Demographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units: The Critical Care Cardiology Trials Network Prospective North American Multicenter Registry of Cardiac Critical Illness
Demographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units: The Critical Care Cardiology Trials Network Prospective North American Multicenter Registry of Cardiac Critical Illness
复制标题
DOI：
10.1001/jamacardio.2019.2467
复制
发表时间：
2019-09-01
期刊：
影响因子：
24
通讯作者：
Vo, Chau
中科院分区：
文献类型：
--
作者：
Bohula, Erin A.;Katz, Jason N.;Vo, Chau
重要性 单中心和基于索赔的研究描述了心脏重症监护病房 (CICU) 护理格局的重大变化。专业协会建议开展研究来指导基于证据的 CICU 重新设计。 目的 描述入住当代先进 CICU 的患者特征。 设计、设置和参与者 本研究建立了重症监护心脏病学试验网络 (CCCTN)，这是一个由研究者发起的由美国和加拿大 16 个先进三级 CICU 组成的多中心网络。每个CICU连续2个月的入院数据被提交给中央数据协调中心（TIMI研究组）。数据于 2017 年 9 月至 2018 年期间收集和分析。 主要结果和措施 人口统计、诊断、管理和结果。 结果 在 3049 名参与者中，1132 名（37.1%）为女性，797 名（31.4%）为有色人种，中位年龄为 65 岁（第 25 和第 75 个百分位数，55-75 岁）。 2017年9月至2018年9月期间，共纳入3310例入院病例，其中2557例（77.3%）因原发性心脏问题入院，337例（10.2%）因术后护理入院，253例（7.7%）因一般和心脏问题混合入院，163例（4.9%）因普通内科ICU超额入院。当仅限于每个中心入院 CICU 的最初 2 个月时，主要分析人群包括 3049 名非心血管合并症负担较高的入院患者。 CICU 入院诊断排名前 2 位的是急性冠脉综合征 (969 例 [31.8%]) 和心力衰竭 (567 例 [18.6%])；然而，不同中心之间急性冠脉综合征的比例差异很大（15%-57%）。 CICU 护理的主要适应症包括呼吸功能不全 (814 例 [26.7%])、休克 (643 例 [21.1%])、不稳定心律失常 (521 例 [17.1%]) 和心脏骤停 (265 例 [8.7%])。 1776 例患者 (58.2%) 需要先进的 CICU 治疗或监测，包括静脉血管活性药物 (1105 例 [36.2%])、有创血流动力学监测 (938 例 [30.8%]) 和机械通气 (652 例 [21.4%])。 CICU 总体死亡率为 8.3%（95% CI，7.3%-9.3%）。与最高死亡率相关的 CICU 适应症是心脏骤停 (101 [38.1%])、心源性休克 (140 [30.6%]) 和需要肾脏替代治疗 (51 [34.5%])。值得注意的是，仅出于术后观察或频繁监测而入院的患者死亡率为 0.2% 至 0.4%。 结论和相关性 在当代三级护理 CICU 网络中，呼吸衰竭和休克是入院的主要指征，且预后不良。虽然各中心的实践模式差异很大，但仍确定了大量低风险人群。 CCCTN 等多中心协作网络可用于帮助重新设计心脏重症监护并测试新的治疗策略。
IMPORTANCE Single-center and claims-based studies have described substantial changes in the landscape of care in the cardiac intensive care unit (CICU). Professional societies have recommended research to guide evidence-based CICU redesigns.OBJECTIVE To characterize patients admitted to contemporary, advanced CICUs.DESIGN, SETTING, AND PARTICIPANTS This study established the Critical Care Cardiology Trials Network (CCCTN), an investigator-initiated multicenter network of 16 advanced, tertiary CICUs in the United States and Canada. For 2 months in each CICU, data for consecutive admissions were submitted to the central data coordinating center (TIMI Study Group). The data were collected and analyzed between September 2017 and 2018.MAIN OUTCOMES AND MEASURES Demographics, diagnoses, management, and outcomes.RESULTS Of 3049 participants, 1132 (37.1%) were women, 797 (31.4%) were individuals of color, and the median age was 65 years (25th and 75th percentiles, 55-75 years). Between September 2017 and September 2018, 3310 admissions were included, among which 2557 (77.3%) were for primary cardiac problems, 337 (10.2%) for postprocedural care, 253 (7.7%) for mixed general and cardiac problems, and 163 (4.9%) for overflow from general medical ICUs. When restricted to the initial 2 months of medical CICU admissions for each site, the primary analysis population included 3049 admissions with a high burden of noncardiovascular comorbidities. The top 2 CICU admission diagnoses were acute coronary syndrome (969 [31.8%]) and heart failure (567 [18.6%]); however, the proportion of acute coronary syndrome was highly variable across centers (15%-57%). The primary indications for CICU care included respiratory insufficiency (814 [26.7%]), shock (643 [21.1%]), unstable arrhythmia (521 [17.1%]), and cardiac arrest (265 [8.7%]). Advanced CICU therapies or monitoring were required for 1776 patients (58.2%), including intravenous vasoactive medications (1105 [36.2%]), invasive hemodynamic monitoring (938 [30.8%]), and mechanical ventilation (652 [21.4%]). The overall CICU mortality rate was 8.3% (95% CI, 7.3%-9.3%). The CICU indications that were associated with the highest mortality rates were cardiac arrest (101 [38.1%]), cardiogenic shock (140 [30.6%]), and the need for renal replacement therapy (51 [34.5%]). Notably, patients admitted solely for postprocedural observation or frequent monitoring had a mortality rate of 0.2% to 0.4%.CONCLUSIONS AND RELEVANCE In a contemporary network of tertiary care CICUs, respiratory failure and shock predominated indications for admission and carried a poor prognosis. While patterns of practice varied considerably between centers, a substantial, low-risk population was identified. Multicenter collaborative networks, such as the CCCTN, could be used to help redesign cardiac critical care and to test new therapeutic strategies.