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Uncertainty is a known barrier to effective communication during family meetings in the pediatric cardiac intensive care unit (CICU), however, limited data has characterized patterns of communication during these meetings, limiting our ability to make best practice recommendations to clinicians. To characterize how uncertainty is communicated by cardiac critical care teams during family meetings, to characterize family responses to uncertainty, and to explore how expressions of uncertainty impact specific responses. We conducted a retrospective study of 58 family meetings recorded in a pediatric CICU. Participants were families of patients admitted to the CICU and members of the interprofessional CICU team. We coded uncertainty statements expressed by clinicians and family responses to uncertainty statements. Codes were extracted and analyzed for thematic content. We identified three themes around which clinicians expressed uncertainty: prognosis, treatment trajectories, and discharge planning. Expressions were most frequently unburied (62.3%) and implicit (66.5%). Five themes were identified within family responses to uncertainty: Brief acknowledgment (36.7%); clarification (30.0%); summary (12.3%); child information (12.3%); and emotions, preferences, and reflections (8.6%). Brief acknowledgements often followed lengthy, complex medical information provided by clinicians. Families often responded to implicitly communicated uncertainty by summarizing, clarifying, and providing additional details about their experiences, observations, and preferences. Our results encourage clinicians to communicate uncertainty in an unburied and explicit manner, which may reduce the burden on families to engage in effective communication strategies, such as clarifying and summarizing opaquely stated information. [ABSTRACT FROM AUTHOR]

Background: The presence of dedicated intensive care unit (ICU) physicians is associated with reduced ICU mortality. However, the information available on the role of cardiac intensivists in cardiac ICUs (CICUs) is limited. Therefore, we investigated the association of cardiac intensivist–directed care with clinical outcomes in adult patients admitted to the CICU. Methods: In this retrospective study, we extracted data from the SMART-RESCUE registry, a multicenter, retrospective, and prospective registry of patients presenting with cardiogenic shock. Overall, 1,247 patients with CS were enrolled, between January 2014 and December 2018, from 12 tertiary centers in Korea. The patients were categorized into two groups based on the involvement of a cardiac intensivist in their care. The primary outcome was in-hospital mortality rate. Results: The all-cause mortality rate was 33.6%. The in-hospital mortality rate was lower (25.4%) in the cardiac intensivist group than in the non-cardiac intensivist group (40.1%). Cardiac mortality rates were 20.5% and 35.4% in the cardiac intensivist and non-cardiac intensivist groups, respectively. In patients undergoing extracorporeal membrane oxygenation, the mortality rate at centers with cardiac intensivists was 38.0%, whereas that at centers without cardiac intensivists was 62.2%. The dopamine use was lower, norepinephrine use was higher, and vasoactive-inotropic score was lower in the cardiac intensivist group than in the non-cardiac intensivist group. Conclusions: Involvement of a cardiac intensivist in CICU patient care was associated with a reduction in in-hospital mortality rate and the administration of a low dose of vasopressors and inotropes according to the cardiogenic shock guidelines. [ABSTRACT FROM AUTHOR]

The HeartMate Risk Score (HMRS), a simple clinical prediction rule based on the patients' age, albumin, creatinine, and the international normalized ratio of the prothrombin time (PT-INR), is correlated with mortality in the cohort of left ventricular assist device (LVAD) recipients. However, in an aging society, an LAVD is indicated for only a small proportion of patients with acute heart failure (AHF), and whether the HMRS has prognostic implications for unselected patients with AHF is unknown. This study aimed to assess the prognostic value of HMRS categories on admission in patients with AHF. We analyzed 339 hospitalized patients with AHF who had albumin, creatinine, and the PT-INR recorded on admission. The patients were categorized as follows: the High group (HMRS > 2.48, n = 131), Mid group (HMRS of 1.58–2.48, n = 97) group, and Low group (HMRS < 1.58, n = 111). The endpoints of this study were all-cause death and readmission for heart failure (HF). During a median follow-up of 247 days, 24 (18.3%) patients died in the High group, 7 (7.2%) died in the Mid group, and 8 (7.2%) died in the Low group. In a multivariable analysis adjusted for highly imbalanced baseline variables, a high HMRS was independently associated with survival, with a hazard ratio of 2.90 (95% confidence interval 1.42–5.96, P = 0.004). With regard to the composite endpoint of all-cause death and readmission for HF, the Mid group had a worse prognosis than the Low group, and the High group had the worst prognosis. A high HMRS on admission is associated with all-cause mortality and readmission for HF, and a mid-HMRS is associated with readmission for HF after AHF hospitalization. The HMRS may be a valid clinical tool to stratify the risk of adverse outcomes after hospitalization in unselected patients with AHF. [ABSTRACT FROM AUTHOR]

Aims: Hospitalized patients with heart failure (HF) are a heterogeneous population, with multiple phenotypes proposed. Prior studies have not examined the biological phenotypes of critically ill patients with HF admitted to the contemporary cardiac intensive care unit (CICU). We aimed to leverage unsupervised machine learning to identify previously unknown HF phenotypes in a large and diverse cohort of patients with HF admitted to the CICU. Methods: We screened 6008 Mayo Clinic CICU patients with an admission diagnosis of HF from 2007 to 2018 and included those without missing values for common laboratory tests. Consensus k‐means clustering was performed based on 10 common admission laboratory values (potassium, chloride, anion gap, blood urea nitrogen, haemoglobin, red blood cell distribution width, mean corpuscular volume, platelet count, white blood cell count and neutrophil‐to‐lymphocyte ratio). In‐hospital mortality was evaluated using logistic regression, and 1 year mortality was evaluated using Cox proportional hazard models after multivariable adjustment. Results: Among 4877 CICU patients with HF who had complete admission laboratory data (mean age 69.4 years, 38.4% females), we identified five clusters with divergent demographics, comorbidities, laboratory values, admission diagnoses and use of critical care therapies. We labelled these clusters based on the characteristic laboratory profile of each group: uncomplicated (25.7%), iron‐deficient (14.5%), cardiorenal (18.4%), inflamed (22.3%) and hypoperfused (19.2%). In‐hospital mortality occurred in 10.7% and differed between the phenotypes: uncomplicated, 2.7% (reference); iron‐deficient, 8.1% [adjusted odds ratio (OR) 2.18 (1.38–3.48), P < 0.001]; cardiorenal, 10.3% [adjusted OR 2.11 (1.37–3.32), P < 0.001]; inflamed, 12.5% [adjusted OR 1.79 (1.18–2.76), P = 0.007]; and hypoperfused, 21.9% [adjusted OR 4.32 (2.89–6.62), P < 0.001]. These differences in mortality between phenotypes were consistent when patients were stratified based on demographics, aetiology, admission diagnoses, mortality risk scores, shock severity and systolic function. One‐year mortality occurred in 31.5% and differed between the phenotypes: uncomplicated, 11.9% (reference); inflamed, 26.8% [adjusted hazard ratio (HR) 1.56 (1.27–1.92), P < 0.001]; iron‐deficient, 33.8% [adjusted HR 2.47 (2.00–3.04), P < 0.001]; cardiorenal, 41.2% [adjusted HR 2.41 (1.97–2.95), P < 0.001]; and hypoperfused, 52.3% [adjusted HR 3.43 (2.82–4.18), P < 0.001]. Similar findings were observed for post‐discharge 1 year mortality. Conclusions: Unsupervised machine learning clustering can identify multiple distinct clinical HF phenotypes within the CICU population that display differing mortality profiles both in‐hospital and at 1 year. Mortality was lowest for the uncomplicated HF phenotype and highest for the hypoperfused phenotype. The inflamed phenotype had comparatively higher in‐hospital mortality yet lower post‐discharge mortality, suggesting divergent short‐term and long‐term prognosis. [ABSTRACT FROM AUTHOR]

