Dataset Information

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.

ABSTRACT:

Importance

Single-center and claims-based studies have described substantial changes in the landscape of care in the cardiac intensive care unit (CICU). Professional societies have recommended research to guide evidence-based CICU redesigns.

Objective

To characterize patients admitted to contemporary, advanced CICUs.

Design, setting, and participants

This study established the Critical Care Cardiology Trials Network (CCCTN), an investigator-initiated multicenter network of 16 advanced, tertiary CICUs in the United States and Canada. For 2 months in each CICU, data for consecutive admissions were submitted to the central data coordinating center (TIMI Study Group). The data were collected and analyzed between September 2017 and 2018.

Main outcomes and measures

Demographics, diagnoses, management, and outcomes.

Results

Of 3049 participants, 1132 (37.1%) were women, 797 (31.4%) were individuals of color, and the median age was 65 years (25th and 75th percentiles, 55-75 years). Between September 2017 and September 2018, 3310 admissions were included, among which 2557 (77.3%) were for primary cardiac problems, 337 (10.2%) for postprocedural care, 253 (7.7%) for mixed general and cardiac problems, and 163 (4.9%) for overflow from general medical ICUs. When restricted to the initial 2 months of medical CICU admissions for each site, the primary analysis population included 3049 admissions with a high burden of noncardiovascular comorbidities. The top 2 CICU admission diagnoses were acute coronary syndrome (969 [31.8%]) and heart failure (567 [18.6%]); however, the proportion of acute coronary syndrome was highly variable across centers (15%-57%). The primary indications for CICU care included respiratory insufficiency (814 [26.7%]), shock (643 [21.1%]), unstable arrhythmia (521 [17.1%]), and cardiac arrest (265 [8.7%]). Advanced CICU therapies or monitoring were required for 1776 patients (58.2%), including intravenous vasoactive medications (1105 [36.2%]), invasive hemodynamic monitoring (938 [30.8%]), and mechanical ventilation (652 [21.4%]). The overall CICU mortality rate was 8.3% (95% CI, 7.3%-9.3%). The CICU indications that were associated with the highest mortality rates were cardiac arrest (101 [38.1%]), cardiogenic shock (140 [30.6%]), and the need for renal replacement therapy (51 [34.5%]). Notably, patients admitted solely for postprocedural observation or frequent monitoring had a mortality rate of 0.2% to 0.4%.

Conclusions and relevance

In a contemporary network of tertiary care CICUs, respiratory failure and shock predominated indications for admission and carried a poor prognosis. While patterns of practice varied considerably between centers, a substantial, low-risk population was identified. Multicenter collaborative networks, such as the CCCTN, could be used to help redesign cardiac critical care and to test new therapeutic strategies.

SUBMITTER: Bohula EA

PROVIDER: S-EPMC6659157 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Publications

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.

Bohula Erin A EA Katz Jason N JN van Diepen Sean S Alviar Carlos L CL Baird-Zars Vivian M VM Park Jeong-Gun JG Barnett Christopher F CF Bhattal Gurjaspreet G Barsness Gregory W GW Burke James A JA Cremer Paul C PC Cruz Jennifer J Daniels Lori B LB DeFilippis Andrew A Granger Christopher B CB Hollenberg Steven S Horowitz James M JM Keller Norma N Kontos Michael C MC Lawler Patrick R PR Menon Venu V Metkus Thomas S TS Ng Jason J Orgel Ryan R Overgaard Christopher B CB Phreaner Nicholas N Roswell Robert O RO Schulman Steven P SP Snell R Jeffrey RJ Solomon Michael A MA Ternus Bradley B Tymchak Wayne W Vikram Fnu F Morrow David A DA

JAMA cardiology 20190901 9

<h4>Importance</h4>Single-center and claims-based studies have described substantial changes in the landscape of care in the cardiac intensive care unit (CICU). Professional societies have recommended research to guide evidence-based CICU redesigns.<h4>Objective</h4>To characterize patients admitted to contemporary, advanced CICUs.<h4>Design, setting, and participants</h4>This study established the Critical Care Cardiology Trials Network (CCCTN), an investigator-initiated multicenter network of ...[more]

PMID: 31339509

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Dataset Information

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.

Importance

Objective

Design, setting, and participants

Main outcomes and measures

Results

Conclusions and relevance

Publications

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.

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