Abstract 19026: Prospective Registry of Cardiac Critical Illness in the Modern Cardiac Intensive Care Unit (CICU)

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Abstract

Introduction: ‘Coronary care units’ were created in the 1960s to rapidly identify and treat patients with arrhythmia after acute myocardial infarction (MI). The landscape of care in the modern Cardiac Intensive Care Unit (CICU) appears to have changed. Few studies have quantitatively characterized the current demographics, diagnoses and outcomes in the contemporary CICU.

Methods: We evaluated patients in a prospective observational database, created to support quality improvement and clinical care redesign in an AHA Level 1 (advanced) CICU at Brigham and Women’s Hospital, Boston, MA. All consecutive patients (n=1555) admitted from January 1, 2015 to December 31, 2016 were included at the time of admission to the CICU.

Results: The median age was 67 y (43% >70y, Fig A), and 44% of patients were female. Non-cardiovascular comorbidities were common, including chronic kidney disease (30%), pulmonary disease (24%), and active cancer (15%). Most patients were admitted to the CICU from the Emergency Department (43%) including 10% via the cardiac cath lab, and 22% were transferred directly from an outside hospital. Only 7% of admissions to the CICU were primarily for an acute coronary syndrome. The top 2 diagnoses for admission to our CICU were shock/hypotension (26%) and cardiopulmonary arrest (11%). Valvular heart disease, congenital heart disease, and severe pulmonary hypertension were also common (Fig B). The top qualifying indications for ICU admission were shock, respiratory failure, and cardiac arrest. The in-hospital mortality rate was 19.8%.

Conclusions: In a tertiary, academic, Level 1 CICU, patients are elderly with a high burden of non-CV comorbid conditions. Care has shifted from ACS to predominantly shock, cardiac arrest, decompensated valvular disease, and other non-ischemic heart disease, and the mortality of these conditions is high. These data are likely to be helpful to guide cardiac critical care redesign in the United States.

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