This consensus statement emerges from collaborative efforts among leading figures in critical care cardiology throughout the United States, who met to share their collective expertise on issues faced by those active in or pursuing contemporary critical care cardiology education. The panel applied fundamentals of adult education and curriculum design, reviewed requisite training necessary to provide high-quality care to critically ill patients with cardiac pathology, and devoted attention to a purposeful approach emphasizing diversity, equity, and inclusion in developing this nascent field. The resulting paper offers a comprehensive guide for current trainees, with insights about the present landscape of critical care cardiology while highlighting issues that need to be addressed for continued advancement. By delineating future directions with careful consideration and intentionality, this Expert Panel aims to facilitate the continued growth and maturation of critical care cardiology education and practice. • CCC is a burgeoning specialty that requires advanced training. • Critical care training for a critical care cardiologist should be no fewer than 12 months. • Standardization of training goals and competencies are next steps for developing the CCC field. [ABSTRACT FROM AUTHOR]

The editorial in Circulation discusses the significant mortality rate associated with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) despite medical advancements. The focus of care for cardiogenic shock has expanded to include noncardiac organ involvement, such as acute kidney injury (AKI), which is associated with higher mortality rates. The study highlights the use of a micro-axial flow pump in patients with AMI-CS and its impact on AKI, emphasizing the need for further research to improve outcomes for critically ill patients. [Extracted from the article]

Background/Objectives: Patient care in Cardiac Intensive Care Units (CICU) has evolved but data on patient characteristics and outcomes are sparse. This retrospective observational study aimed to define clinical characteristics and risk factors of CICU patients, their in-hospital and 30-day mortality, and compare it with established risk scores. Methods: Consecutive patients (n = 294, mean age 70 years, 74% males) hospitalized within 15 months were studied; APACHE II, EHMRG, GWTG-HF, and GRACE II were calculated on admission. Results: Most patients were admitted for ACS (48.3%) and acute decompensated heart failure (ADHF) (31.3%). Median duration of hospitalization was 2 days (IQR = 1, 4). In-hospital infection occurred in 20%, 18% needed mechanical ventilation, 10% renal replacement therapy and 4% percutaneous ventricular assist devices (33%, 29%, 20% and 4%, respectively, for ADHF). In-hospital and 30-day mortality was 18% and 11% for all patients (29% and 23%, respectively, for ADHF). Established scores (especially APACHE II) had a good diagnostic accuracy (area under the curve-AUC). In univariate and multivariate analyses in-hospital intubation and infection, history of coronary artery disease, hypotension, uremia and hypoxemia on admission were the most important risk factors. Based on these, a proposed new score showed a diagnostic accuracy of 0.954 (AUC) for in-hospital mortality, outperforming previous scores. Conclusions: Patients are admitted mainly with ACS or ADHF, the latter with worse prognosis. Several patients need advanced support; intubation and infections adversely affect prognosis. Established scores predict mortality satisfactorily, but larger studies are needed to develop CICU-directed scores to identify risk factors, improve prediction, guide treatment and staff training. [ABSTRACT FROM AUTHOR]

Background and Aims: Acute kidney injury (AKI) is a common complication in pediatric cardiac intensive care unit (CICU). This study aims to identify the prevalence, risk factors, and outcomes of AKI in pediatrics admitted to a CICU unit of a tertiary hospital. Methods: We retrospectively gathered the data of 253 randomly selected patients admitted to the CICU unit from March 2018 to March 2022. Data were collected from EHRs. We used the Kidney Disease Improving Global Outcomes (KDIGO) criteria for identifying AKI in patients. Results: Overall, AKI prevalence was 22.9% in our population. In the multivariable analysis, vancomycin intake (odds ratio [OR]: 2.109, 95% confidence interval [CI]: 1.15–3.84), angiography (OR: 4.38, 95% CI: 1.28–14.93), and mechanical ventilation (OR: 2.08, 95% CI: 1.02–4.23) were independent risk factors of AKI development and patients with AKI had a higher in‐hospital mortality rate (OR: 5.81, 95% CI: 2.55–13.19), higher need for cardiopulmonary resuscitation (OR: 3.08, 95% CI: 1.17–8.09), and longer ICU length of stay (OR: 6.49, 95% CI: 3.31–9.67). Furthermore, furosemide administration was associated with lower risk of developing AKI (OR: 0.52, 95% CI: 0.27–0.97). Conclusion: AKI is common and is associated with worse outcomes in patients with congenital heart disease. Our results emphasize the importance of early identification and monitoring of AKI in the pediatric CICU setting. [ABSTRACT FROM AUTHOR]

Over the last several decades, the cardiac intensive care unit (CICU) has seen a substantial evolution in the patient population, comorbidities, and diagnoses. However, the generation of high-quality evidence to manage these complex and critically ill patients has been slow. Given the scarcity of clinical trials focused on critical care cardiology (CCC), CICU clinicians are often left to extrapolate from studies that either exclude or poorly represent the patient population admitted to CICUs. The lack of high-quality evidence and limited guidance from society guidelines has led to significant variation in practice patterns for many of the most common CICU diagnoses. Several barriers, both common to critical care research and unique to CCC, have impeded progress. In this multinational perspective, we describe key areas of priority for CCC research, current challenges for investigation in the CICU, and essential elements of a path forward for the field. [Display omitted] • Evidence generation in the modern CICU has not matched the evolution of the patient population. • Beyond difficulties of studying critically ill patients, there are unique barriers to research in CCC. • Overcoming these barriers will require novel research designs and collaboration among multiple stakeholders. [ABSTRACT FROM AUTHOR]

