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Troisi F, Guida P, Vitulano N, Argentiero A, Passantino A, Iacoviello M, Grimaldi M. Clinical complexity of an Italian cardiovascular intensive care unit: the role of mortality and severity risk scores. J Cardiovasc Med (Hagerstown) 2024; 25:511-518. [PMID: 38829938 DOI: 10.2459/jcm.0000000000001632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
AIMS The identification of patients at greater mortality risk of death at admission into an intensive cardiovascular care unit (ICCU) has relevant consequences for clinical decision-making. We described patient characteristics at admission into an ICCU by predicted mortality risk assessed with noncardiac intensive care unit (ICU) and evaluated their performance in predicting patient outcomes. METHODS A total of 202 consecutive patients (130 men, 75 ± 12 years) were admitted into our tertiary-care ICCU in a 20-week period. We evaluated, on the first 24 h data, in-hospital mortality risk according to Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score 3 (SAPS 3); Sepsis related Organ Failure Assessment (SOFA) Score and the Mayo Cardiac intensive care unit Admission Risk Score (M-CARS) were also calculated. RESULTS Predicted mortality was significantly lower than observed (5% during ICCU and 7% at discharge) for APACHE II and SAPS 3 (17% for both scores). Mortality risk was associated with older age, more frequent comorbidities, severe clinical presentation and complications. The APACHE II, SAPS 3, SOFA and M-CARS had good discriminative ability in distinguishing deaths and survivors with poor calibration of risk scores predicting mortality. CONCLUSION In a recent contemporary cohort of patients admitted into the ICCU for a variety of acute and critical cardiovascular conditions, scoring systems used in general ICU had good discrimination for patients' clinical severity and mortality. Available scores preserve powerful discrimination but the overestimation of mortality suggests the importance of specific tailored scores to improve risk assessment of patients admitted into ICCUs.
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Affiliation(s)
- Federica Troisi
- Cardiology Department, Regional General Hospital 'F. Miulli', Acquaviva delle Fonti, Italy
| | - Pietro Guida
- Cardiology Department, Regional General Hospital 'F. Miulli', Acquaviva delle Fonti, Italy
| | - Nicola Vitulano
- Cardiology Department, Regional General Hospital 'F. Miulli', Acquaviva delle Fonti, Italy
| | - Adriana Argentiero
- Cardiology Department, Regional General Hospital 'F. Miulli', Acquaviva delle Fonti, Italy
| | - Andrea Passantino
- Scientific Clinical Institutes Maugeri, Institutes of Care and Research, Institute of Bari, Bari
| | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Grimaldi
- Cardiology Department, Regional General Hospital 'F. Miulli', Acquaviva delle Fonti, Italy
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Miller PE, Huber K, Bohula EA, Krychtiuk KA, Pöss J, Roswell RO, Tavazzi G, Solomon MA, Kristensen SD, Morrow DA. Research Priorities in Critical Care Cardiology: JACC Expert Panel. J Am Coll Cardiol 2023; 82:2329-2337. [PMID: 38057075 PMCID: PMC10752230 DOI: 10.1016/j.jacc.2023.09.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/15/2023] [Accepted: 09/20/2023] [Indexed: 12/08/2023]
Abstract
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.
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Affiliation(s)
- P Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Erin A Bohula
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Konstantin A Krychtiuk
- Department of Internal Medicine II, Division of Cardiology Medical University of Vienna, Vienna, Austria; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Janine Pöss
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Robert O Roswell
- Northwell Health, Zucker School of Medicine, Hempstead, New York, USA
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Intensive Care Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Michael A Solomon
- Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland, USA
| | | | - David A Morrow
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Grupper A, Chernomordik F, Herscovici R, Mazin I, Segev A, Beigel R, Matetzky S. The burden of heart failure in cardiac intensive care unit: a prospective 7 years analysis. ESC Heart Fail 2023; 10:1615-1622. [PMID: 36802123 PMCID: PMC10192277 DOI: 10.1002/ehf2.14320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/20/2023] Open
Abstract
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.
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Affiliation(s)
- Avishay Grupper
- Division of CardiologyLeviev Center of Cardiovascular medicine, Sheba Medical Center in Tel‐Ha'ShomerRamat‐GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Fernando Chernomordik
- Division of CardiologyLeviev Center of Cardiovascular medicine, Sheba Medical Center in Tel‐Ha'ShomerRamat‐GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Romana Herscovici
- Division of CardiologyLeviev Center of Cardiovascular medicine, Sheba Medical Center in Tel‐Ha'ShomerRamat‐GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Israel Mazin
- Division of CardiologyLeviev Center of Cardiovascular medicine, Sheba Medical Center in Tel‐Ha'ShomerRamat‐GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Amitai Segev
- Division of CardiologyLeviev Center of Cardiovascular medicine, Sheba Medical Center in Tel‐Ha'ShomerRamat‐GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Roy Beigel
- Division of CardiologyLeviev Center of Cardiovascular medicine, Sheba Medical Center in Tel‐Ha'ShomerRamat‐GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Shlomi Matetzky
- Division of CardiologyLeviev Center of Cardiovascular medicine, Sheba Medical Center in Tel‐Ha'ShomerRamat‐GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
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Sinha SS, Bohula EA, Diepen SVAN, Leonardi S, Mebazaa A, Proudfoot AG, Sionis A, Chia YW, Zampieri FG, Lopes RD, Katz JN. The Intersection Between Heart Failure and Critical Care Cardiology: An International Perspective on Structure, Staffing, and Design Considerations. J Card Fail 2022; 28:1703-1716. [PMID: 35843489 DOI: 10.1016/j.cardfail.2022.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
The overall patient population in contemporary cardiac intensive care units (CICUs) has only increased with respect to patient acuity, complexity, and illness severity. The current population has more cardiac and noncardiac comorbidities, a higher prevalence of multiorgan injury, and consumes more critical care resources than previously. Patients with heart failure (HF) now occupy a large portion of contemporary tertiary or quaternary care CICU beds around the world. In this review, we discuss the core issues that relate to the care of critically ill patients with HF, including global perspectives on the organization, designation, and collaboration of CICUs regionally and across institutions, as well as unique models for provisioning care for patients with HF within a health care setting. The latter includes a discussion of traditional and emerging models, specialized HF units, the makeup and implementation of multidisciplinary team-based decision-making, and cardiac critical care admission and triage practices. This article illustrates the ways in which critically ill patients with HF have helped to shape contemporary CICUs throughout the world and explores how these very patients will similarly help to inform the future maturation of these specialized critical care units. Finally, we will critically examine broad, contemporary, international models of HF and cardiac critical care delivery in North America, Europe, South America, and Asia, and conclude with opportunities for the further investigation and generation of evidence for care delivery.
