Full-Time Cardiac Intensive Care Unit Staffing by Heart Failure Specialists and its Association with Mortality Rates
Graphical Abstract
Visual take-home. Transition from an open cardiac intensive care unit (CICU) to a closed/heart failure (HF)-staffed CICU. An open CICU was staffed by any cardiologist who supervised a house staff team composed of interns, residents and a cardiology fellow. The patient's primary cardiologist was ultimately responsible for the treatment plan. The CICU was transitioned to a closed-unit staffed by an HF-trained cardiologist. The house staff team was unchanged, but the HF cardiologist was responsible for and managed all of the patients in the CICU. Transition to a closed/HF-specialist CICU model was associated with lower CICU mortality rates, lower adjusted CICU mortality, and lower mortality rates of patients treated with mechanical circulatory support devices.
Section snippets
Methods
This was a retrospective cohort study design that covered the period of January 1, 2012, to December 31, 2016. During this study period, 3353 patients were admitted to the CICU at Montefiore Medical Center (Bronx, NY); 382 patients were eliminated from the study because they had no history of cardiovascular disease and were admitted to the CICU as “MICU overflow.” The remaining 2971 patients representing 3348 admissions were divided into an open-unit group (1085 patients with 1185 admissions)
Results
During the study period, 2971 patients were admitted to the CICU and met study criteria (Table 1): 1085 patients had 1185 admissions during the open-unit model of management, and 1886 patients had 2163 admissions during the closed/HF specialist CICU model. Of the patients, 62% were male . Hypertension, diabetes, chronic kidney disease, atrial fibrillation, and histories of stroke were common in both groups. During hospitalization, 21% of patients required mechanical ventilation, 24% of patients
Discussion
This study compared mortality rates in an open-unit CICU model to those in a closed CICU model staffed by dedicated HF specialists. Our principal findings are the following: (1) a closed/HF specialist CICU model is associated with lower CICU mortality rates compared to an open-unit CICU model; (2) length of stay in the CICU was similar for the closed/HF specialist model; and (3) a closed/HF specialist CICU model is associated with lower CICU mortality for sicker patients (ie, those with
Conclusion
Admission to a closed-unit model CICU staffed by a HF cardiologist is associated with lower CICU mortality rates. Having a HF cardiologist staff a closed CICU model may be another appropriate strategy for caring for critically ill cardiac patients.
Disclosures
Ulrich P. Jorde is a consultant for Abbott. All other authors have no disclosures to report.
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These authors contributed equally to the study.