This literature review study aimed to develop a set of key evidence-based design considerations for a prototype (3-Dimensional) cardiac intensive care unit (CICU) that promotes patient health and safety as well as staff work efficiency. To provide convergent evidence about the association between cardiac intensive care and the physical environment, searches were conducted in the PubMed, Google Scholar, and other databases as well as in certain specialized journals. The inclusion criteria included qualitative, quantitative, mixed-methods studies, or systematic reviews; written in English; and related to the built environmental design of cardiac intensive care. The contents of the selected articles were first extracted and then analyzed and synthesized. The results of this review demonstrated that the CICU physical design had a strong influence on patient health and safety. A total of more than forty CICU design recommendations were identified. In practice, all environmental and nonenvironmental factors should be holistically considered in the design decision-making process. The next step is the development and testing of prototypes that incorporate relevant design strategies before wide application. This literature review disclosed the key design strategies that enhance the physical design of CICUs. Further research is needed to evaluate the prototype and to investigate the future needs and issues in designing CICUs. [ABSTRACT FROM AUTHOR]

Background: Cardiogenic shock (CS) is a common cause of morbidity and mortality in cardiac intensive care units (CICUs), even in the contemporary era. Main text: Although mechanical circulatory supports have recently become widely available and used in transforming the management of CS, their routine use to improve outcomes has not been established. Transportation to a high-volume center, early reperfusion, tailored mechanical circulatory supports, regionalized systems of care with multidisciplinary CS teams, a dedicated CICU, and a systemic approach, including preventing noncardiogenic complications, are the key components of CS treatment strategies. Conclusions: This narrative review aimed to discuss the challenges of preventing patients from developing CS-related complications and provide a comprehensive practical approach for its management. [ABSTRACT FROM AUTHOR]

Aims: The profiles of patients at cardiac intensive care units (CICU) have evolved towards a patient population with an increasing number of co‐morbid medical conditions and acute heart failure (HF). The current study was designed to illustrate the burden of HF patients admitted to CICU, and evaluate patient characteristics, in‐hospital course and outcomes of CICU patients with HF compared with patients with acute coronary syndrome (ACS). Methods and results: A prospective study including all consecutive patients admitted to the CICU at a tertiary medical centre between 2014 and 2020. The main outcome was a direct comparison between HF and ACS patients in processes of care, resource use, and outcomes during CICU hospitalization. A secondary analysis compared ischaemic versus non‐ischaemic HF aetiology. Adjusted analysis evaluated parameters associated with prolonged hospitalization. The cohort included 7674 patients with a total annual CICU admissions of 1028–1145 patients. HF diagnosis patients represented 13–18% of the annual CICU admissions and were significantly older with higher incidence of multiple co‐morbidities compared with patients with ACS. HF patients also required more intensive therapies and demonstrated higher incidence of acute complications as compared with ACS patients. Length of stay at the CICU was significantly longer among HF patients compared with patients with ACS (either STEMI or NSTEMI) (6.2 ± 4.3 vs. 4.1 ± 2.5 vs. 3.5 ± 2.1, respectively, P < 0.001). HF patients represented a disproportionately higher amount of total CICU patient days during the study period, as the total length of hospitalization of HF patients was 44–56% out of the total cumulative days in CICU of patients with ACS every year. In hospital mortality rates were also significantly higher among patients with HF compared with STEMI or NSTEMI (4.2% vs. 3.1% vs. 0.7%, respectively, P < 0.001). Despite several differences in baseline characteristics between patients with ischaemic versus non‐ischaemic HF, which can be attributed mainly to disease aetiology, hospitalization length and outcomes were similar among the groups regardless of HF aetiology. In multivariable analysis for the risk of prolonged hospitalization in the CICU adjusted to potential significant co‐morbidities associated with poor outcomes, HF was found to be an independent and significant parameter associated with the risk of prolonged hospitalization with an OR of 3.5 (95% CI 2.9–4.1, P < 0.001). Conclusions: Patients with HF in CICU have higher severity of illness with a prolonged and complicated hospital course, all of which can substantially increase the burden on clinical resources. [ABSTRACT FROM AUTHOR]

The use of venoarterial (VA) extracorporeal membrane oxygenation therapy (ECMO) in patients admitted to cardiac intensive care units (CICU) has increased. Data regarding infections in this population are scarce. In this retrospective study, we analyzed the risk factors, outcome, and predictors of in-hospital mortality due to nosocomial infections in patients with ECMO admitted to a single coronary intensive care unit between July 2013 and March 2019 treated with VA-ECMO for >48 h. From 69 patients treated with VA-ECMO >48 h, (median age 58 years), 29 (42.0%) patients developed 34 episodes of infections with an infection rate of 0.92/1000 ECMO days. The most frequent were ventilator-associated pneumonia (57.6%), tracheobronchitis (9.1%), bloodstream infections (9.1%), skin and soft tissue infections (9.1%), and cytomegalovirus reactivation (9.1%). In-hospital mortality was 47.8%, but no association with nosocomial infections was found (p = 0.75). The number of days on ECMO (OR 1.14, 95% CI 1.01–1.30, p = 0.029) and noninfectious complications were higher in the infected patients (OR: 3.8 95% CI = 1.05–14.1). A higher baseline creatinine value (OR: 8.2 95% CI = 1.12–60.2) and higher blood lactate level at 4 h after ECMO initiation (OR: 2.0 95% CI = 1.23–3.29) were significant and independent risk factors for mortality. Conclusions: Nosocomial infections in medical patients treated with VA-ECMO are very frequent, mostly Gram-negative respiratory infections. Preventive measures could play an important role for these patients. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal membrane oxygenation (ECMO) use in the United States occurs often in cardiothoracic ICUs (CTICU). It is unknown how it varies across ICU types. Methods: We identified 10 893 ECMO runs from the Extracorporeal Life Support Organization (ELSO) Registry across 2018 and 2019. Primary outcome was ECMO case volume by ICU type (CTICU vs. non‐CTICU). Adjusting for pre‐ECMO characteristics and case mix, secondary outcomes were on‐ECMO physiologic variables by ICU location stratified by support type. Results: CTICU ECMO occurred in 65.1% and 55.1% (2018 and 2019) of total runs. A minority of total runs related to cardiac surgery procedures (CTICU: 21.7% [2018], 18% [2019]; non‐CTICU: 11.2% [2018], 13% [2019]). After multivariate adjustment, non‐CTICU ECMO for cardiac support associated with lower 4‐ and 24‐h circuit flow (3.9 liters per minute [LPM] vs. 4.1 LPM, p < 0.0001; 4.1 LPM vs. 4.3 LPM, p < 0.0001); for respiratory support, lower on‐ECMO mean fraction of inspired oxygen ([FiO2], 67% vs. 69%, p = 0.02) and lower respiratory rate (14 vs. 15, p < 0.0001); and, for extracorporeal cardiopulmonary resuscitation (ECPR), lower ECMO flow rates at 24 h (3.5 LPM vs. 3.7 LPM, p = 0.01). Conclusions: ECMO mostly remains in CTICUs though a minority is associated with cardiac surgery. Statistically significant but clinically minor differences in on‐ECMO metrics were observed across ICU types. [ABSTRACT FROM AUTHOR]