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Affiliation(s)
- Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Erin A Bohula
- Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sean VAN Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sergio Leonardi
- Fondazione IRCCS Policlinico San Matteo, Pavia and University of Pavia, Pavia, Italy
| | - Alexandre Mebazaa
- Université de Paris, Inserm 942 MASCOT, APHP Hôpitaux Universitaires Saint-Louis-Lariboisière, Paris, France
| | - Alastair G Proudfoot
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Clinic For Anaesthesiology & Intensive Care, Charité-Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Univesität zu, Berlin, Germany
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Yew Woon Chia
- Cardiac Intensive Care Unit, Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Fernando G Zampieri
- HCor Research Institute, São Paulo, Brazil Intensive Care Unit, Federal University of São Paulo, Brazil
| | - Renato D Lopes
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Brazilian Clinical Research Institute (BCRI), Sao Paulo, Brazil
| | - Jason N Katz
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Gulizia MM, Fabbri G, Lucci D, Di Pasquale G, Gabrielli D, Campodonico J, Mauro A, Inciardi R, Di Lorenzo E, Oliva F, Nardi F, Colivicchi F, De Luca L. Type of hospitalisations and in-hospital outcomes in the Italian coronary care unit network at the time of COVID-19 pandemic: the BLITZ-COVID19 Registry. BMJ Open 2022; 12:e062382. [PMID: 36446450 PMCID: PMC9709809 DOI: 10.1136/bmjopen-2022-062382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The aim of the study was to describe the epidemiology and outcome of patients hospitalised during the COVID-19 pandemic in intensive cardiac care units (ICCs). DESIGN Non-interventional, retrospective and prospective, nationwide study. SETTING 109 private or public ICCs in Italy. PARTICIPANTS 6054 consecutive patients admitted to Italian ICCs during COVID-19 pandemic. PRIMARY AND SECONDARY OUTCOME MEASURES To obtain accurate and up-to-date information on epidemiology and outcome of patients admitted to ICCs during the COVID-19 pandemic, the impact that the COVID-19 infection may have determined on the organisational pathways and in-hospital management of the various clinical conditions being admitted to ICCs. RESULTS Acute coronary syndromes were the most frequent ICC discharge diagnoses followed by heart failure and hypokinetic arrhythmias. The prevalence of COVID-19 positivity was approximately 3%. Most patients with a COVID-19 diagnosis at discharge (52%) arrived to ICC from other wards, in particular 22% from non-cardiology ICCs. The overall mortality was 4.2% during ICC and 5.8% during hospital stay. The cause of in-hospital death was cardiac in 74.4% of the cases, non-cardiovascular in 13.5%, vascular in 5.8% and related to COVID-19 in 6.3% of the patients. CONCLUSIONS This study provides a unique nationwide picture of current ICC care during COVID-19 pandemic. TRIAL REGISTRATION NUMBER NCT04744415.
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Affiliation(s)
- Michele Massimo Gulizia
- Division of Cardiology, National Centre of Excellence Garibaldi-Nesima Hospital, Catania, Italy
- Heart Care Foundation, Firenze, Italy
| | - Gianna Fabbri
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy
| | - Donata Lucci
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy
| | - Giuseppe Di Pasquale
- Regional Authority for Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Domenico Gabrielli
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, Roma, Italy
| | - Jeness Campodonico
- Intensive Cardiac Care Unit, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Andrea Mauro
- Division of Cardiology, San Gerardo Hospital, Monza, Italy
| | - Riccardo Inciardi
- Division of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Fabrizio Oliva
- Division of Cardiology 1, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Federico Nardi
- Division of Cardiology, Santo Spirito Hospital, Casale Monferrato, Italy
| | - Furio Colivicchi
- Division of Clinical Cardiology, Presidio Ospedaliero San Filippo Neri, Roma, Italy
| | - Leonardo De Luca
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, Roma, Italy
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Clinical presentation and outcomes of acute heart failure in the critically ill patient: A prospective, observational, multicentre study. MEDICINA INTENSIVA (ENGLISH EDITION) 2022; 47:221-231. [PMID: 36272910 DOI: 10.1016/j.medine.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Abstract
AIMS To assess the clinical profile and factors associated with 30-day mortality in patients with acute heart failure (AHF) admitted to the intensive care unit (ICU). DESIGN Prospective, multicentre cohort study. SCOPE Thirty-two Spanish ICUs. PATIENTS Adult patients admitted to the ICU between April and June 2017. INTERVENTION Patients were classified into three groups according to AHF status: without AHF (no AHF); AHF as the primary reason for ICU admission (primary AHF); and AHF developed during the ICU stay (secondary AHF). MAIN VARIABLES OF INTEREST Incidence of AHF and 30-day mortality. RESULTS A total of 4330 patients were included. Of these, 627 patients (14.5%) had primary (n=319; 7.4%) or secondary (n=308; 7.1%) AHF. Among the main precipitating factors, fluid overload was more common in the secondary AHF group than in the primary group (12.9% vs 23.4%, p<0.001). Patients with AHF had a higher risk of 30-day mortality than those without AHF (OR 2.45; 95% CI: 1.93-3.11). APACHE II, cardiogenic shock, left ventricular ejection fraction, early inotropic therapy, and diagnostic delay were independently associated with 30-day mortality in AHF patients. Diagnostic delay was associated with a significant increase in 30-day mortality in the secondary group (OR 6.82; 95% CI 3.31-14.04). CONCLUSIONS The incidence of primary and secondary AHF was similar in this cohort of ICU patients. The risk of developing AHF in ICU patients can be reduced by avoiding modifiable precipitating factors, particularly fluid overload. Diagnostic delay was associated with significantly higher mortality rates in patients with secondary AHF.
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De Luca L, Rubboli A, Lettino M, Tubaro M, Leonardi S, Casella G, Valente S, Rossini R, Sciahbasi A, Natale E, Trambaiolo P, Navazio A, Cipriani M, Corda M, De Nardo A, Francese GM, Napoletano C, Tizzani E, Nardi F, Roncon L, Caldarola P, Riccio C, Gabrielli D, Oliva F, Massimo Gulizia M, Colivicchi F. ANMCO position paper on antithrombotic treatment of patients with atrial fibrillation undergoing intracoronary stenting and/or acute coronary syndromes. Eur Heart J Suppl 2022; 24:C254-C271. [PMID: 35663586 PMCID: PMC9155223 DOI: 10.1093/eurheartj/suac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with or without acute coronary syndromes (ACS) represent a subgroup with a challenging pharmacological management. Indeed, if on the one hand, antithrombotic therapy should reduce the risk related to recurrent ischaemic events and/or stent thrombosis; on the other hand, care must be taken to avoid major bleeding events. In recent years, several trials, which overall included more than 12 000 patients, have been conducted demonstrating the safety of different therapeutic combinations of oral antiplatelet and anticoagulant agents. In the present ANMCO position paper, we propose a decision-making algorithm on antithrombotic strategies based on scientific evidence and expert consensus to be adopted in the periprocedural phase, at the time of hospital discharge, and in the long-term follow-up of patients with AF undergoing PCI with/without ACS.
