TY - JOUR
T1 - Full-Time Cardiac Intensive Care Unit Staffing by Heart Failure Specialists and its Association with Mortality Rates
AU - SIMS, DANIEL B.
AU - KIM, YEKATERINA
AU - KALININSKIY, ALEKSANDR
AU - YANAMANDALA, MOUNICA
AU - JOSEPHS, JOSHUA
AU - RIVAS-LASARTE, MERCEDES
AU - AHMED, NAVID
AU - ASSA, ANDREI
AU - JAHUFAR, FATHIMA
AU - KUMAR, SALIL
AU - SUN, E. R.I.C.
AU - RAHGOZAR, KUSHA
AU - ALI, SYED ZAIN
AU - ZHANG, M. I.N.G.
AU - PATEL, SHREYANS
AU - EDWARDS, PAULINE
AU - SAEED, O. M.A.R.
AU - SHIN, J. JULIA
AU - MURTHY, SANDHYA
AU - PATEL, SNEHAL
AU - SHAH, A. M.A.N.
AU - JORDE, ULRICH P.
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/3
Y1 - 2022/3
N2 - Background: Cardiac intensive care units (CICUs) serve medically complex patients with multiorgan dysfunction. Whether a CICU that is staffed full time by heart failure (HF) specialists is associated with decreased mortality is unclear. Methods and Results: A retrospective review of consecutive CICU admissions from January 1, 2012, to December 31, 2016, was performed. In January 2014, the CICU changed from an open unit staffed by any cardiologist to a closed unit managed by HF specialists. Patients’ baseline characteristics were determined, and a multivariate regression analysis was performed to ascertain mortality rates in the CICU. Baseline severity of illness was higher in the closed/HF specialist CICU model (P< 0.001). Death occurred in 101 of 1185 patients admitted to the CICU (8.5%) in the open-unit model and in 139 of 2163 patients (6.4%) admitted to the closed/HF specialist model (absolute risk reduction 2.1%, 95% confidence interval [CI] 0.1–4.0%; P = 0.01). The transition from an open to a closed/HF specialist model was associated with a lower overall CICU mortality rate (odds ratio [OR] 0.63; 95% CI 0.43–0.93). Prespecified interaction with a mechanical circulatory support device and unit model showed that treatment with such a device was associated with lower mortality rates in the closed/HF specialist model of a CICU (OR 0.6; 95% CI 0.18–0.78; P for interaction <0.01). Conclusion: Transition to a closed unit model staffed by a dedicated HF specialist is associated with lower CICU mortality rates.
AB - Background: Cardiac intensive care units (CICUs) serve medically complex patients with multiorgan dysfunction. Whether a CICU that is staffed full time by heart failure (HF) specialists is associated with decreased mortality is unclear. Methods and Results: A retrospective review of consecutive CICU admissions from January 1, 2012, to December 31, 2016, was performed. In January 2014, the CICU changed from an open unit staffed by any cardiologist to a closed unit managed by HF specialists. Patients’ baseline characteristics were determined, and a multivariate regression analysis was performed to ascertain mortality rates in the CICU. Baseline severity of illness was higher in the closed/HF specialist CICU model (P< 0.001). Death occurred in 101 of 1185 patients admitted to the CICU (8.5%) in the open-unit model and in 139 of 2163 patients (6.4%) admitted to the closed/HF specialist model (absolute risk reduction 2.1%, 95% confidence interval [CI] 0.1–4.0%; P = 0.01). The transition from an open to a closed/HF specialist model was associated with a lower overall CICU mortality rate (odds ratio [OR] 0.63; 95% CI 0.43–0.93). Prespecified interaction with a mechanical circulatory support device and unit model showed that treatment with such a device was associated with lower mortality rates in the closed/HF specialist model of a CICU (OR 0.6; 95% CI 0.18–0.78; P for interaction <0.01). Conclusion: Transition to a closed unit model staffed by a dedicated HF specialist is associated with lower CICU mortality rates.
KW - Critical care cardiology
KW - advanced heart failure
KW - mechanical circulatory support
KW - staffing patterns
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U2 - 10.1016/j.cardfail.2021.09.013
DO - 10.1016/j.cardfail.2021.09.013
M3 - Article
C2 - 34634449
AN - SCOPUS:85118717540
SN - 1071-9164
VL - 28
SP - 394
EP - 402
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 3
ER -