Driven by evolving patient demographics and disease burdens over the past several decades, the demands placed on the cardiac intensive care unit have steadily increased. Originally born out of the need for post-infarction arrhythmia monitoring, the modern cardiac intensive care space is now encountering progressively more complex patients with multisystem organ failure and, increasingly, complex mechanical circulatory support. This complexity has fueled a demand for specifically trained cardiac intensivists, and many different training pathways have emerged nationwide. In this article, we provide an overview of the evolution, landscape, training, and future of the subspecialty of cardiac critical care. [ABSTRACT FROM AUTHOR]

The myocardial contraction fraction (MCF) is proposed as an improved measure of left ventricular (LV) systolic function that overcomes important limitations of the left ventricular ejection fraction (LVEF). We sought to determine whether a low MCF was associated with higher mortality in cardiac intensive care unit (CICU) patients. We retrospectively analyzed unique Mayo Clinic CICU patients from 2007 to 2018 with MCF calculated as the ratio of the stroke volume to the left ventricular myocardial volume from a transthoracic echocardiogram within 1 day of CICU admission. Multivariable logistic regression analyzed the association between MCF and hospital mortality, after adjustment for LVEF and clinical variables. We included 4794 patients with a mean age of 68.0 ± 14.8 years (37.1% females). The mean MCF was 0.41 ± 0.16, and was lower in the 6.6% of patients who died in the hospital (0.32 ± 0.14 versus 0.42 ± 0.16, p < 0.001). On multivariable analysis, higher MCF remained associated with lower hospital mortality (adjusted OR 0.78 per 0.1 higher, 95% CI 0.69–0.89, p < 0.001), whereas LVEF was not significantly associated with hospital mortality (unadjusted OR 0.91 per 10% higher, OR 95% CI 0.82–1.02, p = 0.09). Patients with MCF <0.2 had the highest in-hospital mortality, and those with MCF ≥0.5 had the lowest in-hospital mortality, irrespective of admission diagnosis or LVEF. MCF demonstrated a strong, inverse relationship with hospital mortality in CICU patients, even after adjusting for LVEF and clinical variables. MCF can be used to identify prognostically-relevant myocardial dysfunction at the bedside, even among patients with preserved LVEF. • Myocardial contraction fraction (MCF) was measurable at bedside by echocardiography. • A lower MCF was associated with higher hospital mortality across admission diagnoses. • On multivariable analysis, MCF was associated with hospital mortality (adjusted OR 0.8 per 0.1 higher MCF). • MCF was a better predictor of mortality than left ventricular ejection fraction. [ABSTRACT FROM AUTHOR]

Purpose: To study the effect of hypoalbuminemia on short- and long-term mortality in Cardiac Intensive Care Unit (CICU) patients. Methods: We reviewed 12,418 unique CICU patients from 2007 to 2018. Hypoalbuminemia was defined as an admission albumin level <3.5 g/dL. Predictors of hospital mortality were identified using multivariable logistic regression. Results: We included 2,680 patients (22%) with a measured admission albumin level. The median age was 68 (39% females). Admission diagnoses included acute coronary syndrome, heart failure, cardiac arrest, and cardiogenic shock. The median albumin level was 3.4 g/dL and 55% of patients had hypoalbuminemia. Hospital mortality occurred in 16%, and patients with hypoalbuminemia had higher hospital mortality (21% vs. 9%, adjusted OR 2.64, 95% CI 2.09-3.34, p < 0.001). Albumin level was inversely associated with hospital mortality (adjusted OR 0.60 per 1 g/dL higher albumin level, 95% CI 0.47-0.75, p <0.001), with a stepwise increase in the hospital mortality at lower albumin levels. Post-discharge mortality was higher in hospital survivors with hypoalbuminemia, and increased as a function of lower albumin levels. Conclusion: Hypoalbuminemia is common in CICU patients and associated with higher short- and long-term mortality. Progressively lower serum albumin was incrementally associated with higher hospital and post-discharge mortality. [ABSTRACT FROM AUTHOR]

Introduction: Thrombocytopenia (TCP) is a common finding in patients receiving continuous renal replacement therapy (CRRT). Objective: The purpose of this study was to assess the nature of TCP in patients receiving CRRT. Methods: This is a single-center case-control observational study of 795 patients involving over 166,950 h of delivered CRRT at Johns Hopkins Hospital. Concurrent TCP in patients receiving CRRT was defined as a decrease in platelet count of ≥50% any time within 72 h of initiation of CRRT with strict exclusion criteria. Results: There was a higher incidence of TCP in the cardiac intensive care unit (CICU) (22.5%) compared to medical ICU (MICU) (13.1%). Using logistic regression, the odds of developing concurrent TCP in patients receiving CRRT was 2.46 (95% CI 1.32–3.57, p < 0.05) times higher in the CICU compared with the MICU. There was no difference in the incidence of severe or profound TCP or timing of acute TCP between the CICU and MICU. Conclusion: Safe delivery of dialysis care in the ICU is paramount and creating awareness of potential risks such as concurrent TCP in patients receiving CRRT should be part of this care. [ABSTRACT FROM AUTHOR]

Background: The neutrophil percentage-to-albumin ratio (NPAR) is a systemic inflammation-based predictor associated with many diseases' outcomes. Nevertheless, there are few studies on the relationship between NPAR and inflammatory markers, and more importantly, the prognostic value of NPAR in critically ill patients with cardiovascular disease (CVD) remains unknown. Methods: The data of this retrospective cohort study were from the Medical Information Mart data for Intensive Care III database (MIMIC-III) and the Second Affiliated Hospital of Wenzhou Medical University. Linear regression, logistic regression model, and Cox regression model were used to assess the associations between NPAR levels and length of stay, renal replacement therapy (RRT) use, and 30-day, 90-day and one-year mortality, respectively. The Pearson correlation coefficient was used to present the correlation between NPAR and C-reactive protein (CRP). Results: Our study included 1599 patients in MIMIC-III and 143 patients in the Second Affiliated Hospital of Wenzhou Medical University. The elevated NPAR was independently associated with increased 30-day, 90-day, and one-year all-cause mortality (adjusted HR, 95% CI:1.51 (1.02– 2.24); 1.61 (1.14– 2.28); 1.53 (1.15– 2.03); P trend = 0.0297; 0.0053; 0.0023; respectively), and it was also associated with increase the length of stay in hospital and ICU (β, 95% CI: 2.76 (1.26– 4.27); 1.54 (0.62– 2.47), respectively, both P trend < 0.001). We found that patients with higher NPAR were more likely to receive RRT (OR, 95% CI: 2.50 (1.28– 4.89), P trend =0.0023). Moreover, we confirmed that NPAR was statistically positively correlated with CRP (correlation coefficient r = 0.406, P < 0.0001). Conclusion: Elevated NPAR on admission was independently associated with increased all-cause mortality and length of stay among CICU patients. The results showed that CICU patients with higher NPAR were more likely to receive RRT. Besides, we also provided the evidence that there is a positive correlation between NPAR and inflammatory indicators (ie, CRP). [ABSTRACT FROM AUTHOR]

