Jacob C Jentzer1, Sean van Diepen2, Gregory W Barsness3, Jason N Katz4, Brandon M Wiley5, Courtney E Bennett6, Sunil V Mankad7, Lawrence J Sinak8, Patricia J Best9, Joerg Herrmann10, Allan S Jaffe11, Joseph G Murphy12, David A Morrow13, R Scott Wright14, Malcolm R Bell15, Nandan S Anavekar16. 1. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: jentzer.jacob@mayo.edu. 2. Divisions of Cardiology and Pulmonary and Critical Care Medicine, University of Alberta Hospital, Edmonton, Alberta. Electronic address: sv9@ualberta.ca. 3. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: barsness.gregory@mayo.edu. 4. Divisions of Cardiology and Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, NC. Electronic address: katzj@med.unc.edu. 5. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: wiley.brandon@mayo.edu. 6. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: bennett.courtney@mayo.edu. 7. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: mankad.sunil@mayo.edu. 8. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: sinak.lawrence@mayo.edu. 9. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: best.patricia@mayo.edu. 10. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: herrmann.joerg@mayo.edu. 11. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: jaffe.allan@mayo.edu. 12. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: murphy.joseph@mayo.edu. 13. TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Electronic address: dmorrow@bwh.harvard.edu. 14. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: wright.scott@mayo.edu. 15. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: bell.malcolm@mayo.edu. 16. Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN. Electronic address: anavekar.nandan@mayo.edu.
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.
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.
Authors: Alexander Thomas; Sean van Diepen; Rachel Beekman; Shashank S Sinha; Samuel B Brusca; Carlos L Alviar; Jacob Jentzer; Erin A Bohula; Jason N Katz; Andi Shahu; Christopher Barnett; David A Morrow; Emily J Gilmore; Michael A Solomon; P Elliott Miller Journal: JACC Adv Date: 2022-08-26
Authors: Thomas S Metkus; P Elliott Miller; Carlos L Alviar; Vivian M Baird-Zars; Erin A Bohula; Paul C Cremer; Daniel A Gerber; Jacob C Jentzer; Ellen C Keeley; Michael C Kontos; Venu Menon; Jeong-Gun Park; Robert O Roswell; Steven P Schulman; Michael A Solomon; Sean van Diepen; Jason N Katz; David A Morrow Journal: Crit Care Explor Date: 2020-09-17
Authors: Shiva Nandiwada; Sunjidatul Islam; Jacob C Jentzer; P Elliott Miller; Christopher B Fordyce; Patrick Lawler; Carlos L Alviar; Louise Y Sun; Douglas C Dover; Renato D Lopes; Padma Kaul; Sean van Diepen Journal: Eur Heart J Acute Cardiovasc Care Date: 2021-10-01
Authors: Jacob C Jentzer; Brandon M Wiley; Yogesh N V Reddy; Christopher Barnett; Barry A Borlaug; Michael A Solomon Journal: Eur Heart J Acute Cardiovasc Care Date: 2022-03-16
Authors: Jacob C Jentzer; Brandon Wiley; Courtney Bennett; Dennis H Murphree; Mark T Keegan; Ognjen Gajic; Kianoush B Kashani; Gregory W Barsness Journal: Clin Cardiol Date: 2020-01-30 Impact factor: 2.882
Authors: P Elliott Miller; Alexander Thomas; Thomas J Breen; Fouad Chouairi; Yukiko Kunitomo; Faisal Aslam; Abdulla A Damluji; Nandan S Anavekar; Joseph G Murphy; Sean van Diepen; Gregory W Barsness; Joseph Brennan; Jacob Jentzer Journal: Am J Med Date: 2020-10-28 Impact factor: 4.965