Changes in comorbidities, diagnoses, therapies and outcomes in a contemporary cardiac intensive care unit population

Jacob C. Jentzer, Sean van Diepen, Gregory W. Barsness, Jason N. Katz, Brandon M. Wiley, Courtney Bennett, Sunil V. Mankad, Lawrence J. Sinak, Patricia Best, Joerg Herrmann, Allan S Jaffe, Joseph G. Murphy, David A. Morrow, R. Scott Wright, Malcolm R. Bell, Nandan S. Anavekar

Research output: Contribution to journalArticle

Abstract

Prior studies have demonstrated that the cardiac intensive care unit (CICU) patient population has evolved over time. We sought to describe the temporal changes in comorbidities, illness severity, diagnoses, procedures and adjusted mortality within our CICU practice in recent years. Methods: We retrospectively reviewed unique CICU admissions at the Mayo Clinic from January 2007 to April 2018. Comorbidities, severity of illness scores, discharge diagnosis codes and CICU procedures and therapies were recorded, and temporal trends were assessed using linear regression and Cochran-Armitage trend tests. Trends in adjusted hospital mortality over time were assessed using multivariable logistic regression. Results: We included 12,418 patients with a mean age of 67.6 years (including 37.7% females). Temporal trends in the prevalence of several comorbidities and discharge diagnoses were observed, reflecting an increase in the prevalence of non-coronary cardiovascular diseases, critical care diagnoses, and organ failure (all P ≪ .05). The use of several CICU therapies and procedures increased over time, including mechanical ventilation, invasive lines and vasoactive drugs (all P ≪ .05). A temporal decrease in adjusted hospital mortality was observed among the subgroup of patients with (adjusted OR per year 0.97, 95% CI 0.94–0.99, P = .023) and without (adjusted OR per year 0.91, 95% CI 0.85–0.96, P = .002) a critical care discharge diagnosis. Conclusions: We observed an increasing prevalence of critical care and organ failure diagnoses as well as increased utilization of critical care therapies in this CICU cohort, associated with a decrease in risk-adjusted hospital mortality over time.

Original languageEnglish (US)
Pages (from-to)12-19
Number of pages8
JournalAmerican Heart Journal
Volume215
DOIs
StatePublished - Sep 1 2019

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Intensive Care Units
Comorbidity
Critical Care
Population
Hospital Mortality
Therapeutics
Artificial Respiration
Linear Models
Cardiovascular Diseases
Logistic Models
Mortality
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Changes in comorbidities, diagnoses, therapies and outcomes in a contemporary cardiac intensive care unit population. / Jentzer, Jacob C.; van Diepen, Sean; Barsness, Gregory W.; Katz, Jason N.; Wiley, Brandon M.; Bennett, Courtney; Mankad, Sunil V.; Sinak, Lawrence J.; Best, Patricia; Herrmann, Joerg; Jaffe, Allan S; Murphy, Joseph G.; Morrow, David A.; Wright, R. Scott; Bell, Malcolm R.; Anavekar, Nandan S.

In: American Heart Journal, Vol. 215, 01.09.2019, p. 12-19.

Research output: Contribution to journalArticle

Jentzer, JC, van Diepen, S, Barsness, GW, Katz, JN, Wiley, BM, Bennett, C, Mankad, SV, Sinak, LJ, Best, P, Herrmann, J, Jaffe, AS, Murphy, JG, Morrow, DA, Wright, RS, Bell, MR & Anavekar, NS 2019, 'Changes in comorbidities, diagnoses, therapies and outcomes in a contemporary cardiac intensive care unit population', American Heart Journal, vol. 215, pp. 12-19. https://doi.org/10.1016/j.ahj.2019.05.012
Jentzer, Jacob C. ; van Diepen, Sean ; Barsness, Gregory W. ; Katz, Jason N. ; Wiley, Brandon M. ; Bennett, Courtney ; Mankad, Sunil V. ; Sinak, Lawrence J. ; Best, Patricia ; Herrmann, Joerg ; Jaffe, Allan S ; Murphy, Joseph G. ; Morrow, David A. ; Wright, R. Scott ; Bell, Malcolm R. ; Anavekar, Nandan S. / Changes in comorbidities, diagnoses, therapies and outcomes in a contemporary cardiac intensive care unit population. In: American Heart Journal. 2019 ; Vol. 215. pp. 12-19.
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AU - van Diepen, Sean

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AU - Katz, Jason N.

AU - Wiley, Brandon M.

AU - Bennett, Courtney

AU - Mankad, Sunil V.

AU - Sinak, Lawrence J.

AU - Best, Patricia

AU - Herrmann, Joerg

AU - Jaffe, Allan S

AU - Murphy, Joseph G.

AU - Morrow, David A.

AU - Wright, R. Scott

AU - Bell, Malcolm R.

AU - Anavekar, Nandan S.

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N2 - Prior studies have demonstrated that the cardiac intensive care unit (CICU) patient population has evolved over time. We sought to describe the temporal changes in comorbidities, illness severity, diagnoses, procedures and adjusted mortality within our CICU practice in recent years. Methods: We retrospectively reviewed unique CICU admissions at the Mayo Clinic from January 2007 to April 2018. Comorbidities, severity of illness scores, discharge diagnosis codes and CICU procedures and therapies were recorded, and temporal trends were assessed using linear regression and Cochran-Armitage trend tests. Trends in adjusted hospital mortality over time were assessed using multivariable logistic regression. Results: We included 12,418 patients with a mean age of 67.6 years (including 37.7% females). Temporal trends in the prevalence of several comorbidities and discharge diagnoses were observed, reflecting an increase in the prevalence of non-coronary cardiovascular diseases, critical care diagnoses, and organ failure (all P ≪ .05). The use of several CICU therapies and procedures increased over time, including mechanical ventilation, invasive lines and vasoactive drugs (all P ≪ .05). A temporal decrease in adjusted hospital mortality was observed among the subgroup of patients with (adjusted OR per year 0.97, 95% CI 0.94–0.99, P = .023) and without (adjusted OR per year 0.91, 95% CI 0.85–0.96, P = .002) a critical care discharge diagnosis. Conclusions: We observed an increasing prevalence of critical care and organ failure diagnoses as well as increased utilization of critical care therapies in this CICU cohort, associated with a decrease in risk-adjusted hospital mortality over time.

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