An artificial intelligence-augmented electrocardiogram (AI-ECG) can identify left ventricular systolic dysfunction (LVSD). We examined the accuracy of AI ECG for identification of LVSD (defined as LVEF ≤40% by transthoracic echocardiogram [TTE]) in cardiac intensive care unit (CICU) patients. We included unique Mayo Clinic CICU patients admitted from 2007 to 2018 who underwent AI-ECG and TTE within 7 days, at least one of which was during hospitalization. Discrimination of the AI-ECG for LVSD was determined using receiver-operator characteristic curve (AUC) values. We included 5680 patients with a mean age of 68 ± 15 years (37% females). Acute coronary syndrome (ACS) was present in 55%. LVSD was present in 34% of patients (mean LVEF 48 ± 16%). The AI-ECG had an AUC of 0.83 (95% confidence interval 0.82–0.84) for discrimination of LVSD. Using the optimal cut-off, the AI-ECG had 73%, specificity 78%, negative predictive value 85% and overall accuracy 76% for LVSD. AUC values were higher for patients aged <70 years (0.85 versus 0.80), males (0.84 versus 0.79), patients without ACS (0.86 versus 0.80), and patients who did not undergo revascularization (0.84 versus 0.80). The AI-ECG algorithm had very good discrimination for LVSD in this critically-ill CICU cohort with a high prevalence of LVSD. Performance was better in younger male patients and those without ACS, highlighting those CICU patients in whom screening for LVSD using AI ECG may be more effective. The AI-ECG might potentially be useful for identification of LVSD in resource-limited settings when TTE is unavailable. • Artificial intelligence (AI) can identify left ventricular systolic dysfunction (LVSD) on the ECG. • AI ECG had good discrimination for LVSD in 5680 unique cardiac intensive care unit (CICU) patients. • AI ECG performed better for CICU patients without acute coronary syndrome, especially males <70 years old. [ABSTRACT FROM AUTHOR]

Aims: Age is an important risk factor for mortality among patients with cardiogenic shock and heart failure (HF). We sought to assess the extent to which age modified the performance of the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage for in‐hospital and 1 year mortality in cardiac intensive care unit (CICU) patients with and without HF. Methods and results: We retrospectively reviewed unique admissions to the Mayo Clinic CICU during 2007–2015 and stratified patients by age and SCAI shock stage. The association between age and in‐hospital mortality was analysed using multivariable logistic regression, and 1 year mortality was analysed using Cox proportional hazards analysis, both in the entire cohort and among patients with an admission diagnosis of HF or acute coronary syndrome (ACS). The final study population included 10 004 unique patients with a mean age of 67 ± 15 years, including 46.1% with HF and 43.1% with ACS. Older patients more frequently had HF and had more extensive co‐morbidities, higher illness severity, more organ failure, and differential use of critical care therapies. The percentage of patients with SCAI shock stages A, B, C, D, and E were 46%, 30%, 16%, 7%, and 1%, respectively. Patients with HF were older, had greater severity of illness and higher SCAI shock stage, and had higher rates of death at all time points. In‐hospital mortality occurred in 908 (9%) patients, including 549 (12%) patients with HF (61% of all hospital deaths). Age was independently associated with hospital mortality (adjusted odds ratio per 10 years 1.3, 95% confidence interval 1.2–1.4, P < 0.001) and 1 year mortality (adjusted hazard ratio per 10 years 1.2, 95% confidence interval 1.2–1.3, P < 0.001) in the overall cohort. The associations of age with both hospital mortality (adjusted odds ratio 1.6 vs. 1.3 per 10 years older) and 1 year mortality (adjusted hazard ratio 1.5 vs. 1.3 per 10 years older) were higher for patients with ACS compared with patients with HF. Older age was associated with higher adjusted hospital mortality and 1 year mortality in each SCAI shock stage (all P < 0.05). Additive increases in both hospital mortality and 1 year mortality were observed with increasing age and SCAI shock stage. Conclusions: Age is an independent risk factor for mortality that modifies the relationship between the SCAI shock stage and mortality risk in CICU patients, providing robust risk stratification for in‐hospital and 1 year mortality. Although patients with HF had a higher risk of dying, age was more strongly associated with mortality among patients with ACS. [ABSTRACT FROM AUTHOR]

Dexmedetomidine induces cooperative and arousable sedation. Our aim was to analyze dexmedetomidine use in medical cardiac intensive care units (CICU). Multicenter prospective registry of patients treated with dexmedetomidine in CICU. Consecutive inclusion during a 12-month period. A total of 410 patients were included, mean age was 67.4 ± 13.9 years, and 94 (22.9%) were women. Before using dexmedetomidine, 247 patients (60.2%) had delirium, 48 developed delirium after dexmedetomidine use. In 178 (43.4%) dexmedetomidine was used during weaning from mechanical ventilation, with a reintubation rate of 10.1%, early reintubation rate (<24 h) 1.7%. Seventy-seven patients (18.8%) died during admission. Dexmedetomidine mean dose infusion was 0.51 ± 0.25 μ/kg/h, during a median of 34 h (interquartile range 12–78 h). Three hundred forty-eight patients received adjuvant sedatives (84.9%). Sixty-eight patients (16.6%) had adverse effects. The most frequent adverse effects were hypotension with systolic blood pressure <80 mmHg (44 patients - 10.7%), bradycardia <40 beats per minute (15 patients - 3.7%), and both bradycardia and hypotension (4 patients - 1.0%). Patients with adverse effects received more frequently inotropes (53 [81.6%] vs. 212 [65.4%], p = 0.02) and fewer adjuvant sedatives (49 [75.4%] vs. 282 [87.0%], p = 0.01). The independent predictors of adverse effects were inotropes use (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.30-5.74, p = 0.008) and lack of adjuvant sedatives (OR 3.03, 95% CI 1.49–6.26, p = 0.002). Dexmedetomidine safety for medical CICU patients seems to be similar to that for general intensive care unit patients. Inotropes and lack of adjuvant sedatives were associated with adverse effects. • Dexmedetomidine induces cooperative and arousable sedation, with reported benefits as sedative for surgical procedures. • Evidence about dexmedetomidine in critically ill cardiac patients is lower than in patients with other conditions. • Our data suggest that dexmedetomidine in cardiac intensive care units is as safety as in intensive care units. • Inotropes and lack of adjuvant sedatives were associated with adverse effects in patients treated with dexmedetomidine. [ABSTRACT FROM AUTHOR]

