Full-Time Cardiac Intensive Care Unit Staffing by Heart Failure Specialists and its Association with Mortality Rates

DANIEL B. SIMS, YEKATERINA KIM, ALEKSANDR KALININSKIY, MOUNICA YANAMANDALA, JOSHUA JOSEPHS, MERCEDES RIVAS-LASARTE, NAVID AHMED, ANDREI ASSA, FATHIMA JAHUFAR, SALIL KUMAR, E. R.I.C. SUN, KUSHA RAHGOZAR, SYED ZAIN ALI, M. I.N.G. ZHANG, SHREYANS PATEL, PAULINE EDWARDS, O. M.A.R. SAEED, Jooyoung (Julia) Shin, Sandhya Murthy, Snehal R. PatelA. M.A.N. SHAH, ULRICH P. JORDE

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Cardiac intensive care units (CICUs) serve medically complex patients with multiorgan dysfunction. Whether a CICU that is staffed full time by heart failure (HF) specialists is associated with decreased mortality is unclear. Methods and Results: A retrospective review of consecutive CICU admissions from January 1, 2012, to December 31, 2016, was performed. In January 2014, the CICU changed from an open unit staffed by any cardiologist to a closed unit managed by HF specialists. Patients’ baseline characteristics were determined, and a multivariate regression analysis was performed to ascertain mortality rates in the CICU. Baseline severity of illness was higher in the closed/HF specialist CICU model (P< 0.001). Death occurred in 101 of 1185 patients admitted to the CICU (8.5%) in the open-unit model and in 139 of 2163 patients (6.4%) admitted to the closed/HF specialist model (absolute risk reduction 2.1%, 95% confidence interval [CI] 0.1–4.0%; P = 0.01). The transition from an open to a closed/HF specialist model was associated with a lower overall CICU mortality rate (odds ratio [OR] 0.63; 95% CI 0.43–0.93). Prespecified interaction with a mechanical circulatory support device and unit model showed that treatment with such a device was associated with lower mortality rates in the closed/HF specialist model of a CICU (OR 0.6; 95% CI 0.18–0.78; P for interaction <0.01). Conclusion: Transition to a closed unit model staffed by a dedicated HF specialist is associated with lower CICU mortality rates.

Original languageEnglish (US)
JournalJournal of Cardiac Failure
DOIs
StateAccepted/In press - 2021

Keywords

  • advanced heart failure
  • Critical care cardiology
  • mechanical circulatory support
  • staffing patterns

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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