Clinical characteristics and in-hospital outcomes of patients receiving contemporary intensive cardiac care: retrospective study from a large centre in China

Fei CHEN; Yi-Ming LI; Qi LIU; Bao-Tao HUANG; Fang-Yang HUANG; Yong PENG; Mao CHEN

doi:10.11909/j.issn.1671-5411.2021.02.005

Volume 18 Issue 2

Mar. 2021

Turn off MathJax

Article Contents

Article Navigation > Journal of Geriatric Cardiology > 2021 > 18(2): 94-103

Please cite this article as: CHEN F, LI YM, LIU Q, HUANG BT, HUANG FY, PENG Y, CHEN M. Clinical characteristics and in-hospital outcomes of patients receiving contemporary intensive cardiac care: retrospective study from a large centre in China. J Geriatr Cardiol 2021; 18(2): 94−103. DOI: 10.11909/j.issn.1671-5411.2021.02.005

Citation:

Please cite this article as: CHEN F, LI YM, LIU Q, HUANG BT, HUANG FY, PENG Y, CHEN M. Clinical characteristics and in-hospital outcomes of patients receiving contemporary intensive cardiac care: retrospective study from a large centre in China. J Geriatr Cardiol 2021; 18(2): 94−103. DOI: 10.11909/j.issn.1671-5411.2021.02.005

Citation:

PDF( 6317 KB)

Clinical characteristics and in-hospital outcomes of patients receiving contemporary intensive cardiac care: retrospective study from a large centre in China

doi: 10.11909/j.issn.1671-5411.2021.02.005

1.
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
2.
West China School of Medicine, Sichuan University, Chengdu, China

More Information

Corresponding author: hmaochen@vip.sina.com; pengyongcd@126.com
Available Online: 2021-02-28
Publish Date: 2021-03-05

Abstract

Abstract

BACKGROUND Few studies from developed countries have quantitatively characterized the clinical characteristics and outcomes of patients receiving contemporary intensive cardiac care. We sought to investigate these data in patients admitted to a Chinese intensive cardiac care unit (ICCU). METHODS We conducted a retrospective study using data from 2,337 consecutive admissions to the ICCU at a large centre in China from June 2016 to May 2017. Data were captured after systematic inspection of individual medical records regarding current demographics, primary diagnosis, comorbidities, illnesses severity, and in-hospital outcomes. RESULTS The mean age was 65.6 ± 14.2 years, and females accounted for 32.0% of patients. The Charlson Comorbidity Index and Oxford Acute Severity of Illness Score were 2.4 ± 1.8 and 22.5 ± 10.4, respectively. The top reason for admission was ST-segment elevation myocardial infarction (32.0%), and nonischaemic heart diseases accounted for 31.2% of all primary diagnoses. Noncardiovascular diseases were prevalent in the ICCU population, including chronic illnesses and acute noncardiovascular critical illnesses (ANCIs); in particular, 21.7% of patients were marked by acute respiratory failure (14.6%), acute kidney injury (13.7%), sepsis (4.2%), or gastrointestinal bleeding (3.3%). The median length of stay in the ICCU and hospital were 1.1 days [interquartile range (IQR): 0.8–2.6 days] and 6.3 days (IQR: 3.8−10.9 days), respectively. The overall incidence of in-hospital death or discharge against medical advice under extremely critical conditions was 7.6% (n = 177). Multivariate logistic regression analysis showed that the complexity of chronic illnesses and incident ANCIs were strong independent determinants for in-hospital outcomes. CONCLUSIONS Remarkable patient diversity and breadth of critical illnesses were observed in a Chinese ICCU population. Particularly, noncardiovascular diseases were prevalent and associated with adverse outcomes. Reformation of organization and staffing practices may be considered to adapt to the changed landscape.

FullText(HTML)

References(29)