Background: Previous studies have described a circadian pattern of death from cardiovascular causes with a morning peak. Our aim is to describe the daytime oscillations in mortality in hospitalized patients with cardiovascular diseases. Methods: Our retrospective registry including all patients who died in the Cardiology Department, including the cardiac intensive care unit, Madrid, Spain. Results: From a total of 500 patients, time of death was registered in 373 (74.6%), which are the focus of our study; 354 (70.8%) died in the cardiac intensive care unit and 146 (29.2%) in the conventional ward. Mean age was 74.2 ± 13.1 years, and 239 (64.1%) were male. Cardiovascular causes were the leading cause of death (308 patients; 82.6%). Mortality followed a circadian biphasic pattern with a peak at dawn (00.00–05.59 a.m.: 104 patients [27.9%]) and in the afternoon (12.00–17.59 p.m.: 135 patients [36.2%]), irrespective of the cause of death. The peak of mortality occurred in the afternoon (12.00–17.59 p.m.) in the case of cardiovascular mortality (119 deaths [38.6%]) and in the evening (18.00–23.59 p.m.) for non-cardiovascular deaths (21 deaths [32.3%], p = 0.03). This pattern was present regardless from the place of death (conventional ward or cardiac intensive care unit) and also throughout the four seasons. Conclusions: Mortality in hospitalized patients with cardiovascular diseases follows a circadian biphasic pattern. [ABSTRACT FROM AUTHOR]

Goal: Determination of 20-year trends in demographic characteristics, frequencies of main and other diagnoses, risk factors, type and number of admissions, Cardiac Intensive Care Unit (CICU) and hospital stay, employed therapeutic agents and procedures, as well as outcomes including mortality. Patient and Methods: Data from medical records and electronic hospital information system on all patients hospitalized in CICU University Hospital Centre „Sestre milosrdnice“, Zagreb, Croatia during March 2003, March 2013 and March 2023 were investigated. Descriptive data are presented as medians and interquartile ranges or counts and frequencies. Chi-square test was used for categorical variables, Kruskal-Wallis H test for continuous variables. Two-tailed significance tests were performed, and p<0.05 was considered significant. Results: In investigated period, a total of 304 patients were hospitalized in CICU, 64.8% were male, median age was 68 years (59-78). Number of admissions (74 vs. 87 vs. 143 per month), especially from referral hospitals (1.4 vs. 28.7 vs. 34.3%, p<0.01) and patients with ST-elevation myocardial infarction (STEMI) (6.8 vs. 31.0 vs. 28.7%, p<0.01) increased over time. Use of echocardiography, mostly bedside, increased (33.9 vs. 56.5 vs. 65.7%, p<0.01), as well as utilization of percutaneous coronary intervention (PCI) (35.6 vs. 61.2 vs. 67.8%, p<0.01). The use of drugs depended on contemporary international guidelines and drug availability (eptifibatide 0.0 vs. 10.6 vs. 7.0%, p<0.05, LWMH 11.9 vs. 69.6 vs. 72.0%, p<0.01). For antibiotics (3.4 vs. 18.8 vs. 22.9%, p<0.01), an increase followed the frequency of infections. Median time CICU (59 vs. 43 vs. 22 hours, p<0.01) and in-hospital stay (10 vs. 7 vs. 3 days, p<0.01) decreased during investigated period (Figure 1 and 2), similar to mortality (9.5 vs. 5.7 vs 2.8%, p<0.01)Conclusion: The results indicate an increasing trend in the number of patients hospitalized in the CICU (especially those with STEMI) with a shortening of stay, and a decrease in mortality. The number of patients who underwent echocardiographic diagnostics and PCI, as well as those treated with antibiotics, increased. As for trends in the use of mechanical circulatory and respiratory support, and continuous renal replacement therapy, a larger number of examined patients is required to reach statistical significance.1-3. [ABSTRACT FROM AUTHOR]

A new 5-stage cardiogenic shock (CS) classification scheme was recently proposed by the Society for Cardiovascular Angiography and Intervention (SCAI) for the purpose of risk stratification. This study sought to apply the SCAI shock classification in a cardiac intensive care unit (CICU) population. The study retrospectively analyzed Mayo Clinic CICU patients admitted between 2007 and 2015. SCAI CS stages A through E were classified retrospectively using CICU admission data based on the presence of hypotension or tachycardia, hypoperfusion, deterioration, and refractory shock. Hospital mortality in each SCAI shock stage was stratified by cardiac arrest (CA). Among the 10,004 unique patients, 43.1% had acute coronary syndrome, 46.1% had heart failure, and 12.1% had CA. The proportion of patients in SCAI CS stages A through E was 46.0%, 30.0%, 15.7%, 7.3%, and 1.0% and unadjusted hospital mortality in these stages was 3.0%, 7.1%, 12.4%, 40.4%, and 67.0% (p < 0.001), respectively. After multivariable adjustment, each higher SCAI shock stage was associated with increased hospital mortality (adjusted odds ratio: 1.53 to 6.80; all p < 0.001) compared with SCAI shock stage A, as was CA (adjusted odds ratio: 3.99; 95% confidence interval: 3.27 to 4.86; p < 0.001). Results were consistent in the subset of patients with acute coronary syndrome or heart failure. When assessed at the time of CICU admission, the SCAI CS classification, including presence or absence of CA, provided robust hospital mortality risk stratification. This classification system could be implemented as a clinical and research tool to identify, communicate, and predict the risk of death in patients with, and at risk for, CS. [ABSTRACT FROM AUTHOR]

Objectives: Our goal was to determine the presentation and prognosis of influenza in an intensive cardiac care unit and to analyze the impact of an active surveillance program in the diagnosis. Methods: We performed a prospective registry during the flu season in a coronary unit. In the first phase, no systematic screening was performed. Systematic influenza A and B detection was performed in a second phase for all patients admitted. Results: From 227 patients, we identified 17 (7.5%) with influenza. Influenza patients were more likely to have a non-ischemic cause of admission (14 patients [82.4%] vs. 48 patients [40.3%], p = 0.002), fever (8 patients [47.1%] vs. 3 patients [2.6%], p < 0.001), and respiratory failure (7 patients [41.2%] vs. 8 patients [7%], p = 0.001). Influenza infection was an independent predictor of mortality (odds ratio 12.0, 95% confidence interval 1.9–13.6, p < 0.001). The incidence of influenza was 6.6% (6 patients) when no active screening was performed and 7.9% (11 patients) when systematic detection was performed (p = 0.005). The time to diagnosis was shorter in the systematic screening phase (0.92 ± 1.6 vs. 5.2 ± 3.8 days, p = 0.01). Conclusions: Influenza affects approximately 8% of patients admitted to an intensive cardiac care unit during the flu season, with a high mortality rate. An active surveillance program improves early detection. [ABSTRACT FROM AUTHOR]

