Association Between Presence of a Cardiac Intensivist and Mortality in an Adult Cardiac Care Unit
Association Between Presence of a Cardiac Intensivist and Mortality in an Adult Cardiac Care Unit
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DOI：
10.1016/j.jacc.2016.09.947
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发表时间：
2016-12-20
影响因子：
24
通讯作者：
Yang, Jeong Hoon
中科院分区：
文献类型：
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作者：
Na, Soo Jin;Chung, Chi Ryang;Yang, Jeong Hoon
专门的重症监护室（ICU）医生配备与普通内科和外科ICU中ICU死亡率的降低相关。然而，有限的数据可用于心脏重症监护病房（CICU）的心脏重症监护医生的作用。结论本研究调查了心脏重症监护医生指导的护理与成人患者的临床结局之间的关系。方法本研究分析了2012年1月至2015年12月在韩国首尔三星医疗中心入住CICU的2,431例患者。2013年1月，CICU从低强度人员配置模式变更为高强度人员配置模式，由专门的心脏重症监护医师管理。符合条件的患者分为低强度管理组（n = 616）或高强度管理组（n = 1，815）。还进行了具有可变匹配比率的一对多（1：N）倾向评分匹配。结果CICU低强度组死亡55例（8.9%），高强度组死亡74例（4.1%）（p < 0.001）。在接受体外膜肺氧合的135例患者中，高强度组的CICU死亡率也低于低强度组（54.5% vs. 22.5%; p = 0.001）。在倾向评分匹配中，发现高强度人员配备与匹配患者队列中较低的CICU死亡率相关（7.5% vs. 3.7%;调整后比值比：0.53; 95%置信区间：0.32至0.86; p = 0.010）。在整体和倾向匹配的患者，有没有实质性的差异，无论是中位长度的CICU住院或再入院率之间的2 groups.CONCLUSIONS的存在下，一个专门的心脏重症监护与CICU死亡率降低心血管疾病患者谁需要重症监护。(C)2016年由美国心脏病学会基金会。
BACKGROUND Dedicated intensive care unit (ICU) physician staffing is associated with a reduction in ICU mortality rates in general medical and surgical ICUs. However, limited data are available on the role of a cardiac intensivist in the cardiac intensive care unit (CICU).OBJECTIVES This study investigated the association of cardiac intensivist-directed care with clinical outcomes in adult patients admitted to the CICU.METHODS This study analyzed 2,431 patients admitted to the CICU at Samsung Medical Center in Seoul, South Korea, from January 2012 to December 2015. In January 2013 the CICU was changed from a low-intensity staffing model to a high-intensity staffing model managed by a dedicated cardiac intensivist. Eligible patients were divided into either a low-intensity management group (n = 616) or a high-intensity management group (n = 1,815). One-to-many (1:N) propensity score matching with variable matching ratios was also performed. The primary outcome was death in the CICU.RESULTS Death in the CICU occurred in 55 patients (8.9%) in the low-intensity group versus 74 patients (4.1%) in the high-intensity group (p < 0.001). Of 135 patients who underwent extracorporeal membrane oxygenation, the CICU mortality rate in the high-intensity group was also lower than that in the low-intensity group (54.5% vs. 22.5%; p = 0.001). On propensity score matching, high-intensity staffing was found associated with a lower CICU mortality rate in the matched cohort of patients (7.5% vs. 3.7%; adjusted odds ratio: 0.53; 95% confidence interval: 0.32 to 0.86; p = 0.010). In overall and propensity-matched patients, there were no substantive differences in either median length of CICU stay or readmission rates between the 2 groups.CONCLUSIONS The presence of a dedicated cardiac intensivist was associated with a reduction in CICU mortality rates in patients with cardiovascular disease who required critical care. (C) 2016 by the American College of Cardiology Foundation.