Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, USA.
Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Eur Heart J Acute Cardiovasc Care. 2019 Dec;8(8):755-761. doi: 10.1177/2048872618789053. Epub 2018 Jul 23.
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.
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 (=2193) admitted from 1 January 2015 to 31 December 2017 were included at the time of admission to the CICU.
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%.
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.
心脏重症监护病房（CICU）护理模式的不断变化促使人们努力重新设计高级 CICU 的结构和组织。很少有研究定量描述当代 CICU 的当前人口统计学、诊断和结局。
我们评估了在美国马萨诸塞州波士顿市布莱根妇女医院的美国心脏协会 1 级（高级）CICU 中创建的前瞻性观察数据库中的患者。所有连续患者（=2193 例）于 2015 年 1 月 1 日至 2017 年 12 月 31 日期间入住 CICU 时纳入研究。
中位年龄为 65 岁（43%>70 岁），44%的患者为女性。常见非心血管合并症，包括慢性肾脏病（27%）、肺部疾病（22%）和活动性癌症（13%）。只有 7%的 CICU 入院是急性冠状动脉综合征的主要原因，这是第七种最常见的单一诊断。入住 CICU 的主要原因是休克/低血压（26%）、心搏骤停（11%）或无停搏的原发性心律失常（9%）。呼吸衰竭是 CICU 分诊的主要或主要次要原因之一，占 17%。院内死亡率为 17.6%。
在一家三级、学术性、高级 CICU，患者年龄较大，伴有多种非心血管合并症。护理重点已从急性冠状动脉综合征转移到主要的休克和心搏骤停以及非缺血性疾病，这些疾病的死亡率较高。这些数据可能有助于指导心脏重症监护的重新设计。