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Affiliation(s)
- Leonardo De Luca
- Cardiology, Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Andrea Rubboli
- Cardiology, Cardiovascular Department, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Maddalena Lettino
- Department of Cardiology, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Marco Tubaro
- CCU, Intensive and Interventional Cardiology Department, P.O. San Filippo Neri, Roma, Italy
| | - Sergio Leonardi
- University of Pavia and IRCCS S. Matteo Foundation General Hospital, Pavia, Italy
| | - Gianni Casella
- Cardiology Department, Ospedale Maggiore, Azienda USL di Bologna, Bologna, Italy
| | - Serafina Valente
- Cardio-Thoracic Department, A.O.U. Senese, Ospedale Santa Maria alle Scotte, Siena, Italy
| | - Roberta Rossini
- Emergency Department and Critical Areas, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | | | - Enrico Natale
- Cardiology, Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Paolo Trambaiolo
- Cardiology Department, Ospedale Sandro Pertini, ASL RM2, Roma, Italy
| | - Alessandro Navazio
- Hospital Cardiology Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Manlio Cipriani
- Cardiology 2-Heart Failure and Transplants, Dipartimento Cardiotoracovascolare “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Marco Corda
- Cardiology Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Alfredo De Nardo
- Cardiology-ICU Department, Ospedale Civile “G. Jazzolino”, Vibo Valentia, Italy
| | - Giuseppina Maura Francese
- Cardiology Department, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Cosimo Napoletano
- Cardiology-ICU Department—Cath Lab, Presidio Ospedaliero “G. Mazzini”, Teramo, Italy
| | | | - Federico Nardi
- Cardiology Department, Ospedale Santo Spirito, Casale Monferrato (AL), Italy
| | - Loris Roncon
- Cardiology Department, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | | | - Carmine Riccio
- Follow-up of the Post-Acute Patient, Cardio-Vascular Department, AORN Sant'Anna and San Sebastiano, Caserta, Italy
| | - Domenico Gabrielli
- Cardiology, Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Fabrizio Oliva
- Cardiology 2-Heart Failure and Transplants, Dipartimento Cardiotoracovascolare “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma, Italy
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Zapata L, Guía C, Gómez R, García-Paredes T, Colinas L, Portugal-Rodriguez E, Rodado I, Leache I, Fernández-Ferreira A, Hermosilla-Semikina I, Roche-Campo F. Clinical presentation and outcomes of acute heart failure in the critically ill patient: A prospective, observational, multicentre study. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ohbe H, Matsui H, Yasunaga H. Intensive care unit versus high-dependency care unit for patients with acute heart failure: a nationwide propensity score-matched cohort study. J Intensive Care 2021; 9:78. [PMID: 34930470 PMCID: PMC8686245 DOI: 10.1186/s40560-021-00592-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/10/2021] [Indexed: 12/28/2022] Open
Abstract
Background A structure and staffing model similar to that in general intensive care unit (ICUs) is applied to cardiac intensive care unit (CICUs) for patients with acute heart failure. However, there is limited evidence on the structure and staffing model of CICUs. The present study aimed to assess whether critical care for patients with acute heart failure in the ICUs is associated with improved outcomes than care in the high-dependency care units (HDUs), the hospital units in which patient care levels and costs are between the levels found in the ICU and general ward. Methods This nationwide, propensity score-matched, retrospective cohort study was performed using a national administrative inpatient database in Japan. We identified all patients who were hospitalized for acute heart failure and admitted to the ICU or HDU on the day of hospital admission from April 2014 to March 2019. Propensity score-matching analysis was performed to compare the in-hospital mortality between acute heart failure patients treated in the ICU and HDU on the day of hospital admission. Results Of 202,866 eligible patients, 78,646 (39%) and 124,220 (61%) were admitted to the ICU and HDU, respectively, on the day of admission. After propensity score matching, there was no statistically significant difference in in-hospital mortality between patients who were admitted to the ICU and HDU on the day of admission (10.7% vs. 11.4%; difference, − 0.6%; 95% confidence interval, − 1.5% to 0.2%). In the subgroup analyses, there was a statistically significant difference in in-hospital mortality between the ICU and HDU groups among patients receiving noninvasive ventilation (9.4% vs. 10.5%; difference, − 1.0%; 95% confidence interval, − 1.9% to − 0.1%) and patients receiving intubation (32.5% vs. 40.6%; difference, − 8.0%; 95% confidence interval, − 14.5% to − 1.5%). There were no statistically significant differences in other subgroup analyses. Conclusions Critical care in ICUs was not associated with lower in-hospital mortality than critical care in HDUs among patients with acute heart failure. However, critical care in ICUs was associated with lower in-hospital mortality than critical care in HDUs among patients receiving noninvasive ventilation and intubation. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-021-00592-2.
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
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Ferrer M, García-García C, El Ouaddi N, Rueda F, Serra J, Oliveras T, Labata C, Dégano IR, Montero S, De Diego O, Elosúa R, Lupón J, Bayes-Genis A. Transitioning from a coronary to a critical cardiovascular care unit: trends over the past three decades. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:437–444. [PMID: 32672051 DOI: 10.1177/2048872620936038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/31/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary care units were established in the 1960s to reduce acute-phase mortality in acute coronary syndrome. In the 21st century, the original coronary care unit concept has evolved into an intensive cardiovascular care unit. The aim of this study was to analyse trend changes in characteristics and mortality of patients admitted to a coronary care unit over the past three decades. METHOD Between February 1989 and December 2017, a total of 18,334 patients was consecutively admitted to the coronary care unit of a university hospital in Barcelona. Data were analysed in five time frames: 1989-1994, 1995-1999, 2000-2004, 2005-2009 and 2010-2017. We analysed demographic profile, diagnoses at admission and trend changes in mortality across periods. RESULTS During the periods, the patients' ages and comorbidities increased. Diagnoses at admission have evolved. Acute coronary syndrome cases declined from the first to the last period (72.6% vs. 62.8%) while heart failure (6.0% vs. 8.6%) and malignant arrhythmias (0.8% vs. 4.0%) increased significantly. Overall, coronary care unit mortality decreased 34% from the first to the last period (6.8% vs. 4.5%, P<0.001). Furthermore, the cause of death has changed, those due to acute coronary syndrome declining (66.7% vs. 45.5%), and death from malignant arrhythmias increasing (1.9% vs. 16.2%) from the first to the last period. CONCLUSIONS Although acute coronary syndrome remained the main diagnosis, heart failure and arrhythmias have increased. Despite the aging and comorbidities, overall mortality in the coronary care unit decreased by 34% in the past three decades. Deaths due to acute coronary syndrome have declined, whereas those due to malignant arrhythmias have increased.
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Affiliation(s)
- Marc Ferrer
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Cosme García-García
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER. Enfermedades Cardiovasculares (CIBERCV). Cardiology department. Spain
| | - Nabil El Ouaddi
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Ferran Rueda
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Jordi Serra
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Teresa Oliveras
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Carlos Labata
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Irene R Dégano
- CIBER. Enfermedades Cardiovasculares (CIBERCV). Cardiology department. Spain
- REGICOR Study Group, IMIM (Institut Hospital Del Mar d'Investigacions Mèdiques, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Spain
| | - Santiago Montero
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Oriol De Diego
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
| | - Roberto Elosúa
- CIBER. Enfermedades Cardiovasculares (CIBERCV). Cardiology department. Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Spain
- Cardiovascular Epidemiology and Genetics Group, IMIM, Spain
| | - Josep Lupón
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER. Enfermedades Cardiovasculares (CIBERCV). Cardiology department. Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain
- CIBER. Enfermedades Cardiovasculares (CIBERCV). Cardiology department. Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
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11
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:993-1001. [DOI: 10.1177/2048872619883997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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12
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 9:993-1001. [DOI: mj claeys, f roubille, g casella, r zukermann, n nikolaou, l de luca, m gierlotka, z iakobishvili, h thiele, m koutouzis, a sionis, s monteiro, c beauloye, c held, d tint, i zakke, p serpytis, z babic, j belohlavev, a magdy, m sivagowry rasalingam, k daly, d arroyo, m vavlukis, n radovanovic, e trendafilova, t marandi, c hassenger, m lettino, s price, e bonnefoy, organization of intensive cardiac care units in europe: results of a multinational survey, european heart journal.acute cardiovascular care, volume 9, issue 8, 1 december 2020, pages 993–1001, https:/doi.org/10.1177/2048872619883997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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13
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Pini S, Abelli M, Gesi C, Lari L, Cardini A, Di Paolo L, Felice F, Di Stefano R, Mazzotta G, Oligeri C, Bovenzi F, Borelli L, Bertoli D, Michi P, Muccignat A, Micchi J, Balbarini A. Frequency and clinical correlates of bipolar features in acute coronary syndrome patients. Eur Psychiatry 2020; 29:253-8. [DOI: 10.1016/j.eurpsy.2013.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 06/24/2013] [Accepted: 06/30/2013] [Indexed: 01/01/2023] Open
Abstract
AbstractBackground:Depression and acute coronary syndrome (ACS) are both extremely prevalent diseases. Studies aimed at evaluating whether depression is an independent risk factor for cardiac events provided no definitive results. In most of these studies, depression has been broadly defined with no differentiation between unipolar (MDD) versus bipolar forms (BD). The aim of this study was to evaluate the frequency of DSM-IV BD (bipolar I and bipolar II subtypes, cyclothymia), as well as temperamental or isolated bipolar features in a sample of 171 patients hospitalized for ACS. We also explored whether these psychopathological conditions were associated with some clinical characteristics of ACS.Methods:Patients with ACS admitted to three neighboring Cardiac Intensive Care Units (CICUs) in a 12-month continuative period of time were eligible for inclusion if they met the criteria for either acute myocardial infarct with or without ST-segment elevation or unstable angina, verified by standard ACS criteria. All patients underwent standardized cardiological and psychopathological evaluations.Results:Of the 171 ACS patients enrolled, 37 patients (21.7%) were found to have a DSM-IV mood disorder. Of these, 20 (11.7%) had bipolar type I or type II or cyclothymia, while 17 (10%) were the cases of MDD. Rapid mood switches ranged from 11% of ACS patients with no mood disorders, to 47% of those with MDD to 55% of those with BD. Linear regression analysis showed that a diagnosis of BD (p = .023), but not that of MDD (p = .721), was associated with a significant younger age at the index episode of ACS. A history of previous coronary events was more frequent in ACS patients with BD than in those with MDD.Conclusions:Our data indicate that bipolar features and diagnosis are frequent in ACS patients. Bipolar disorder has a negative impact on cardiac symptomatology. Further research in this area is warranted.
