Epidemiology and Outcomes of Patients Readmitted to the Intensive Care Unit After Cardiac Intensive Care Unit Admission

https://doi.org/10.1016/j.amjcard.2022.01.038Get rights and content

Readmission to the intensive care unit (ICU) during the index hospitalization is associated with poor outcomes in medical or surgical ICU survivors. Little is known about critically ill patients with acute cardiovascular conditions cared for in a cardiac intensive care unit (CICU). We sought to describe the incidence, risk factors, and outcomes of all ICU readmissions in patients who survived to CICU discharge. We retrospectively reviewed Mayo Clinic patients from 2007 to 2015 who survived the index CICU admission and identified patients with a second ICU stay during their index hospitalization; these patients were categorized as ICU transfers (patients who went directly from the CICU to another ICU) or ICU readmissions (patients initially transferred from the CICU to the ward, and then back to an ICU). Among 9,434 CICU survivors (mean age 67 years), 138 patients (1.5%) had a second ICU stay during the index hospitalization: 60 ICU transfers (0.6%) and 78 ICU readmissions (0.8%). The most common indications for ICU readmission were respiratory failure and procedure/surgery. On multivariable modeling, respiratory failure, severe acute kidney injury, and Charlson Comorbidity Index at the time of discharge from the index ICU stay were associated with ICU readmission. Death during the first ICU readmission (n = 78) occurred in 7.7% of patients. In-hospital mortality was higher for patients with a second ICU stay. In conclusion, few CICU survivors have a second ICU stay during their index hospitalization; these patients are at a higher risk of in-hospital and 1-year mortality. Respiratory failure, severe acute kidney injury, and higher co-morbidity burden identify CICU survivors at elevated risk of ICU readmission.

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Methods

This study was approved by the Institutional Review Board of Mayo Clinic (IRB # 16-000722) as posing minimal risk to patients and was performed under a waiver of informed consent according to the Declaration of Helsinki. We retrospectively analyzed data from the index CICU admission of consecutive unique adult patients aged ≥18 years admitted to the CICU at Mayo Clinic Hospital St. Mary's Campus between January 1, 2007, and December 31, 2015, who survived the index CICU admission; patients who

Results

Of 10,004 unique CICU admissions, 570 (5.7%) died during the index CICU admission and were excluded (Figure 1). The remaining 9,434 CICU survivors had a mean age of 67.1 ± 15.2 years, and 3,520 (37.3%) were female. Admission diagnoses included heart failure in 45.6%, acute coronary syndrome in 43.0%, respiratory failure in 18.6%, shock in 11.1%, cardiac arrest in 9.4%, and sepsis in 5.5%. Code status was available in 6,336 (67.2%) and was full code in 88.3% of these patients on CICU admission;

Discussion

In this large single-center cohort of tertiary-care center CICU survivors, we observed a low ICU readmission rate with most readmissions for noncardiovascular causes such as respiratory failure. Patients who were readmitted to the ICU had longer hospital LOS and were at higher risk of in-hospital mortality, as expected based on their higher risk profile. The risk of ICU readmission was higher in patients with critical care admission diagnoses, and the 3 strongest risk factors for ICU

Disclosures

The authors have no conflicts of interest to declare.

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