References

[1]	Julian DG. Treatment of cardiac arrest in acute myocardial ischemia and infarction. Lancet 1961; 278: 840−844. doi: 10.1016/S0140-6736(61)90738-3
[2]	Brown KW, Macmillan RL, Forbath N, et al. Coronary unit: an intensive-care centre for acute myocardial infarction. Lancet 1963; 282: 349−352. doi: 10.1016/S0140-6736(63)93011-3
[3]	Day HW. An intensive coronary care area. Dis Chest 1963; 44: 423−426. doi: 10.1378/chest.44.4.423
[4]	Killip T 3rd, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 1967; 20: 457−464. doi: 10.1016/0002-9149(67)90023-9
[5]	Katz JN, Turer AT, Becker RC. Cardiology and the critical care crisis: a perspective. J Am Coll Cardiol 2007; 49: 1279−1282. doi: 10.1016/j.jacc.2006.11.036
[6]	Katz JN, Shah BR, Volz EM, et al. Evolution of the coronary care unit: clinical characteristics and temporal trends in healthcare delivery and outcomes. Crit Care Med 2010; 38: 375−381. doi: 10.1097/CCM.0b013e3181cb0a63
[7]	Na SJ, Chung CR, Jeon K, et al. Association between presence of a cardiac intensivist and mortality in an adult cardiac care unit. J Am Coll Cardiol 2016; 68: 2637−2648. doi: 10.1016/j.jacc.2016.09.947
[8]	Holland EM, Moss TJ. Acute noncardiovascular illness in the cardiac intensive care unit. J Am Coll Cardiol 2017; 69: 1999−2007. doi: 10.1016/j.jacc.2017.02.033
[9]	Sinha SS, Sjoding MW, Sukul D, et al. Changes in primary noncardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States. Circ Cardiovasc Qual Outcomes 2017; 10: e003616. doi: 10.1161/CIRCOUTCOMES.117.003616
[10]	van Diepen S, Fordyce CB, Wegermann ZK, et al. Organizational structure, staffing, resources, and educational initiatives in cardiac intensive care units in the United States. An American Heart Association Acute Cardiac Care Committee and American College of Cardiology Critical Care Cardiology Working Group Cross-Sectional Survey. Circ Cardiovasc Qual Outcomes 2017; 10: e003864. doi: 10.1161/CIRCOUTCOMES.117.003864
[11]	Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373−383. doi: 10.1016/0021-9681(87)90171-8
[12]	Johnson AE, Kramer AA, Clifford GD. A new severity of illness scale using a subset of Acute Physiology And Chronic Health Evaluation data elements shows comparable predictive accuracy. Crit Care Med 2013; 41: 1711−1718. doi: 10.1097/CCM.0b013e31828a24fe
[13]	Walker DM, West NE, Ray SG. From coronary care unit to acute cardiac care unit: the evolving role of specialist cardiac care. Heart 2012; 98: 350−352. doi: 10.1136/heartjnl-2011-301459
[14]	Roubille F, Mercier G, Delmas C, et al. Description of acute cardiac care in 2014: a French nation-wide database on 277, 845 admissions in 270 ICCUs. Int J Cardiol 2017; 240: 433−437. doi: 10.1016/j.ijcard.2017.04.002
[15]	Fanari Z, Barekatain A, Kerzner R, et al. Impact of a multidisciplinary team approach including an intensivist on the outcomes of critically ill patients in the cardiac care unit. Mayo Clin Proc 2016; 91: 1727−1734. doi: 10.1016/j.mayocp.2016.08.004
[16]	Liu J, Zhao D, Liu J, et al. [Changes in the diagnosis and treatment of hospitalized patients with acute coronary syndrome from 2006 to 2012 in China]. Zhonghua Xin Xue Guan Bing Za Zhi 2014; 42: 957−962. [In Chinese]. doi: 10.3760/cma.j.issn.0253–3758.2014.11.016
[17]	Ratcliffe JA, Wilson E, Islam S, et al. Mortality in the coronary care unit. Coron Artery Dis 2014; 25: 60−65. doi: 10.1097/MCA.0000000000000043
[18]	Jentzer JC, Bennett C, Wiley BM, et al. Predictive value of the sequential organ failure assessment score for mortality in a contemporary cardiac intensive care unit population. J Am Heart Assoc 2018; 7: e008169. doi: 10.1161/JAHA.117.008169
[19]	Katz JN, Minder M, Olenchock B, et al. The genesis, maturation, and future of critical care cardiology. J Am Coll Cardiol 2016; 68: 67−79. doi: 10.1016/j.jacc.2016.04.036
[20]	Hasin Y, Danchin N, Filippatos GS, et al. Recommendations for the structure, organization, and operation of intensive cardiac care units. Eur Heart J 2005; 26: 1676−1682. doi: 10.1093/eurheartj/ehi202
[21]	Tarnow-Mordi WO, Hau C, Warden A, et al. Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit. Lancet 2000; 356: 185−189. doi: 10.1016/S0140-6736(00)02478-8
[22]	Neuraz A, Guérin C, Payet C, et al. Patient mortality is associated with staff resources and workload in the ICU: a multicenter observational study. Crit Care Med 2015; 43: 1587−1594. doi: 10.1097/CCM.0000000000001015
[23]	Katz JN, Lishmanov A, van Diepen S, et al. Length of stay, mortality, cost, and perceptions of care associated with transition from an open to closed staffing model in the cardiac intensive care unit. Crit Pathw Cardiol 2017; 16: 62−70. doi: 10.1097/HPC.0000000000000104
[24]	Dudzinski DM, Januzzi JL Jr. The evolving medical complexity of the modern cardiac intensive care unit. J Am Coll Cardiol 2017; 69: 2008−2010. doi: 10.1016/j.jacc.2017.01.061
[25]	Rimes-Stigare C, Frumento P, Bottai M, et al. Long-term mortality and risk factors for development of end-stage renal disease in critically ill patients with and without chronic kidney disease. Crit Care 2015; 19: 383. doi: 10.1186/s13054-015-1101-8
[26]	Morrow DA, Fang JC, Fintel DJ, et al. Evolution of critical care cardiology: transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: a scientific statement from the American Heart Association. Circulation 2012; 126: 1408−1428. doi: 10.1161/CIR.0b013e31826890b0
[27]	SepNet Critical Care Trials Group. Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study. Intensive Care Med 2016; 42: 1980−1989. doi: 10.1007/s00134-016-4504-3
[28]	Shankar-Hari M, Deutschman CS, Singer M. Do we need a new definition of sepsis? Intensive Care Med 2015; 41: 909−911. doi: 10.1007/s00134-015-3680-x
[29]	Simpson SQ. New sepsis criteria: a change we should not make. Chest 2016; 149: 1117−1118. doi: 10.1016/j.chest.2016.02.653