Context: Interprofessional teams often develop a care plan before engaging in a family meeting in the pediatric cardiac intensive care unit (CICU)-a process that can affect the course of the family meeting and alter team dynamics but that has not been studied.Objectives: To characterize the types of interactions that interprofessional team members have in pre-family meeting huddles in the pediatric CICU by 1) evaluating the amount of time each team member speaks; 2) assessing team communication and teamwork using standardized instruments; and 3) measuring team members' perceptions of collaboration and satisfaction with decision making.Methods: We conducted a prospective observational study in a pediatric CICU. Subjects were members of the interprofessional team attending preparation meetings before care meetings with families of patients admitted to the CICU for longer than two weeks. We quantitatively coded the amount each team member spoke. We assessed team performance of communication and teamwork using the PACT-Novice tool, and we measured perception of collaboration and satisfaction with decision making using the Collaboration and Satisfaction About Care Decisions questionnaire.Results: Physicians spoke for an average of 83.9% of each meeting's duration (SD 7.5%); nonphysicians averaged 9.9% (SD 5.2%). Teamwork behaviors were present and adequately performed as judged by trained observers. Significant differences in physician and nonphysician perceptions of collaboration were found in three of 10 observed meetings.Conclusion: Interprofessional team members' interactions in team meetings provide important information about team dynamics, revealing potential opportunities for improved collaboration and communication in team meetings and subsequent family meetings. [ABSTRACT FROM AUTHOR]

This study aimed to delineate correlation between stress hyperglycemia ratio (SHR) and clinical outcomes among patients in the cardiac intensive care unit (CICU). Participants were categorized based on their SHR threshold values. Key outcomes were short-term mortality and major adverse cardiovascular events (MACEs) at 1-year follow-up. The association between SHR and outcomes was estimated using inverse probability of treatment weighting (IPTW) and Kaplan-Meier analyses. The C-statistic was used to gauge the predictive capability of SHR. The study included 1,133 patients from the Medical Information Mart for Intensive Care IV and 412 from the Second Affiliated Hospital of Wenzhou Medical University. Kaplan-Meier curves revealed that individuals with elevated SHR exhibited higher 90-day mortality and MACEs. When considering SHR levels and diabetes status simultaneously, those with increased SHR but non-diabetes had the highest 90-day mortality and MACEs. SHR was associated with short-term mortality and MACEs (HR adjusted 1.63 95%CI 1.15–2.30; HR IPTW 1.47 95%CI 1.05–2.05). Upon integrating SHR into the foundational model, the C-statistic was 0.821, outperforming other hyperglycemia metrics. SHR is a valuable indicator for predicting poor outcomes in CICU patients. Its utility spans potential risk stratification and offers insights for tailoring prognostic treatments to CICU patients. [ABSTRACT FROM AUTHOR]

Keywords: cardiac arrest; cardiac intensive care unit; epinephrine; low dose epinephrine; pediatric cardiac arrest; pediatric intensive care unit EN cardiac arrest cardiac intensive care unit epinephrine low dose epinephrine pediatric cardiac arrest pediatric intensive care unit 1093 1095 3 06/24/20 20200701 NES 200701 Cardiac arrests (CAs) occur in 2.6-6% of hospitalized children with heart disease and 4-6 times more frequently in cardiac than noncardiac PICUs ([1], [2]). The impact of the epinephrine practice change is likely significant, but it is important, in so far as this article describes, to know that to implement a policy of rapidly dosing bolus epinephrine without the other bundle components may not be as successful. Cardiac arrest, cardiac intensive care unit, epinephrine, low dose epinephrine, pediatric cardiac arrest, pediatric intensive care unit. [Extracted from the article]

Background: Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark. Methodology: A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries. The study was conducted from January to December 2016. The primary focus was to identify the reasons for reintubation within 72 h of extubation after CICU discharge and its association with outcome. Results: Out of 750 patients who shifted out from CICU following successful extubation, only 32 were readmitted and among them in 25 patients (3.33%) were reintubated and their reasons reintubation were noted. Patients underwent a coronary artery bypass grafting (CABG) with valve replacement had a higher incidence of reintubation 3/39 (7.69%) when compared with CABG 13/517 (2.51%) and 4/135 (2.96%) valve procedure alone. Single cause of endotracheal reintubation was observed in 7 patients (28%), in which 5 patients (20%) had respiratory and 2 patients had (8%) cardiac reason while 18 patients (72%) were observed with multisystem involvement, in which 7 patients (28%) had both respiratory and cardiovascular causes, and 2 (8%) had both respiratory and neurological causes. More than 70% cause of endotracheal reintubation was both respiratory and cardiovascular. The CICU stay after reintubations was 12.88 ± 16.88 days and the hospital stay prolonged to 23.84 ± 21.61 days. Conclusion: Reasons of reintubation were mainly respiratory and cardiac. The rate of reintubations is high when multisystem involvement is there. CICU, hospital stay, and mortality are increases after reintubation. [ABSTRACT FROM AUTHOR]

Background and Aim: The Cardiac Intensive Care Unit (CICU) is characterized by a high level of complexity of patient care activity, which implies particular responsibilities, skills and demands for professionals in these wards. To face these challenges, effective communication is needed within the multiprofessional medical team. Materials and Methods: We carried out a retrospective study for a period of 8 years (2015-2022), and we evaluated the number of patients cared for, the reason and type of admission, the presence of complex monitoring and life support devices, the activity score for the ICU (OMEGA-RO), and the length of stay in CICU. Results: The evolution of patients from 2015-2019 showed a constant upward trend: patients cared for - from 750 to 960; surgical patients - from 346 to 595; emergencies - from 300 to 508. Also, the number of patients with complex monitoring and assistance increased constantly, from 263 to 485. A constant increase was also observed for OMEGA-RO - from 149 to 170.2 and the average length of stay - from 2.8 to 4.5 days. The impact of the COVID-19 pandemic led to a reduction in patients' access to medical services, as evidenced by the decrease in the number of patients during 2020-2021. However, the data analyzed for 2022 prove the return to the trend of increasing the number of patients and the complexity of their care. Conclusions: The high complexity of the patient care process in CICU argues for the need to ensure an optimal level of human and material resources to facilitate the provision of safe and quality care. There is also a need for the periodic participation of the staff in training programs and continuous medical education, which ensures the maintenance and development of the specific skills of the professionals in these departments. [ABSTRACT FROM AUTHOR]

Cardiac arrest (CA) is a common reason for admission to the cardiac intensive care unit (CICU), though the relative burden of morbidity, mortality, and resource use between admissions with in-hospital (IH) and out-of-hospital (OH) CA is unknown. We compared characteristics, care patterns, and outcomes of admissions to contemporary CICUs after IHCA or OHCA. The Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs in the US and Canada. Participating centers contributed data from consecutive admissions during 2-month annual snapshots from 2017 to 2021. We analyzed characteristics and outcomes of admissions by IHCA vs OHCA. We analyzed 2,075 admissions across 29 centers (50.3% IHCA, 49.7% OHCA). Admissions with IHCA were older (median 66 vs 62 years), more commonly had coronary disease (38.3% vs 29.7%), atrial fibrillation (26.7% vs 15.6%), and heart failure (36.3% vs 22.1%), and were less commonly comatose on CICU arrival (34.2% vs 71.7%), p < 0.001 for all. IHCA admissions had lower lactate (median 4.3 vs 5.9) but greater utilization of invasive hemodynamics (34.3% vs 23.6%), mechanical circulatory support (28.4% vs 16.8%), and renal replacement therapy (15.5% vs 9.4%); p < 0.001 for all. Comatose IHCA patients underwent targeted temperature management less frequently than OHCA patients (63.3% vs 84.9%, p < 0.001). IHCA admissions had lower unadjusted CICU (30.8% vs 39.0%, p < 0.001) and in-hospital mortality (36.1% vs 44.1%, p < 0.001). Despite a greater burden of comorbidities, CICU admissions after IHCA have lower lactate, greater invasive therapy utilization, and lower crude mortality than admissions after OHCA. [ABSTRACT FROM AUTHOR]

