Organization of intensive cardiac care units in Europe: Results of a multinational survey

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.

The Role of Prognostic Scores in Assessing the Prognosis of Patients Admitted in the Cardiac Intensive Care Unit: Emphasis on Heart Failure Patients

“…This finding indicates that, irrespective of the patient's profile, the need for CICU admission per se is a marker of severe underlying conditions with high mortality. The majority of hospitalized patients were admitted with an ACS or ADHF and the median length of stay in the CICU was 2 days, similar to previous studies [5][6][7]. In-hospital mortality rates were found to be lower compared to previously published data [6,8].…”

“…Historically, there is a gradual decline in the percentage of admissions for ACS and an increase in ADHF admissions, while patients admitted to the CICU are older with multiple comorbidities and various non-cardiac complications such as infections/sepsis, acute kidney injury and respiratory failure; these highlight the epidemiological changes in cardiovascular disease over the last decades, advocating the transition from a coronary care unit to a CICU covering many different acute cardiac pathologies [9]. According to recent data, 98% of hospitals in Europe have a dedicated CICU; 70% have a first level unit treating medical conditions demanding low levels of intensive care, 76% have a second level unit, able to provide moderate levels of care, while 51% have a third level unit treating patients with acute cardiac conditions severe enough or highly probable to require mechanical circulatory, renal or pulmonary support [5]. CICU staffing appears to have great differences among countries; the most striking of those appears to be the availability of nursing and medical personnel per patient [10].…”

Association between hospital and ICU structural factors and patient outcomes in China: a secondary analysis of the National Clinical Improvement System Data in 2019

“…It is well known that ICU structural factors vary within different countries and regions [4,5]. However, most related studies have been conducted in Western countries [6,7]. Little evidence regarding the structural factors of ICUs in China is available [8].…”

Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Consensus Document of the Acute CardioVascular Care (ACVC) association and the ESC council of Cardio-Oncology—Part 1: acute coronary syndromes and acute pericardial diseases

“…Cancer patients presenting with acute CV complications may be unstable and require multidisciplinary care with dedicated healthcare professionals care in a specialized acute cardiology department with level 2 care and monitoring. 7 A rapid diagnosis and the differentiation between a primary cardiac problem and a cardiac problem secondary to cancer or cancer treatment, if possible, are important to direct appropriate therapy in a timely manner and avoid any inappropriate escalation or de-escalation of the cancer treatment. An interdisciplinary discussion, preferably based on a local protocol, should be initiated as soon as possible after admission with precise documentation of the statements of the different specialists consulted.…”