Cardiac ICU patient composition is changing over time

August 17, 2017
A new University of Michigan study finds slightly more than half of heart patients are admitted to the CICU for noncardiac conditions, such as sepsis or renal failure, rather than for a heart condition. Credit: University of Michigan

A new study uncovers changes in the makeup of the cardiac intensive care unit as more patients are primarily diagnosed with noncardiac conditions.

The unit is no longer only a place for patients recovering from attacks, like the coronary care units of decades past. A new University of Michigan study finds slightly more than half of heart patients are admitted to the CICU for noncardiac , such as sepsis or , rather than for a heart condition.

"It's an opportunity for providers to assess training and staffing models," says lead author Shashank S. Sinha, M.D., M.Sc., an advanced and cardiac transplantation fellow at U-M's Frankel Cardiovascular Center. The study was recently published in Circulation: Cardiovascular Quality and Outcomes.

"In order to get admitted to a CICU, you either have a primary cardiac condition - such as a heart attack or heart failure - or you have a sick heart from a prior event and now are admitted with a primary noncardiac condition - such as sepsis or lung or kidney failure," Sinha says. "We found a remarkable rise in primary noncardiac conditions associated with a rise in secondary cardiac comorbidities. This suggests patients with sick hearts from prior disease are now getting admitted to CICUs with conditions that anyone can get."

Sinha says this is the first data on numbers, types and outcomes of elderly CICU patients across the U.S., although others have reported similar findings at single academic centers.

"It's useful to understand what types of patients are now getting admitted to the ICU to ensure that all staff, from nurses to respiratory support to physicians, are appropriately trained to manage them," says co-author Michael Sjoding, M.D., M.Sc., an assistant professor of internal medicine and pulmonologist at Michigan Medicine.

Methodology

The researchers combed through Medicare data from 3.4 million CICU admissions between 2003 and 2013. They report 51.7 percent of admissions represented a primary noncardiac diagnosis in 2013, up from just 38 percent in 2003.

Rates of infectious diseases (15.1 percent) and respiratory diseases (7.6 percent) were the fastest-growing noncardiac reasons for admittance. Meanwhile, the CICU was seeing fewer patients with a primary diagnosis of coronary artery disease, as patients are living longer with chronic heart conditions.

Across the board, patients had increased rates of comorbidities including heart failure, pulmonary vascular disease, valvular heart disease and renal failure.

Sinha says, "Although patients with primary noncardiac diagnoses appear to be more complex and require more procedures, the outcomes haven't suggested overall care is compromised in the present configuration."

"Among the patients in the CICU, we're seeing the same trend that we see overall in intensive care, which is sepsis and are becoming more common," says Sjoding, a member of U-M's Institute for Healthcare Policy and Innovation. He says the data provides another reminder that sepsis has become such an important diagnosis, particularly for the critically ill.

'A call to action'

Sinha says anecdotal experience was motivating physicians primarily taking care of these patients in the CICU to start talking about the changing case mix, yet data lagged behind.

The American Heart Association recognized this in 2012, when it published a scientific statement on the need to train cardiologists on managing these noncardiac conditions they are likely to encounter in the CICU. In 2015, the American College of Cardiology enhanced training requirements, including requiring critical care cardiology trainees to learn ventilator management.

Researchers say the future critical care cardiology workforce could be different in many ways, including training cardiologists to develop additional expertise in critical care or bringing in intensivists to co-manage those patients with noncardiac conditions such as infectious diseases or respiratory .

Sjoding says it's important to ensure that these complex , wherever they are getting admitted, receive optimal care.

"It's a call to action," says Sinha, also a member of U-M IHPI. "The question is: How do we change?"

Explore further: Study examines palliative care in cardiac intensive care units

More information: Shashank S. Sinha et al, Changes in Primary Noncardiac Diagnoses Over Time Among Elderly Cardiac Intensive Care Unit Patients in the United States, Circulation: Cardiovascular Quality and Outcomes (2017). DOI: 10.1161/CIRCOUTCOMES.117.003616

Related Stories

Study examines palliative care in cardiac intensive care units

March 5, 2015
(HealthDay)—Increased palliative care education and training among clinicians who are involved in cardiac critical care could benefit care, according to a study published in the March 1 issue of The American Journal of ...

One in five undergoing telemetry for noncardiac indications

February 3, 2017
(HealthDay)—More than 20 percent of patients undergoing telemetry have noncardiac indications, according to a study published online Jan. 27 in the Journal of Evaluation in Clinical Practice.

Pre-surgery beta blockers, risk of death examined in noncardiac surgery

May 27, 2015
The controversial practice of administering pre-surgery beta-blockers to patients having noncardiac surgery was associated with an increased risk of death in patients with no cardiac risk factors but it was beneficial for ...

Rate of death, heart attack after noncardiac surgery decreases, although risk of stroke increases

December 28, 2016
In a study published online by JAMA Cardiology, Sripal Bangalore, M.D., M.H.A., of the New York University School of Medicine, New York, and colleagues examined national trends in perioperative cardiovascular outcomes and ...

ICU care for COPD, heart failure and heart attack may not be better

February 17, 2017
Does a stay in the intensive care unit give patients a better chance of surviving a chronic obstructive pulmonary disease (COPD) or heart failure flare-up or even a heart attack, compared with care in another type of hospital ...

Heart failure patients readmitted to the same hospital may have better outcomes

May 10, 2017
When patients with heart failure were re-hospitalized within a month, those who returned to the same hospital were discharged quicker and were more likely to survive, according to new Canadian research in the Journal of the ...

Recommended for you

Could this protein protect people against coronary artery disease?

November 17, 2017
The buildup of plaque in the heart's arteries is an unfortunate part of aging. But by studying the genetic makeup of people who maintain clear arteries into old age, researchers led by UNC's Jonathan Schisler, PhD, have identified ...

New model estimates odds of events that trigger sudden cardiac death

November 16, 2017
A new computational model of heart tissue allows researchers to estimate the probability of rare heartbeat irregularities that can cause sudden cardiac death. The model, developed by Mark Walker and colleagues from Johns ...

Popular e-cigarette liquid flavorings may change, damage heart muscle cells

November 16, 2017
Chemicals used to make some popular e-cigarette liquid flavorings—including cinnamon, clove, citrus and floral—may cause changes or damage to heart muscle cells, new research indicates.

Possible use for botulinum toxin to treat atrial fibrillation

November 16, 2017
From temporarily softening wrinkles to easing migraines, botulinum toxin has become a versatile medical remedy because of its ability to block nerve signals that can become bothersome or risky.

Proteome of the human heart mapped for the first time

November 15, 2017
A healthy heart beats about two billion times during a lifetime, thanks to the interplay of more than 10,000 proteins. Researchers from the Max Planck Institute of Biochemistry (MPIB) and the German Heart Centre at the Technical ...

First transcatheter implant for diastolic heart failure successful

November 15, 2017
Results presented today at the American Heart Association Scientific Sessions and published in Circulation show that a new device designed to treat diastolic heart failure is safe and effective. The first patient in the randomized, ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.