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Single and multi-center studies have described substantial changes in the landscape of health care in cardiac intensive care units (CICU). Few reports have quantitatively characterized current diagnoses in a contemporary CICU in Latin America.
This study aims to describe demographics, diagnoses, care patterns, and outcomes in patients admitted to a CICU in a high-volume center in South America.
A total of 1629 consecutive patients admitted to CICU from December 2017 to April 2020 were included in a prospective registry. The variables analyzed included demographic data, admission and final diagnoses, management, and outcomes.
Among 1629 participants, 32.4% were women, and the median age was 62 years (53-71). Admissions were due to primary cardiac causes in 1335 (81.9%), postsurgical care in 13.3%, and a combination of general and cardiac diagnoses in 4.8% of patients. The most frequent diagnosis on admission was acute coronary syndrome (ACS) (35.7%). Primary reasons for CICU admission were postprocedural observation (PPO) (31.8%), diagnosed or suspected ACS (31.7%), heart failure (10.1%), postsurgical management after cardiovascular surgery (8.9%), arrhythmia (5.8%), shock (4.5%) and cardiac arrest (CA) (1.2%). Advanced CICU therapy requirements were ventilatory assistance (19.3%) and vasoactive or inotropic drug use (19.6%). The overall mortality rate was 6.4%. Admission diagnoses associated with the highest mortality rates were CA (52.6%), noncardiogenic shock (39.5%), and cardiogenic shock (32.3%). Notably, patients admitted solely for PPO had a mortality rate of 0.8%.
In a contemporary CICU from a high-volume reference center in South America, the most frequent diagnosis was an ACS, although it represented only one-third of the admissions.
One-fifth of admissions required advanced CICU therapies. CA and shock on admission carried a poor prognosis. We identified PPO as a substantially low-risk population.
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2- Katz, JN, Turer, AT, Becker, RC. Cardiology and the critical care crisis: a perspective. J Am Coll Cardiol 2007;49(12):1279-1282. 2007;49(12): 1279-1282.
3- Tubaro, M, Danchin, N, Filippatos, G, Goldstein, P, Vranckx, P. ESC textbook Textbook of Acute and Intensive Cardiac Care. Oxford: Oxford University Press; 2011.
4- Katz JN, Shah BR, Volz EM, et al. Evolution of the coronary care unit: clinical characteristics and temporal trends in healthcare delivery and outcomes. Crit Care Med.2010;38(2):375-381.
5- Ratcliffe, JA, Wilson, E, Islam, S. Mortality in the coronary care unit. Coron Artery Dis. 2014;25(1): 60-65.
6- Holland, EM, Moss, TJ Acute noncardiovascular illness in the cardiac intensive care unit. J Am Coll Cardiol. 2017;69(16): 1999-2007.
7- Watson, RA, Bohula, EA, Gilliland, TC, Sanchez, PA, Berg, DD. Editor’s Choice-Prospective registry of cardiac critical illness in a modern tertiary care Cardiac Intensive Care Unit. Eur Heart J. 2019;8(8): 755-761.
8- Sinha, SS, Sjoding, MW, Sukul, D. Changes in primary non cardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States. Circ Cardiovasc Qual Outcomes. 2017;10(8)
9- Wong, GC, Van Diepen, S, Ainsworth, C. CCS Post Cardiac Arrest Guidelines Committee Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology position Statement on the optimal care of the postarrest patient. Can J Cardiol. 2017;33(1): 1-16.
10- Bonnefoy-Cudraz, E, Bueno, H, Casella, G. Editor’s choice—acute cardiovascular care association position paper on intensive cardiovascular care units: an update on their definition, structure, organisation and function. Eur Heart J Acute Cardiovasc Care. 2018;7(1): 80-95.
11- Groeger, JS, Guntupalli, KK, Strosberg, M. Descriptive analysis of critical care units in the United States: patient characteristics and intensive care unit utilization. Crit Care Med. 1993;21(2): 279-291.
12- Ruiz, C, Díaz, MA, Zapata, J. Características y evolución de los pacientes que ingresan a una Unidad de Cuidados Intensivos de un hospital público. Revista médica de Chile. 2016;144(10): 1297-1304.
13- Bohula, E.A, Katz, JN, Van Diepen, S. Demographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units: The Critical Care Cardiology Trials Network Prospective North American Multicenter Registry of Cardiac Critical Illness. JAMA Cardiol 2019;4(9):928-935. 2019;4(9): 928-935.
14- Casella, G, Cassin, M, Chiarella, F. Epidemiology and patterns of care of patients admitted to Italian Intensive Cardiac Care units: the BLITZ-3 registry. J Cardiovasc Med (Hagerstown). 2010;11(6): 450-461.
15- Morrow, DA, Fang, JC, Fintel, DJ. Evolution of critical care cardiology: transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: a scientific statement from the American Heart Association. Circulation. 2012;126(11): 1408-1428.
16- Cohen Arazi, H, Nani, S, Giorgi, M. Catéter de Swan Ganz. Opinión de expertos [Swan Ganz catheter Experts opinion]. Medicina (B Aires). 2014;74(4): 326-332.