Introduction: Cardiac intensive care involves delivery of comprehensive critical care using advanced therapies for high-risk conditions. It is unclear if the outcomes such patients experience are evenly distributed throughout all care settings and what patient- and hospital-level factors impact these health outcomes. We evaluated the distribution of case-mix, acuity and processes of care from a nationally reflective convenience sample of intensive care units (ICUs).
Methods: The Cerner Healthfacts Database was used to identify critically ill cardiac encounters (CICE). The sample consisted of inpatients hospitalized between January 2009 and December 2014 coded with a cardiac principal diagnosis and requiring direct admission or transfer to an ICU within 48 hours of hospital admission. Hospitals were dichotomized into those with a single undifferentiated ICU (Group 1) and those with a multidisciplinary ICU framework (≥1 ICU including at least 1 cardiac type; Group 2).
Results: There were a total of 44012 individual hospital encounters in 68 hospitals, including 18001 patients in Group 1 and 26011 in Group 2. The majority of hospitals in Group 2 were teaching. There were no difference in admission SOFA score for cardiac patients admitted to the ICU, and no difference in the unadjusted in-hospital death rates. Further hospital-level factors are in Table 1. Acute myocardial infarction was the leading diagnosis in Group 1 (6429 encounters; 35.7% of total encounters) and Group 2 (11394 encounters; 43.8% of total encounters).
Conclusion: Critically ill patients with cardiac diagnoses demonstrated equivalent baseline severity of illness, in-hospital mortality and lengths of stay when admitted to hospitals with single of multiple ICU care settings. However, hospitals with a multi-ICU setting tended to be teaching hospitals.