Changes in Primary Noncardiac Diagnoses Over Time Among Elderly Cardiac Intensive Care Unit Patients in the United States

Abstract

Background Early reports suggest the number of CICU patients with primary non-cardiac diagnoses is rising in the U.S., but no national data currently exist. We examined changes in primary non-cardiac diagnoses among elderly patients admitted to a cardiac intensive care unit (CICU) over the last decade. Methods and Results Using 2003–2013 Medicare data, we grouped elderly patients admitted to CICUs into two categories based on principal diagnosis at discharge: 1) primary non-cardiac diagnoses and 2) primary cardiac diagnoses. We examined changes in patient demographics, comorbidities, procedure use, and risk-adjusted in-hospital mortality. Among 3.4 million admissions with a CICU stay, primary non-cardiac diagnoses rose in prevalence from 38.0% to 51.7% between 2003 and 2013. The fastest rising primary non-cardiac diagnoses were infectious diseases (7.8% to 15.1%) and respiratory diseases (6.0% to 7.6%) (p < 0.001 for both), while the fastest declining primary cardiac diagnosis was coronary artery disease (32.3% to 19.0%) (p < 0.001). Simultaneously, the prevalence of both cardiovascular and non-cardiovascular comorbidities rose: heart failure (13.9% to 34.4%), pulmonary vascular disease (1.2% to 7.1%), valvular heart disease (5.0% to 9.8%) and renal failure (7.1% to 19.6%) (p < 0.001 for all). As compared with those with primary cardiac diagnoses, elderly CICU patients with primary non-cardiac diagnoses had higher rates of non-cardiac procedure use and risk-adjusted in-hospital mortality (p < 0.001 for all). Risk-adjusted in-hospital mortality declined slightly in the overall cohort from 9.3% to 8.9% (p < 0.001). Conclusions More than half of all elderly patients with a CICU stay across the U.S. now have primary non-cardiac diagnoses at discharge. These patients receive different types of care and have worse outcomes than patients with primary cardiac diagnoses. Our work has important implications for the development of appropriate training and staffing models for the future critical care workforce.

Association of Fine Particulate Matter Exposure with Acute Noncardiovascular Critical Illnesses and In-hospital Outcomes in Patients Receiving Intensive Cardiac Care

“…Consequently, these patients may suffer a larger clinically meaningful impact of short-term PM 2.5 exposure that is not limited to the cardiovascular system. On the other hand, some studies have reported that ANCI is common and associates with increased mortality risk in contemporary ICCU settings (9,10). In consideration of a possible multisystemic consequence following short-term PM 2.5 exposure and the meaningfulness of ANCI, it is crucial to explore whether short-term PM 2.5 exposure is associated with the incidence of major ANCI.…”

Unsupervised Machine learning to subtype Sepsis-Associated Acute Kidney Injury

“…There are inherent differences between patients admitted to different specialty units on admission diagnoses, nosocomial infection rates, and mortality. (33–35) Unfortunately, we are unable to identify medical patients who were boarded in non-medical ICUs as this may have an impact on mortality. Finally, while the MIMIC-III database is a large, granular, ICU database; it is a single center database.…”

Trends in Cardiac Critical Care

“…7 CICU-specific revenue center codes within the claim records identified hospitalizations with a CICU stay. The principal finding of Sinha et al was a remarkable increase in the proportion of noncardiac primary diagnoses from 38.0% to 51.7% with a concurrent decline in primary diagnoses related to coronary artery disease from 32.3% to 19.0%.…”

“…7 By 2013, renal replacement therapy exceeded the use of pulmonary artery catheters and mechanical circulatory support combined. Patients with noncardiac primary diagnoses had more than double the rate of positive pressure ventilation and nearly double the rate of hemodialysis.…”

“…2 A series of single center and small multicenter studies, mostly in academic hospitals, have started to detail the progression of demographics, comorbid conditions, and procedures that characterize the contemporary CICU environment. [3][4][5][6] Now, in this issue of Circulation: Cardiovascular Quality and Outcomes, Sinha et al 7 extend this investigation to a national level. Their study contributes meaningfully to an expanding database that will facilitate evidence-based redesign of the structure, staffing, and organization of our CICUs.…”