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14
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Jentzer JC, Wiley B, Bennett C, Murphree DH, Keegan MT, Gajic O, Kashani KB, Barsness GW. Early noncardiovascular organ failure and mortality in the cardiac intensive care unit. Clin Cardiol 2020; 43:516-523. [PMID: 31999370 PMCID: PMC7244298 DOI: 10.1002/clc.23339] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 11/07/2022] Open
Abstract
Background Noncardiac organ failure has been associated with worse outcomes among a cardiac intensive care unit (CICU) population. Hypothesis We hypothesized that early organ failure based on the sequential organ failure assessment (SOFA) score would be associated with mortality in CICU patients. Methods Adult CICU patients from 2007 to 2015 were reviewed. Organ failure was defined as any SOFA organ subscore ≥3 on the first CICU day. Organ failure was evaluated as a predictor of hospital mortality and postdischarge survival after adjustment for illness severity and comorbidities. Results We included 10 004 patients with a mean age of 67 ± 15 years (37% female). Admission diagnoses included acute coronary syndrome in 43%, heart failure in 46%, cardiac arrest in 12%, and cardiogenic shock in 11%. Organ failure was present in 31%, including multiorgan failure in 12%. Hospital mortality was higher in patients with organ failure (22% vs 3%, adjusted OR 3.0, 95% CI 2.5‐3.7, P < .001). After adjustment, each failing organ system predicted twofold higher odds of hospital mortality (adjusted OR 1.9, 95% CI 1.1‐2.1, P < .001). Mortality risk was highest with cardiovascular, coagulation and liver failure. Among hospital survivors, organ failure was associated with higher adjusted postdischarge mortality risk (P < .001); multiorgan failure did not confer added long‐term mortality risk. Conclusions Early noncardiovascular organ failure, especially multiorgan failure, is associated with increased hospital mortality in CICU patients, and this risk continues after hospital discharge, emphasizing the need to promote early recognition of organ failure in CICU patients.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, The Mayo Clinic, Rochester, Minnesota.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Brandon Wiley
- Department of Cardiovascular Medicine, The Mayo Clinic, Rochester, Minnesota.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Courtney Bennett
- Department of Cardiovascular Medicine, The Mayo Clinic, Rochester, Minnesota.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Dennis H Murphree
- Department of Health Sciences Research, The Mayo Clinic, Rochester, Minnesota
| | - Mark T Keegan
- Department of Anesthesiology and Perioperative Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Kianoush B Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota.,Division of Nephrology and Hypertension, Department of Internal Medicine, The Mayo Clinic, Rochester, Minnesota
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, The Mayo Clinic, Rochester, Minnesota
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15
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Campanile A, Castellani C, Santucci A, Annunziata R, Tutarini C, Reccia MR, Del Pinto M, Verdecchia P, Cavallini C. Predictors of in-hospital and long-term mortality in unselected patients admitted to a modern coronary care unit. J Cardiovasc Med (Hagerstown) 2019; 20:327-334. [PMID: 30865139 DOI: 10.2459/jcm.0000000000000785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AIMS Objective data on epidemiology, management and outcome of patients with acute cardiac illness are still scarce, and producing evidence-based guidelines remains an issue. In order to define the clinical characteristics and the potential predictors of in-hospital and long-term mortality, we performed a retrospective, observational study, in a tertiary cardiac centre in Italy. METHODS One thousand one hundred and sixty-five consecutive patients, admitted to our intensive cardiac care unit (ICCU) during the year 2016, were included in the study. The data were collected from the hospital discharge summary and the electronic chart records. RESULTS Global in-hospital mortality was 7.2%. Predictors of in-hospital mortality were age [odds ratio (OR): 2.0; P = 0.011], female sex (OR: 2.18; P = 0.003), cardiac arrest (OR: 12.21; P = 0.000), heart failure/cardiogenic shock (OR: 9.99; P = 0.000), sepsis/septic shock (OR: 5.54; P = 0.000), acute kidney injury (OR: 3.25; P = 0.021) and a primary diagnosis of acute heart failure or a condition other than acute heart failure and acute coronary syndrome. During a mean follow-up period of 17.4 ± 4.8 months, 96 all-cause deaths occurred in patients who were still alive at discharge. One-year mortality rate was 8.2%. Predictors of long-term mortality were age (hazard ratio: 1.08; P = 0.000), female sex (hazard ratio: 0.59; P = 0.022), comorbidity at least 3 (hazard ratio: 1,60; P = 0.047), acute kidney injury (hazard ratio: 3.15; P = 0.001), inotropic treatment (hazard ratio: 2.54; P = 0.002) and a primary diagnosis of acute heart failure. CONCLUSION In our Level-2 ICCU, predictors of in-hospital and long-term mortality are similar to those commonly found in a Level-3 ICU. These data strongly suggest that ICUs dealing with acute cardiovascular patients should be reorganized with a necessary upgrading of competences and resources for medical and nursing staff.
