Contemporary Snapshot of the Heterogeneity Admixture of Patients Admitted to a Large Tertiary Center Intensive Cardiac Care Unit - PLATIS ICCU

Background: The intensive cardiac care unit (ICCU), originally designed to treat fatal arrhythmias in patients with STEMI, has undergone profound changes in recent years. We report on the characteristics of contemporary patients admitted to a large real-world tertiary medical center ICCU.

Methods: The registry included 2,103 consecutive patients who were hospitalized in a 10 bed ICCU in Sheba medical center from January 2014 to October 2015. Patient`s demographics, cause for admission, treatment and interventions, in-hospital course and length of stay were prospectively recorded using a pre-specified form.

Results: Patients` mean age was 66±15 (17-101) years and 21% of patients were ≥80 years. 27% were females. Cause of admission was ACS in only 40%, while CHF\shock, arrhythmia, post-complicated procedures in 24%, 18%, and 14% respectively. Other causes included pulmonary embolism, myocarditis, or pericardial disease. Of the ACS patients about half presented with STEMI and 12% had type II infarction. 1,699 patients (81%) had significant co-morbidity including: DM, renal failure, anemia, COPD, or a history of CVA in 34%, 16%, 12%, 11%, and10% respectively. Advanced therapy (mechanical ventilation, dialysis, hypothermia, hemodynamic support, and\or resuscitation) was provided to 1263 patients (41%), who were significantly older and more likely to present due to CHF\sock, type II infarction, or arrhythmia (p< 0.001 for all) and sustained higher mortality (9%vs0.7%, p<0.001). During the in-hospital course major complications included new onset CHF (15%), shock (7%), malignant arrhythmias (7%), major bleedings (3.4%), and ARF (9.9%). The overall mortality was 2.8%. The mean hospital stay was 3.3±3.1days, which (p<0.001) differed significantly between patients hospitalized for STEMI (2.2±3.8), and those hospitalized for CHF\sock, arrhythmia\OHCA or PE (4.5±3.6).

Conclusions: ACS constitutes a minority of patients admitted to the current age ICCU. The wide spectrum of patients admitted to the ICCU demands that ICCU physicians master an unprecedented range of clinical competencies.