scholarly journals Which patients with acute coronary syndrome need the cardiac intensive care unit: tuning the tools for risk stratification

2020 ◽  
Vol 9 (6) ◽  
pp. 543-545
Author(s):  
Antonio De Paiva Fagundes ◽  
David A Morrow
Keyword(s):  
Intensive Care Unit ◽  
Acute Coronary Syndrome ◽  
Intensive Care ◽  
Risk Stratification ◽  
Cardiac Intensive Care Unit ◽  
Coronary Syndrome ◽  
Cardiac Intensive Care

scholarly journals Editor’s Choice-Prospective registry of cardiac critical illness in a modern tertiary care Cardiac Intensive Care Unit

2018 ◽  
Vol 8 (8) ◽  
pp. 755-761 ◽  
Author(s):  
Ryan A Watson ◽  
Erin A Bohula ◽  
Thomas C Gilliland ◽  
Pablo A Sanchez ◽  
David D Berg ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Arrest ◽  
Clinical Care ◽  
Tertiary Care ◽  
Cardiac Intensive Care Unit ◽  
Coronary Syndrome ◽  
Cardiovascular Comorbidities ◽  
Cardiac Intensive Care ◽  
Time Of Admission

Background: The changing landscape of care in the Cardiac Intensive Care Unit (CICU) has prompted efforts to redesign the structure and organization of advanced CICUs. Few studies have quantitatively characterized 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, USA. All consecutive patients ( N=2193) admitted from 1 January 2015 to 31 December 2017 were included at the time of admission to the CICU. Results: The median age was 65 years (43% >70 years) and 44% of patients were women. Non-cardiovascular comorbidities were common, including chronic kidney disease (27%), pulmonary disease (22%), and active cancer (13%). Only 7% of CICU admissions were primarily for an acute coronary syndrome, which was the seventh most common individual diagnosis. The top three reasons for admission to the CICU were shock/hypotension (26%), cardiopulmonary arrest (11%), or primary arrhythmia without arrest (9%). Respiratory failure was a primary or major secondary reason for triage to the CICU in 17%. In-hospital mortality was 17.6%. Conclusions: In a tertiary, academic, advanced CICU, patients are elderly with a high burden of non-cardiovascular comorbid conditions. Care has shifted from ACS toward predominantly shock and cardiac arrest, as well as non-ischemic conditions, and the mortality of these conditions is high. These data may be useful to guide cardiac critical care redesign.

Abstract 17002: Performance of the Mortality Probability Model (MPM0) in a Contemporary Cardiac Intensive Care Unit

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Maria E Rodrigo ◽  
Federico M Asch ◽  
Tania A Singh ◽  
Tishangi Kumar ◽  
David A Morrow ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Risk Score ◽  
Surgical Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Coronary Syndrome ◽  
C Statistic ◽  
Prediction Of Mortality ◽  
Cardiac Intensive Care

Introduction: The Mortality Prediction Model (MPM0) was developed to estimate the probability of hospital mortality among patients in general and surgical intensive care units (ICUs). Although this score is widely accepted, its applicability in patients with primary cardiac conditions has not been thoroughly evaluated. The aim of this study is to assess the performance of the MPM0 score in a cardiac intensive care unit (CICU). Methods: From 2007 to 2012, data related to variables from the MPM0 (Table 1) were prospectively collected on all consecutive patients admitted due to a primary cardiac condition to the CICU of a tertiary referral center. MPM0 was applied to all patients. Two variables of the original risk score were not included in the analysis: intracranial mass effect and cirrhosis. The incidence of each variable within the score was determined. Test performance was assessed using the area under the receiver operating characteristic curve (c-statistic). Results: A total of 6,433 patients were admitted to the CICU, of whom 5,710 (89%) had a primary cardiac diagnosis. Complete data were available for 4,641 patients, who comprise the study population. Primary cardiac diagnoses were: acute coronary syndrome (54%), arrhythmia (13%), valvular (12%), cardiomyopathy (8%), cardiac arrest (4%) and other (9%). Overall hospital mortality was 10.4%. The c-statistic for application of MPM0 to this population was 0.82 (95% CI 0.81-0.84), indicating excellent discriminatory capacity. Conclusions: The MPM0 risk score, described originally to aid in prediction of mortality for patients admitted to medical and surgical ICUs, performed extremely well when applied to cardiac patients admitted to a large contemporary CICU.

scholarly journals Defining Shock and Preshock for Mortality Risk Stratification in Cardiac Intensive Care Unit Patients

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Jacob C. Jentzer ◽  
Barry Burstein ◽  
Sean Van Diepen ◽  
Joseph Murphy ◽  
David R. Holmes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Cardiac Intensive Care Unit ◽  
Coronary Syndrome ◽  
Cardiac Intensive Care