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Affiliation(s)
| | | | - Andrea Santucci
- Cardiology Department, Santa Maria della Misericordia Hospital
| | | | | | | | | | - Paolo Verdecchia
- 'Fondazione Umbra Cuore e Ipertensione-ONLUS', Cardiology Department, Santa Maria della Misericordia Hospital, Perugia, Italy
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16
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Jentzer JC, Bennett C, Wiley BM, Murphree DH, Keegan MT, Barsness GW. Predictive value of individual Sequential Organ Failure Assessment sub-scores for mortality in the cardiac intensive care unit. PLoS One 2019; 14:e0216177. [PMID: 31107889 PMCID: PMC6527229 DOI: 10.1371/journal.pone.0216177] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/15/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To determine the impact of Sequential Organ Failure Assessment (SOFA) organ sub-scores for hospital mortality risk stratification in a contemporary cardiac intensive care unit (CICU) population. Materials and methods Adult CICU admissions between January 1, 2007 and December 31, 2015 were reviewed. The SOFA score and organ sub-scores were calculated on CICU day 1; patients with missing SOFA sub-score data were excluded. Discrimination for hospital mortality was assessed using area under the receiver-operator characteristic curve (AUROC) values, followed by multivariable logistic regression. Results We included 1214 patients with complete SOFA sub-score data. The mean age was 67 ± 16 years (38% female); all-cause hospital mortality was 26%. Day 1 SOFA score predicted hospital mortality with an AUROC of 0.72. Each SOFA organ sub-score predicted hospital mortality (all p <0.01), with AUROC values of 0.53 to 0.67. On multivariable analysis, only the cardiovascular, central nervous system, renal and respiratory SOFA sub-scores were associated with hospital mortality (all p <0.01). A simplified SOFA score containing the cardiovascular, central nervous system and renal sub-scores had an AUROC of 0.72. Conclusions In CICU patients with complete SOFA sub-score data, risk stratification for hospital mortality is determined primarily by the cardiovascular, central nervous system, renal and respiratory SOFA sub-scores.
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Affiliation(s)
- Jacob C. Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
| | - Courtney Bennett
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Brandon M. Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Dennis H. Murphree
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Mark T. Keegan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Gregory W. Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
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17
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Bennett CE, Wright RS, Jentzer J, Gajic O, Murphree DH, Murphy JG, Mankad SV, Wiley BM, Bell MR, Barsness GW. Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit. J Crit Care 2018; 50:242-246. [PMID: 30612068 DOI: 10.1016/j.jcrc.2018.12.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess trends in life support interventions and performance of the automated Acute Physiology and Chronic Health Evaluation (APACHE) IV model at mortality prediction compared with Oxford Acute Severity of Illness Score (OASIS) in a contemporary cardiac intensive care unit (CICU). METHODS AND MATERIALS Retrospective analysis of adults (age ≥ 18 years) admitted to CICU from January 1, 2007, through December 31, 2015. Temporal trends were assessed with linear regression. Discrimination of each risk score for hospital mortality was assessed with use of area under the receiver operating characteristic curve (AUROC) values. Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test. RESULTS The study analyzed 10,004 patients. CICU and hospital mortality rates were 5.7% and 9.1%. APACHE IV predicted death had an AUROC of 0.82 (0.81-0.84) for hospital death, compared with 0.79 for OASIS (P < .05). Calibration was better for OASIS than APACHE IV. Increases were observed in CICU and hospital lengths of stay (both P < .001), APACHE IV predicted mortality (P = .007), Charlson Comorbidity Index (P < .001), noninvasive ventilation use (P < .001), and noninvasive ventilation days (P = .02). CONCLUSIONS Contemporary CICU patients are increasingly ill, observed in upward trends in comorbid conditions and life support interventions. APACHE IV predicted death and OASIS showed good discrimination in predicting death in this population. APACHE IV and OASIS may be useful for benchmarking and quality improvement initiatives in the CICU, the former having better discrimination.
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Affiliation(s)
- Courtney E Bennett
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.
| | - R Scott Wright
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Jacob Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Dennis H Murphree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
| | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Sunil V Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Brandon M Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
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Watson RA, Bohula EA, Gilliland TC, Sanchez PA, Berg DD, Morrow DA. Editor’s Choice-Prospective registry of cardiac critical illness in a modern tertiary care Cardiac Intensive Care Unit. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:755-761. [DOI: 10.1177/2048872618789053] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The changing landscape of care in the Cardiac Intensive Care Unit (CICU) has prompted efforts to redesign the structure and organization of advanced CICUs. Few studies have quantitatively characterized current demographics, diagnoses, and outcomes in the contemporary CICU. Methods: We evaluated patients in a prospective observational database, created to support quality improvement and clinical care redesign in an AHA Level 1 (advanced) CICU at Brigham and Women’s Hospital, Boston, MA, USA. All consecutive patients ( N=2193) admitted from 1 January 2015 to 31 December 2017 were included at the time of admission to the CICU. Results: The median age was 65 years (43% >70 years) and 44% of patients were women. Non-cardiovascular comorbidities were common, including chronic kidney disease (27%), pulmonary disease (22%), and active cancer (13%). Only 7% of CICU admissions were primarily for an acute coronary syndrome, which was the seventh most common individual diagnosis. The top three reasons for admission to the CICU were shock/hypotension (26%), cardiopulmonary arrest (11%), or primary arrhythmia without arrest (9%). Respiratory failure was a primary or major secondary reason for triage to the CICU in 17%. In-hospital mortality was 17.6%. Conclusions: In a tertiary, academic, advanced CICU, patients are elderly with a high burden of non-cardiovascular comorbid conditions. Care has shifted from ACS toward predominantly shock and cardiac arrest, as well as non-ischemic conditions, and the mortality of these conditions is high. These data may be useful to guide cardiac critical care redesign.
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Affiliation(s)
- Ryan A Watson
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Erin A Bohula
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Thomas C Gilliland
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Pablo A Sanchez
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - David D Berg
- Deparment of Medicine, Division of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - David A Morrow
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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Jentzer JC, Bennett C, Wiley BM, Murphree DH, Keegan MT, Gajic O, Wright RS, Barsness GW. Predictive Value of the Sequential Organ Failure Assessment Score for Mortality in a Contemporary Cardiac Intensive Care Unit Population. J Am Heart Assoc 2018. [PMID: 29525785 PMCID: PMC5907568 DOI: 10.1161/jaha.117.008169] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Optimal methods of mortality risk stratification in patients in the cardiac intensive care unit (CICU) remain uncertain. We evaluated the ability of the Sequential Organ Failure Assessment (SOFA) score to predict mortality in a large cohort of unselected patients in the CICU. METHODS AND RESULTS Adult patients admitted to the CICU from January 1, 2007, to December 31, 2015, at a single tertiary care hospital were retrospectively reviewed. SOFA scores were calculated daily, and Acute Physiology and Chronic Health Evaluation (APACHE)-III and APACHE-IV scores were calculated on CICU day 1. Discrimination of hospital mortality was assessed using area under the receiver-operator characteristic curve values. We included 9961 patients, with a mean age of 67.5±15.2 years; all-cause hospital mortality was 9.0%. Day 1 SOFA score predicted hospital mortality, with an area under the receiver-operator characteristic curve value of 0.83; area under the receiver-operator characteristic curve values were similar for the APACHE-III score, and APACHE-IV predicted mortality (P>0.05). Mean and maximum SOFA scores over multiple CICU days had greater discrimination for hospital mortality (P<0.01). Patients with an increasing SOFA score from day 1 and day 2 had higher mortality. Patients with day 1 SOFA score <2 were at low risk of mortality. Increasing tertiles of day 1 SOFA score predicted higher long-term mortality (P<0.001 by log-rank test). CONCLUSIONS The day 1 SOFA score has good discrimination for short-term mortality in unselected patients in the CICU, which is comparable to APACHE-III and APACHE-IV. Advantages of the SOFA score over APACHE include simplicity, improved discrimination using serial scores, and prediction of long-term mortality.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN .,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Courtney Bennett
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Brandon M Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Mark T Keegan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - R Scott Wright
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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The Difficult Evolution of Intensive Cardiac Care Units: An Overview of the BLITZ-3 Registry and Other Italian Surveys. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6025470. [PMID: 29362712 PMCID: PMC5736902 DOI: 10.1155/2017/6025470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/03/2017] [Indexed: 12/20/2022]
Abstract
Coronary care units, initially developed to treat acute myocardial infarction, have moved to the care of a broader population of acute cardiac patients and are currently defined as Intensive Cardiac Care Units (ICCUs). However, very limited data are available on such evolution. Since 2008, in Italy, several surveys have been designed to assess ICCUs' activities. The largest and most comprehensive of these, the BLITZ-3 Registry, observed that patients admitted are mainly elderly males and suffer from several comorbidities. Direct admission to ICCUs through the Emergency Medical System was rather rare. Acute coronary syndromes (ACS) account for more than half of the discharge diagnoses. However, numbers of acute heart failure (AHF) admissions are substantial. Interestingly, age, resources availability, and networking have a strong influence on ICCUs' epidemiology and activities. In fact, while patients with ACS concentrate in ICCUs with interventional capabilities, older patients with AHF or non-ACS, non-AHF cardiac diseases prevail in peripheral ICCUs. In conclusion, although ACS is still the core business of ICCUs, aging, comorbidities, increasing numbers of non-ACS, technological improvements, and resources availability have had substantial effects on epidemiology and activities of ICCUs. The Italian surveys confirm these changes and call for a substantial update of ICCUs' organization and competences.
