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CICU: It’s Not Just for Heart Attacks Anymore

By John Commins  
   August 17, 2017

With more than half of patients in the cardiac intensive care unit admitted for non-cardiac conditions, critical care cardiology specialists may require additional training or help from interventionists.

The cardiac intensive care unit is no longer reserved exclusively for patients recovering from heart attacks.

In fact, a University of Michigan study out this week has found that more than half of heart patients are admitted to the CICU for non-cardiac conditions, such as sepsis or renal failure, rather than for a heart condition.

“It’s an opportunity for providers to assess training and staffing models,” says lead author Shashank S. Sinha, MD, an advanced heart failure and cardiac transplantation fellow at U-M’s Frankel Cardiovascular Center. The study was recently published in Circulation: Cardiovascular Quality and Outcomes.

Sinha’s team examined Medicare data from 3.4 million CICU admissions between 2003 and 2013. They found that nearly 52% of admissions represented a primary non-cardiac diagnosis in 2013, up from 38% in 2003.

Rates of infectious diseases (15%) and respiratory diseases (7.6%) were the fastest-growing non-cardiac admittees. At the same time, the CICU was seeing fewer patients with a primary diagnosis of coronary artery disease, as patients are living longer with chronic heart conditions.

Overall, patients had increased rates of comorbidities including heart failure, pulmonary vascular disease, valvular heart disease and renal failure.

“In order to get admitted to a CICU, you either have a primary cardiac condition – such as a heart attack or heart failure – or you have a sick heart from a prior event and now are admitted with a primary non-cardiac condition – such as sepsis or lung or kidney failure,” Sinha said.

“We found a remarkable rise in primary non-cardiac conditions associated with a rise in secondary cardiac comorbidities,” he said. “This suggests patients with sick hearts from prior disease are now getting admitted to CICUs with conditions that anyone can get.”

Sinha said this is the first data on numbers, types and outcomes of elderly CICU patients across the nation, although others have reported similar findings at single academic centers.

“Although patients with primary non-cardiac diagnoses appear to be more complex and require more procedures, the outcomes haven’t suggested overall care is compromised in the present configuration,” he said.

Study co-author Michael Sjoding, MD, an assistant professor of internal medicine and pulmonologist at Michigan Medicine, said it’s important to understand what types of patients are being admitted to the CICU to ensure that staff are appropriately trained.

“Among the patients in the CICU, we’re seeing the same trend that we see overall in intensive care, which is sepsis and respiratory failure are becoming more common,” says Sjoding, adding that the data provides another reminder that sepsis has become such an important diagnosis, particularly for the critically ill.

In 2012, the American Heart Association published a scientific statement on the need to train cardiologists on managing these non-cardiac conditions in the CICU. In 2015, the American College of Cardiology enhanced training requirements, including requiring critical care cardiology trainees to learn ventilator management.

Sjoding said the training for the critical care cardiology workforce could be different in many ways. That could include training cardiologists to develop additional expertise in critical care or bringing in intensivists to co-manage those patients with non-cardiac conditions such as infectious diseases or respiratory failure. 

John Commins is a senior editor at HealthLeaders.

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