Background: Previous studies have defined preshock as isolated hypotension or isolated hypoperfusion, whereas shock has been variably defined as hypoperfusion with or without hypotension. We aimed to evaluate the mortality risk associated with hypotension and hypoperfusion at the time of admission in a cardiac intensive care unit population. Methods: We analyzed Mayo Clinic cardiac intensive care unit patients admitted between 2007 and 2015. Hypotension was defined as systolic blood pressure <90 mm Hg or mean arterial pressure <60 mm Hg, and hypoperfusion as admission lactate >2 mmol/L, oliguria, or rising creatinine. Associations between hypotension and hypoperfusion with hospital mortality were estimated using multivariable logistic regression. Results: Among 10 004 patients with a median age of 69 years, 43.1% had acute coronary syndrome, and 46.1% had heart failure. Isolated hypotension was present in 16.7%, isolated hypoperfusion in 15.3%, and 8.7% had both hypotension and hypoperfusion. Stepwise increases in hospital mortality were observed with hypotension and hypoperfusion compared with neither hypotension nor hypoperfusion (3.3%; all P <0.001): isolated hypotension, 9.3% (adjusted odds ratio, 1.7 [95% CI, 1.4–2.2]); isolated hypoperfusion, 17.2% (adjusted odds ratio, 2.3 [95% CI, 1.9–3.0]); both hypotension and hypoperfusion, 33.8% (adjusted odds ratio, 2.8 [95% CI, 2.1–3.6]). Adjusted hospital mortality in patients with isolated hypoperfusion was higher than in patients with isolated hypotension ( P =0.02) and not significant different from patients with both hypotension and hypoperfusion ( P =0.18). Conclusions: Hypotension and hypoperfusion are both associated with increased mortality in cardiac intensive care unit patients. Hospital mortality is higher with isolated hypoperfusion or concomitant hypotension and hypoperfusion (classic shock). We contend that preshock should refer to isolated hypotension without hypoperfusion, while patients with hypoperfusion can be considered to have shock, irrespective of blood pressure.

scholarly journals Right Ventricular Pulmonary Artery Coupling and Mortality in Cardiac Intensive Care Unit Patients

2021 ◽  
Author(s):  
Jacob C. Jentzer ◽  
Nandan S. Anavekar ◽  
Yogesh N. V. Reddy ◽  
Dennis H. Murphree ◽  
Brandon M. Wiley ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pulmonary Artery ◽  
Hospital Mortality ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Doppler Velocity ◽  
Cardiac Intensive Care Unit ◽  
Coronary Syndrome ◽  
Cardiac Intensive Care

Background Impaired right ventricular (RV) pulmonary artery coupling has been associated with higher mortality in patients with chronic heart disease, but few studies have examined this metric in critically ill patients. We sought to evaluate the association between RV pulmonary artery coupling, defined by the ratio of tricuspid annular peak systolic tissue Doppler velocity (TASV)/estimated RV systolic pressure (RVSP), and mortality in cardiac intensive care unit patients. Methods and Results Using a database of unique cardiac intensive care unit admissions from 2007 to 2018, we included patients with TASV/RVSP ratio measured within 1 day of hospitalization. Hospital mortality was analyzed using multivariable logistic regression, and 1‐year mortality was analyzed using multivariable Cox proportional‐hazards analysis. We included 4259 patients with a mean age of 69±15 years (40.1% women). Admission diagnoses included acute coronary syndrome in 56%, heart failure in 52%, respiratory failure in 24%, and cardiogenic shock in 12%. The mean TASV/RVSP ratio was 0.31±0.14, and in‐hospital mortality occurred in 7% of patients. Higher TASV/RVSP ratio was associated with lower in‐hospital mortality (adjusted unit odds ratio, 0.68 per each 0.1‐unit higher ratio; 95% CI, 0.58–0.79; P <0.001) and lower 1‐year mortality among hospital survivors (adjusted unit hazard ratio, 0.83 per each 0.1‐unit higher ratio; 95% CI, 0.77–0.90; P <0.001). Stepwise decreases in hospital and 1‐year mortality were observed in each higher TASV/RVSP quintile. The TASV/RVSP ratio remained associated with mortality after adjusting for left ventricular systolic and diastolic function. Conclusions A low TASV/RVSP ratio is associated with increased short‐term and long‐term mortality among cardiac intensive care unit patients, emphasizing importance of impaired RV pulmonary artery coupling as a determinant of poor prognosis. Further study is required to determine whether interventions to optimize RV pulmonary artery coupling can improve outcomes.

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