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Bonnefoy-Cudraz E, Bueno H, Casella G, De Maria E, Fitzsimons D, Halvorsen S, Hassager C, Iakobishvili Z, Magdy A, Marandi T, Mimoso J, Parkhomenko A, Price S, Rokyta R, Roubille F, Serpytis P, Shimony A, Stepinska J, Tint D, Trendafilova E, Tubaro M, Vrints C, Walker D, Zahger D, Zima E, Zukermann R, Lettino M. Editor's Choice - Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:80-95. [PMID: 28816063 DOI: 10.1177/2048872617724269] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper on acute cardiovascular care organisation, using a multinational working group. The patient population has changed, and intensive cardiovascular care units now manage a large range of conditions from those simply requiring specialised monitoring, to critical cardiovascular diseases with associated multi-organ failure. To describe better intensive cardiovascular care units case mix, acuity of care has been divided into three levels, and then defining intensive cardiovascular care unit functional organisation. For each level of intensive cardiovascular care unit, this document presents the aims of the units, the recommended management structure, the optimal number of staff, the need for specially trained cardiologists and cardiovascular nurses, the desired equipment and architecture, and the interaction with other departments in the hospital and other intensive cardiovascular care units in the region/area. This update emphasises cardiologist training, referring to the recently updated Acute Cardiovascular Care Association core curriculum on acute cardiovascular care. The training of nurses in acute cardiovascular care is additionally addressed. Intensive cardiovascular care unit expertise is not limited to within the unit's geographical boundaries, extending to different specialties and subspecialties of cardiology and other specialties in order to optimally manage the wide scope of acute cardiovascular conditions in frequently highly complex patients. This position paper therefore addresses the need for the inclusion of acute cardiac care and intensive cardiovascular care units within a hospital network, linking university medical centres, large community hospitals, and smaller hospitals with more limited capabilities.
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Affiliation(s)
| | - Hector Bueno
- 2 Centro Nacional de Investigaciones Cardiovasculares, Cardiology Department, Hospital Universitario 12 de Octubre, Spain
| | - Gianni Casella
- 3 Department of Cardiology, Ospedale Maggiore, Bologna, Italy
| | - Elia De Maria
- 4 Cardiology Unit, Ramazzini Hospital, Carpi (Modena), Italy
| | | | - Sigrun Halvorsen
- 6 Department of Cardiology, Oslo University Hospital Ulleval and University of Oslo, Oslo, Norway
| | | | - Zaza Iakobishvili
- 8 Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Israel
| | | | - Toomas Marandi
- 10 North Estonia Medical Centre, Tallinn and University of Tartu, Tartu, Estonia
| | - Jorge Mimoso
- 11 Department of Cardiology, Centro Hospitalar do Algarve, Faro, Portugal
| | | | | | - Richard Rokyta
- 14 Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, Czech Republic
| | - Francois Roubille
- 15 Cardiology Department, University Hospital of Montpellier, France
| | - Pranas Serpytis
- 16 Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Avi Shimony
- 17 Department of Cardiology, Soroka University Medical Center,Ben-Gurion University, Israel
| | | | - Diana Tint
- 19 ICCO Clinics, Faculty of Medicine, Transilvania University Brasov, Romania
| | | | - Marco Tubaro
- 21 ICCU, Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | - David Walker
- 23 East Sussex Healthcare NHS Trust, Hastings, UK
| | - Doron Zahger
- 24 Faculty of Health Sciences, Ben Gurion University of the NegevBeer Sheva, Israel
| | - Endre Zima
- 25 Semmelweis University Heart and Vascular Center, CardiacIntensive Care Unit, Budapest, Hungary
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Roubille F, Mercier G, Delmas C, Manzo-Silberman S, Leurent G, Elbaz M, Riondel A, Bonnefoy-Cudraz E, Henry P. Description of acute cardiac care in 2014: A French nation-wide database on 277,845 admissions in 270 ICCUs. Int J Cardiol 2017; 240:433-437. [PMID: 28400122 DOI: 10.1016/j.ijcard.2017.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/10/2017] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Intensive Cardiac Care Unit (ICCU) has greatly evolved for decades: it no longer includes only patients with coronary artery disease (CAD). The clinical characteristics and pathological profiles of patients have markedly changed. Detailed data on the topic are critically lacking. METHODS We present here a French nation-wide administrative database with an exhaustive description of patients admitted to ICCU throughout a whole year (2014). RESULTS A total of 277,845 patients in 270 centers were admitted to ICCUs at least once in 2014 (exhaustive data). Median age was 71years (IQR: 59-81) and the patients were primarily male (63%). Mean ICCU stay was 2.0days (1.0-4.0). CAD patients (49.0%) represented the major group admitted, followed by patients with arrhythmias (15.2%) and heart failure (HF) (10.0%). Patients admitted with acute CAD were significantly younger (mean age 67.4 y), had better outcomes (mortality 4.0%), and shorter hospital stays (mean stay 6.7 d). Patients with HF were significantly older (mean age 75.2 y), with longer hospital stays (mean stay 12.0 d), and poorer outcomes (mortality 10.5%). CONCLUSION We present here the largest contemporary administrative database on patients admitted to ICCUs in a developed country. CAD (mainly acute coronary syndromes) remains the primary cause of admission but the population is, by far, more complex than generally considered.
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Affiliation(s)
- François Roubille
- Cardiology Department, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France.
| | - Grégoire Mercier
- Economic Evaluation Unit at Montpellier Teaching Hospital, University of Montpellier, Montpellier, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, Toulouse, France
| | - Stéphane Manzo-Silberman
- Department of Cardiology, Inserm U942, Lariboisière Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Guillaume Leurent
- CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes F-35000, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, Toulouse, France
| | - Adeline Riondel
- Economic Evaluation Unit at Montpellier Teaching Hospital, University of Montpellier, Montpellier, France
| | | | - Patrick Henry
- Department of Cardiology, Inserm U942, Lariboisière Hospital, AP-HP, Paris Diderot University, Paris, France
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Doğan S, Dursun H, Can H, Ellidokuz H, Kaya D. Long-term assessment of coronary care unit patient profile and outcomes: analyses of the 12-years patient records. Turk J Med Sci 2016; 46:801-6. [PMID: 27513259 DOI: 10.3906/sag-1502-88] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 08/16/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of this study was to determine the patient profile, treatment, and outcomes of a coronary care unit (CCU) by retrospective screening of 12-year patient records. MATERIALS AND METHODS The data of 13,463 patients admitted to the CCU of a tertiary referral hospital between 1 January 1997 and 30 June 2008 were collected. The patients were assessed with respect to demographics, admission diagnosis, treatment, and outcomes. RESULTS The mean age of patients was 61 ± 13 years (66.7%, male). While the diagnosis of acute coronary syndrome (ACS) accounted for 65%, the rate of ST elevation myocardial infarction (STEMI) was 43.4%. Thrombolytic therapy was administered to 48.7% of the patients with STEMI. Systolic heart failure was the most frequent disease (11.9%) among the non-ACS diagnoses. The mortality rate of the CCU was 12.7% on average; it increased gradually after 2005 when the CCU became a general intensive care unit. CONCLUSION This study is one of the largest comprehensive analyses of patient profile and outcomes of a CCU. Despite advances in the diagnosis and treatment of cardiac emergencies, the mortality rate of the CCU was high. Serving as a general intensive care unit, the absence of a coronary angiography laboratory and lower use of thrombolytic therapy for STEMI might be responsible factors.
