Outcomes of Patients With Primary Cardiac Diagnoses Admitted to Cardiac vs Noncardiac Intensive Care Units

Samuel B Brusca; Panagis Galiatsatos; Sarah Warner; Xiaobai Li; Tiffany M Powell-Wiley; Sameer S Kadri; Michael A Solomon

doi:10.1016/j.jacadv.2022.100114

Outcomes of Patients With Primary Cardiac Diagnoses Admitted to Cardiac vs Noncardiac Intensive Care Units

JACC Adv. 2022 Oct;1(4):100114. doi: 10.1016/j.jacadv.2022.100114. Epub 2022 Oct 28.

Authors

Samuel B Brusca^{1

2}, Panagis Galiatsatos³, Sarah Warner¹, Xiaobai Li⁴, Tiffany M Powell-Wiley^{5

6}, Sameer S Kadri¹, Michael A Solomon^{1

5}

Affiliations

¹ Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
² Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, California, USA.
³ Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
⁴ Biostatistics and Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
⁵ Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
⁶ Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.

Abstract

Background: Demographics in cardiac intensive care units (CICUs) have evolved, with increased prevalence of noncardiac critical illnesses.

Objectives: This study compares outcomes of patients with primary cardiac diagnoses admitted to CICUs vs those of patients with primary cardiac diagnoses admitted to noncardiac ICUs.

Methods: The Cerner Health Facts Database was queried to identify adults with primary cardiac diagnoses admitted to ICUs within 48 hours of presentation between 2009 and 2014. Only hospitals with multiple ICUs including a CICU were studied. Information on ICU staffing was not available. A univariate analysis of ICU type (model 1) and multivariate analyses incorporating patient- and hospital-level variables (model 2) and concurrent, noncardiac, ICU-level diagnoses (model 3) were utilized to assess the impact of ICU type on inpatient mortality.

Results: Of 16,163 encounters across 14 hospitals, 8,499 (52.6%) were admitted to CICUs and 7,664 (47.4%) to noncardiac ICUs. Univariate analysis (model 1) demonstrated increased mortality in noncardiac ICUs compared to CICUs (odds ratio [OR]: 1.47, 95% CI: 1.32-1.64; P < 0.0001). This risk dissipated (OR: 1.04, 95% CI: 0.91-1.18; P = 0.56) after controlling for patient- and hospital-level variables (model 2). Inclusion of concurrent, noncardiac, ICU-level diagnoses (model 3) lead to a reversal with decreased mortality in noncardiac ICUs (OR: 0.86, 95% CI: 0.76-0.98; P = 0.03).

Conclusions: In this historical cohort study evaluating CICU outcomes prior to the evolution of proposed staffing and care model modernization, survival of cardiac patients with concurrent, noncardiac critical illnesses may have been better with the expertise available in general system ICUs. These results may support contemporary efforts to increase the capacity to manage noncardiac critical illnesses in CICUs.

Keywords: cardiac intensive care; cardiogenic shock; critical care cardiology; noncardiac ICU; noncardiac critical illness; staffing models.

Abstract

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