Resuscitating a
            <i>Circulation</i>
            Abstract to Celebrate the 50th Anniversary of the Coronary Care Unit Concept

Fye, W. Bruce

doi:10.1161/circulationaha.111.033597

Cited by 35 publications

(31 citation statements)

References 40 publications

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“…1–4 These early units demonstrated substantial gains in survival for AMI patients, subsequently evolving into cardiac intensive care units (CICUs) that treat a wider array of acute cardiovascular diseases including cardiogenic shock, heart failure and complex arrhythmias. 5, 6 More recently, a handful of reports from large academic centers have suggested that CICUs are expanding their roles even further by caring for a growing number of patients with chronic cardiovascular conditions who present with acute non-cardiac illnesses such as sepsis and renal failure. 7–9 This latest trend has raised some concern among cardiologists, as caring for these groups of patients may require expertise in critical care and non-cardiac procedures that fall beyond the purview of typical general cardiology training.…”

mentioning

confidence: 99%

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

Sinha

Sjoding

Sukul

et al. 2017

Circ: Cardiovascular Quality and Outcomes

102

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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.

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confidence: 99%

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

Sinha

Sjoding

Sukul

et al. 2017

Circ: Cardiovascular Quality and Outcomes

102

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“…15 These same principles were described concurrently by Morris Wilburne in an abstract describing a CCU with an "organized program and step-by-step plan of resuscitation" submitted to the American Heart Association annual meeting in 1961. 16 In the late 1960s, the next phase of development of the CCU was ushered in by Bernard Lown and colleagues at the Peter Bent Brigham Hospital in Boston, MA, who described a shift from resuscitation at the time of an arrest to monitoring for early signs of clinical change and prevention of a cardiac arrest. 15 A precedent for admitting a broader group of patients with suspected acute MI to a dedicated CCU was established, and a rapid proliferation of CCUs throughout industrialized countries ensued.…”

mentioning

confidence: 99%

Evolution of Critical Care Cardiology: Transformation of the Cardiovascular Intensive Care Unit and the Emerging Need for New Medical Staffing and Training Models

Morrow¹,

Fang²,

Fintel³

et al. 2012

Circulation

252

186

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“…The ECG signal can be made available from every human being on the earth by the appropriate healthcare providers. At the time of the early development of the Acute Cardiac Care Unit at Cedars of Lebanon Hospital, 13 I asked my mentor Jeremy Swan, "What benefit will we obtain from its use?" He stated "We will get together patients in one part of the hospital with cardiac diseases that produce SCD so that we can all carefully study it."…”

Section: Laksmentioning

confidence: 99%

On the Need for a Universal Prospective ECG Database

Laks

2012

Circulation

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Resuscitating a Circulation Abstract to Celebrate the 50th Anniversary of the Coronary Care Unit Concept

Cited by 35 publications

References 40 publications

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

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

Evolution of Critical Care Cardiology: Transformation of the Cardiovascular Intensive Care Unit and the Emerging Need for New Medical Staffing and Training Models

On the Need for a Universal Prospective ECG Database

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