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Affiliation(s)
- Selami Doğan
- Bayraklı Adalet Family Health Center, İzmir, Turkey
| | - Hüseyin Dursun
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Hüseyin Can
- Division of Family Medicine, Faculty of Medicine, Katip Çelebi University, İzmir, Turkey
| | - Hülya Ellidokuz
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Dayimi Kaya
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Postinfarct Left Ventricular Remodelling: A Prevailing Cause of Heart Failure. Cardiol Res Pract 2016; 2016:2579832. [PMID: 26989555 PMCID: PMC4775793 DOI: 10.1155/2016/2579832] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/13/2016] [Accepted: 01/17/2016] [Indexed: 12/11/2022] Open
Abstract
Heart failure is a chronic disease with high morbidity and mortality, which represents a growing challenge in medicine. A major risk factor for heart failure with reduced ejection fraction is a history of myocardial infarction. The expansion of a large infarct scar and subsequent regional ventricular dilatation can cause postinfarct remodelling, leading to significant enlargement of the left ventricular chamber. It has a negative prognostic value, because it precedes the clinical manifestations of heart failure. The characteristics of the infarcted myocardium predicting postinfarct remodelling can be studied with cardiac magnetic resonance and experimental imaging modalities such as diffusion tensor imaging can identify the changes in the architecture of myocardial fibers. This review discusses all the aspects related to postinfarct left ventricular remodelling: definition, pathogenesis, diagnosis, consequences, and available therapies, together with experimental interventions that show promising results against postinfarct remodelling and heart failure.
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Uscinska E, Sobkowicz B, Lisowska A, Sawicki R, Dabrowska M, Szmitkowski M, Musial WJ, Tycinska AM. Predictors of Long-Term Mortality in Patients Hospitalized in an Intensive Cardiac Care Unit. Int Heart J 2016; 57:67-72. [DOI: 10.1536/ihj.15-249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ewa Uscinska
- Department of Cardiology, Medical University of Bialystok
| | | | - Anna Lisowska
- Department of Cardiology, Medical University of Bialystok
| | - Robert Sawicki
- Department of Cardiology, Medical University of Bialystok
| | - Milena Dabrowska
- Department of Hematological Diagnostics, Medical University of Bialystok
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Olivari Z, Steffenino G, Savonitto S, Chiarella F, Chinaglia A, Lucci D, Maggioni AP, Pirelli S, Scherillo M, Scorcu G, Tricoci P, Urbinati S. The management of acute myocardial infarction in the cardiological intensive care units in Italy: the 'BLITZ 4 Qualità' campaign for performance measurement and quality improvement. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:143-52. [PMID: 24062902 DOI: 10.1177/2048872612450520] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/14/2012] [Indexed: 02/05/2023]
Abstract
AIM To assess and promote compliance of Italian cardiological intensive care units (CCUs) with evidence-based guidelines for the management of acute myocardial infarction (MI). METHODS AND RESULTS The process of diagnosis and treatment of MI was prospectively evaluated in 163 CCUs by use of 30 indicators during two enrolment phases, each followed by a feedback of both local and general performance. Overall, 5854 patients with ST-segment elevation MI (STEMI) and 5852 with non-ST-segment elevation MI (NSTEMI) were consecutively enrolled. The target for each indicator was defined as compliance with the relevant recommendations in ≥90% of suitable patients and it was met for nine (30%) and 10 (33.3%) indicators in the first and second phases, respectively. Regardless of target, a significant improvement in compliance was observed in the second phase in 10 out of 30 indicators (33.3%). Use of pre-hospital ECG, expedite delivery of reperfusion therapy, dosage of antithrombotic drugs, and non-pharmacological implementation of secondary prevention were often off target. Similar in-hospital mortality was observed in phases I and II, both in patients with STEMI (4.0 vs. 4.2%, p=0.79) and NSTEMI (1.8 vs. 2.4%, p=0.11). Overall, 30-day mortality were 5.7% for patients with STEMI and 3.4% with NSTEMI. CONCLUSIONS Performance indicators can accurately weigh the whole process of diagnosis and treatment of patients with MI and monitor the improvements in the quality of care. In our large population of consecutive patients, satisfactory 30-day outcomes were observed despite suboptimal adherence to guidelines for some indicators of recognised prognostic relevance.
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Casella G, Di Pasquale G, Oltrona Visconti L, Pallotti MG, Lucci D, Caldarola P, Scherillo M, Maggioni AP. Management of patients with acute coronary syndromes in real-world practice in Italy: an outcome research study focused on the use of ANTithRombotic Agents: the MANTRA registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 2:27-34. [PMID: 24062931 DOI: 10.1177/2048872612471213] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 11/24/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although outcomes of acute coronary syndromes (ACS) have greatly improved, bleeding is still an issue. Thus, this study aims to evaluate in-hospital management and outcomes of unselected patients with ACS focusing on antithrombotic therapies and bleeding. METHODS AND RESULTS From 22 April 2009 to 29 December 2010, 6394 consecutive Italian patients were prospectively enrolled and followed for 6 months. Most patients (55.3%) had non-ST-elevation (NSTE) ACS. Of the ST-elevation (STE) ACS patients, 79.8% received reperfusion (mainly mechanical). In-hospital and 6-month unadjusted total mortality rates were 4.2 and 7.8% for STE-ACS and 2.5 and 6.4% for NSTE-ACS, respectively. During hospitalization, TIMI major bleeding rate was 1.2% (1.4% STE-ACS and 1.1% NSTE-ACS, respectively) and TIMI minor bleeding was 3.1%. In-hospital and 6-month unadjusted total mortality rates were 3.1 and 6.7% for patients without bleeding, 1.5 and 8.6% for minor bleeding, and 19.0 and 26.6% for TIMI major bleeding, respectively (p<0.0001). Notably, TIMI major bleeding was one of the strongest predictors of the 6-month composite end point (death or reinfarction) (STE-ACS hazard ratio, HR, 2.86, 95% confidence interval, 95% CI, 1.57-5.23; NSTE-ACS HR, 2.71, 95% CI 1.52-4.80). Predictors of in-hospital TIMI major bleeding were weight (odds ratio, OR, 0.97, 95% CI 0.95-0.99), female gender (OR 1.80, 95% CI 1.09-2.96), history of peripheral vasculopathy (OR 2.95, 95% CI 1.83-4.78), switching anticoagulant therapy (OR 2.62, 95% CI 1.36-5.05), intra-aortic balloon pump implantation (OR 4.44, 95% CI 1.85-10.69), and creatinine ≥2 mg/dl on admission (OR 3.68, 95% CI 1.84-7.33). CONCLUSIONS Despite aggressive management, the rate of bleeding remains relatively low in an unselected ACS population. However, major bleeding adversely affects prognosis and physicians should tailor treatments to reduce it.
