). The transition from an open to a closed/HF specialist model was associated
with a lower overall CICU mortality rate (odds ratio [OR] 0.63; 95% CI 0.43–0.93).
Prespecified interaction with a mechanical circulatory support device and unit model
showed that treatment with such a device was associated with lower mortality rates
in the closed/HF specialist model of a CICU (OR 0.6; 95% CI 0.18–0.78; P for interaction <0.01).
Conclusion
Transition to a closed unit model staffed by a dedicated HF specialist is associated
with lower CICU mortality rates.
Graphical Abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: October 08, 2021
Accepted:
September 27,
2021
Received in revised form:
September 20,
2021
Received:
June 1,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
