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Fewer primary cardiac diagnoses seen in cardiac ICU
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The rate of hospitalizations in the cardiac ICU for primary cardiac diagnoses has decreased from 2003 to 2013 as the number of hospitalizations for primary noncardiac diagnoses increased, according to a study published in Circulation: Cardiovascular Quality and Outcomes.
“We found a remarkable rise in primary noncardiac conditions associated with a rise in secondary cardiac comorbidities,” Shashank S. Sinha, MD, MSc, an advanced heart failure and cardiac transplantation fellow at the Frankel Cardiovascular Center at the University of Michigan in Ann Arbor, said in a press release. “This suggests patients with sick hearts from prior disease are now getting administered to [cardiac] ICUs with conditions anyone can get.”
Researchers reviewed data from 3.4 million patients who are Medicare beneficiaries aged at least 65 years and had a cardiac ICU stay during their hospitalization between 2003 and 2013. Patients were categorized by principal diagnosis at discharge: primary noncardiac diagnoses and primary cardiac diagnoses. Procedures, in-hospital outcomes and demographics were also analyzed.
Primary noncardiac diagnoses increased from 38% in 2003 to 51.7% in 2013 (P < .001), with substantial increases in infectious diseases (7.8% to 15.1%; P < .001) and noninfectious respiratory diseases (6% to 7.6%; P < .001).
Primary CAD diagnoses declined from 32.3% to 19% (P for trend < .001), which led to a decline in primary cardiac diagnoses.
The rate of patients with CV comorbidities increased, specifically pulmonary vascular disease by 5.9-fold (1.2% to 7.1%), congestive HF by 2.6-fold (13.9% to 34.4%) and valvular heart disease by twofold (5% to 9.8%; P for all < .001). Renal failure also increased from 7.1% to 19.6% (P < .001).
Patients with primary noncardiac diagnoses had increased rates of risk-adjusted in-hospital mortality and noncardiac procedures (P for all < .001). In addition, risk-adjusted in-hospital mortality declined in all groups from 9.3% in 2003 to 8.9% in 2013 (P < .001).
“Regardless of the drivers of these changes, the significant evolution in the case mix of the [cardiac] ICU may have important ramifications for training and staffing models in cardiology, especially given in the complexity of patients with primary noncardiac diagnoses,” Sinha and colleagues wrote. “Advanced, specialized training in critical care has not been specifically a part of most cardiologists’ training.”
“Although evidence of progress is apparent, meaningful opportunities remain that challenge us to innovate in this changing environment of critical care cardiology,” David A. Morrow, MD, MPH, director of the Levine Cardiac Intensive Care Unit at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, wrote in a related editorial. “Sinha’s study reveals that the stakes are becoming progressively higher and we need to be prepared.” – by Darlene Dobkowski
Disclosures: Sinha and Morrow report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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