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Affiliation(s)
- Gianni Casella
- Maggiore Hospital, Cardiology Department, Bologna, Italy
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Outcomes, Health Costs and Use of Antiplatelet Agents in 7,082 Patients Admitted for an Acute Coronary Syndrome Occurring in a Large Community Setting. Cardiovasc Drugs Ther 2013; 27:333-40. [DOI: 10.1007/s10557-013-6455-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Roggeri DP, Roggeri A, Rossi E, Cinconze E, De Rosa M, Maggioni AP. Direct healthcare costs and resource consumption after acute coronary syndrome: a real-life analysis of an Italian subpopulation. Eur J Prev Cardiol 2013; 21:1090-6. [PMID: 23515447 DOI: 10.1177/2047487313483608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is the most common cause of morbidity and mortality in Italy and worldwide. Aim of this study was to evaluate the average annual direct healthcare costs for the treatment of patients with a recent hospitalization for ACS. DESIGN AND METHODS The direct medical costs of patients with a first ACS hospitalization (index event) in the period from 1 January 2008 to 31 December 2008 were estimated for a 1-year follow-up period. The resource consumption was measured in terms of: reimbursed drugs, diagnostic procedures, outpatient visits, and hospitalizations. The analysis was performed from the Italian National Health Service perspective. RESULTS A total of 2,758,872 subjects were observed, 7082 (35.8% women) of whom being hospitalized for ACS during the accrual period (2.6 ‰). Among patients with ACS, 60% were medically treated, 33.1% were treated with percutaneous coronary intervention (PCI), and 6.9% died during the index hospitalization. Dual antiplatelet treatment (ASA plus clopidogrel) was prescribed in 25.9% of the medically treated ACS patients and in 70.1% of the ACS patients treated with PCI. The average yearly cost per patient for the total ACS population was 11,464€/year (drugs 1,304€; hospitalizations 9,655€; diagnostic and outpatient visits 505€). The average annual cost was 10,862€ for medically treated patients and 14,111€ for patients treated with PCI. Patients who died of cardiovascular events during follow up had an average cost of 16,231€/patient. CONCLUSIONS Patients with ACS had higher direct healthcare costs, their management and rehospitalizations being the main cost drivers.
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Affiliation(s)
| | | | - Elisa Rossi
- CINECA, Interuniversity Consortium, Bologna, Italy
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Clinical features and short term outcomes of patients with acute pulmonary embolism. The Italian Pulmonary Embolism Registry (IPER). Thromb Res 2012; 130:847-52. [DOI: 10.1016/j.thromres.2012.08.292] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/29/2012] [Accepted: 08/06/2012] [Indexed: 11/23/2022]
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Morrow DA, Fang JC, Fintel DJ, Granger CB, Katz JN, Kushner FG, Kuvin JT, Lopez-Sendon J, McAreavey D, Nallamothu B, Page RL, Parrillo JE, Peterson PN, Winkelman C. Evolution of Critical Care Cardiology: Transformation of the Cardiovascular Intensive Care Unit and the Emerging Need for New Medical Staffing and Training Models. Circulation 2012; 126:1408-28. [DOI: 10.1161/cir.0b013e31826890b0] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Cicero AF, D’Addato S, Santi F, Ferroni A, Borghi C. Leisure-time physical activity and cardiovascular disease mortality. J Cardiovasc Med (Hagerstown) 2012; 13:559-64. [DOI: 10.2459/jcm.0b013e3283516798] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abuzetun JY, Satpathy R, Suker M, Elder M, Mooss A. Naproxen-induced ST-elevation myocardial infarction in a 33-year-old man. J Cardiovasc Med (Hagerstown) 2012; 13:471-3. [DOI: 10.2459/jcm.0b013e32833e57ff] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Marzocchi A, Taglieri N, Saia F, Marrozzini C, Rapezzi C, Gallo P, Cortesi P, Guastaroba P, Palmerini T, Moretti C, Di Pasquale G, Sangiorgio P, De Palma R. Incidence, treatment and outcome of acute coronary syndromes: A community-based study in the era of myocardial infarction networks. Int J Cardiol 2012; 157:419-22. [DOI: 10.1016/j.ijcard.2012.03.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 03/17/2012] [Indexed: 11/30/2022]
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Rizzello V, Lucci D, Maggioni AP, Giampaoli S, Greco C, Pasquale GD, Pallotti MG, Mureddu GF, Chiara AD, Boccanelli A. Clinical epidemiology, management and outcome of acute coronary syndromes in the Italian network on acute coronary syndromes (IN-ACS Outcome study). ACTA ACUST UNITED AC 2012; 14:71-80. [DOI: 10.3109/17482941.2012.655296] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Casella G, Scorcu G, Cassin M, Chiarella F, Chinaglia A, Conte MR, Fradella G, Lucci D, Maggioni AP, Visconti LO. Elderly patients with acute coronary syndromes admitted to Italian intensive cardiac care units. J Cardiovasc Med (Hagerstown) 2012; 13:165-74. [DOI: 10.2459/jcm.0b013e3283515be3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Andreou AY, Georgiou GM, Avraamides PC. Preinfarction angina entailing precordial ST segment depression with positive T wave. J Cardiovasc Med (Hagerstown) 2011; 12:828-32. [DOI: 10.2459/jcm.0b013e3283406413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kopjar T, Biočina B, Gašparović H, Sirić F, Strozzi M, Stern-Padovan R. Combined surgical and angioplasty management of coronary artery aneurysms including the giant form. J Cardiovasc Med (Hagerstown) 2011; 12:657-9. [PMID: 21709579 DOI: 10.2459/jcm.0b013e328348e58c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronary artery aneurysms are a rare form of coronary artery disease. Due to the rarity of these aneurysms, particularly of the giant form, it is difficult to establish a standardized treatment. We report the case of a 65-year-old man who presented with symptoms of an acute coronary syndrome. A posterobasal myocardial infarction was diagnosed with a giant right coronary artery aneurysm as the underlying pathology. Two aneurysms of the left anterior descending artery were also revealed. The management strategy included ligation of the giant aneurysm coupled with distal coronary artery bypass grafting of the right coronary artery. This was complemented with a delayed percutaneous coronary intervention of the left anterior descending artery aneurysms.
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Affiliation(s)
- Tomislav Kopjar
- Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
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Tubaro M. An organized system of emergency care for patients with myocardial infarction: a reality? Future Cardiol 2010; 6:483-9. [DOI: 10.2217/fca.10.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An organized system of emergency care is an essential requirement for the modern treatment of ST-elevation acute myocardial infarction. There is a strong need to deliver reperfusion therapy as soon as possible, with primary percutaneous coronary intervention being the preferred option if performed in a timely manner and thrombolytic therapy, particularly in the prehospital setting, being a good alternative if the primary percutaneous coronary intervention-related delay exceeds the equipoise. In this situation, emergency medical services have a primary role in rescuing patients from cardiac arrest, performing prehospital diagnosis, triage and treatment and safely transporting them to the most appropriate cardiological center, including interhospital transfer. A complete reorganization of the healthcare systems in different countries is frequently needed to build an ST-elevation acute myocardial infarction system of care, focusing on fast transport, use of telemedicine and diversion protocols to skip the unsuited centers.
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Affiliation(s)
- Marco Tubaro
- Cardiovascular Department, San Filippo Neri Hospital, Rome, Italy
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