The presence of left ventricular systolic dysfunction (LVSD) alters clinical management and prognosis in most acute and chronic cardiovascular conditions. While transthoracic echocardiography (TTE) remains the most common diagnostic tool to screen for LVSD, it is operator-dependent, time-consuming, effort-intensive, and relatively expensive. Recent work has demonstrated the ability of an artificial intelligence-augment ECG (AI-ECG) model to accurately predict LVSD in critical intensive care unit (CICU) patients. We demonstrate that the AI-ECG algorithm can maintain its performance in these patients with and without AF despite their clinical differences. An AI-ECG algorithm can serve as a non-invasive, inexpensive, and rapid screening tool for early detection of LVSD in resource-limited settings, and potentially expedite clinical decision making and guideline-directed therapies in the acute care setting. • An AI-ECG algorithm can detect LVSD in CICU patients with and without AF despite their clinical differences. • Use of the AI-ECG model to detect LVSD may expedite clinical decision making and treatment in the acute care setting. • It may be reasonable to treat AF patients with an AI-ECG indicating a high probability LVSD as if they have reduced LVEF. • AI-ECG is a non-invasive, inexpensive, and rapid screening tool for early detection of LVSD in resource-limited settings. [ABSTRACT FROM AUTHOR]

Background: The Braden Skin Score (BSS) is a bedside nursing assessment that may be a measure of frailty and predicts mortality among patients in the cardiac intensive care unit (CICU). We examined the association between each of the 6 individual BSS subscores with hospital mortality in patients in the CICU. We hypothesized that BSS subscores reflecting patient frailty would have a stronger association with outcomes.Methods: Retrospective cohort study of unique adult patients admitted to the Mayo Clinic CICU from 2007 to 2018 with BSS documented on admission. Primary outcome was all-cause hospital mortality. Odds ratios (ORs) were determined using multivariable logistic regression.Results: The 11,954 included patients had a mean age of 67.4 ± 15.2 years (37.8% women). Each individual BSS subscore was lower among patients who died in the hospital (all P < .001). The total BSS was inversely associated with in-hospital mortality across admission diagnoses and among patients with coma or mechanical ventilation; each individual subscore was inversely associated with in-hospital mortality. On multivariable regression, all subscores were inversely associated with hospital mortality after full adjustment. Shear had the strongest association (adjusted OR 0.59), followed by nutrition (adjusted OR 0.67), skin moisture (adjusted OR 0.76), mobility (adjusted OR 0.76), sensory perception (adjusted OR 0.82), and activity level (adjusted OR 0.85).Conclusion: BSS can serve as a rapid noninvasive screening tool for identifying poor outcomes in patients in the CICU. BSS subdomains that are more strongly associated with mortality appear to reflect physical frailty. Insofar as the BSS and its subscores measure frailty, a low BSS may identify frail patients. [ABSTRACT FROM AUTHOR]

• The multi-center study and large sample size made the conclusion reliable. • Monocyte-lymphocyte ratio was proved to be an independent risk factor of in-hospital mortality in cardiac intensive care unit patients. • Patients with low APACHE IV or with less comorbidities had higher risk of mortality for monocyte-lymphocyte ratio. • Lowess curve presented the association between monocyte-lymphocyte ratio and in-hospital mortality vividly. Inflammatory cell plays a very important part in the occurrence and development of cardiovascular disease. As a combination of lymphocyte and monocyte, monocyte-lymphocyte ratio (MLR) was proved to be related to the severity and prognosis of cardiovascular diseases. Our objective was to explore the association between MLR and in-hospital mortality in cardiac intensive care unit (CICU) patients. MLR was obtained by dividing monocyte percentage by lymphocyte percentage. All patients were grouped by MLR quartiles. Primary outcome was in-hospital mortality. Binary logistic regression analysis was performed to determine the independent effect of MLR. 5512 CICU patients were included. In-hospital mortality increased as MLR quartiles increased (Quartile 4 vs Quartile 1: 16.3 vs 7.8, P < 0.001). After adjusting for confounding variables, MLR was proved to be independently associated with increased risk of in-hospital mortality (Quartile 4 vs Quartile 1: OR, 95% CI: 1.87, 1.38–2.56, P < 0.001, P for trend < 0.001). Subgroup analysis revealed that patients with low Acute Physiology and Chronic Health Evaluation IV (APACHE IV) or with less comorbidities had higher risk of mortality for MLR. As MLR quartiles increased, length of CICU stay (Quartile 4 vs Quartile 1: 2.8, 1.7–5.4 vs 2.1, 1.2–3.7, P < 0.001) and hospital stay (Quartile 4 vs Quartile 1: 8.3, 4.8–11.1 vs 5.3, 3.1–9.3, P < 0.001) were prolonged. MLR was independently correlated with in-hospital mortality in CICU patients. [ABSTRACT FROM AUTHOR]

Background: Current cardiac intensive care unit (CICU) practice has seen an increase in patient complexity, including an increase in noncardiac organ failure, critical care therapies, and comorbidities. We sought to describe the changing epidemiology of noncardiac multimorbidity in the CICU population.Methods: We analyzed consecutive unique patient admissions to 2 geographically distant tertiary care CICUs (n = 16,390). We assessed for the prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities (diabetes, chronic lung, liver, and kidney disease, cancer, and stroke/transient ischemic attack) and their associations with hospital and postdischarge 1-year mortality using multivariable logistic regression.Results: The prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities was 37.7%, 31.4%, 19.9%, and 11.0%, respectively. Increasing noncardiac comorbidities were associated with a stepwise increase in mortality, length of stay, noncardiac indications for ICU admission, and increased utilization of critical care therapies. After multivariable adjustment, compared with those without noncardiac comorbidities, there was an increased hospital mortality for patients with 1 (odds ratio [OR] 1.30; 95% confidence interval [CI], 1.10-1.54, P = .002), 2 (OR 1.47; 95% CI, 1.22-1.77, P < .001), and ≥3 (OR 1.79; 95% CI, 1.44-2.22, P < .001) noncardiac comorbidities. Similar trends for each additional noncardiac comorbidity were seen for postdischarge 1-year mortality (P < .001, all).Conclusions: In 2 large contemporary CICU populations, we found that noncardiac multimorbidity was highly prevalent and a strong predictor of short- and long-term adverse clinical outcomes. Further study is needed to define the best care pathways for CICU patients with acute cardiac illness complicated by noncardiac multimorbidity. [ABSTRACT FROM AUTHOR]