Fading Echoes of The Past – The Changing face of Intensive Cardiac Care Units

Background: The changing paradigm in the admixture of patient admitted to the intensive cardiac care unit is changing, with patients with more comorbidities being admitted. As such the length of hospitalization of patients in the ICCU is prolonged, and with it also the complexity of the procedures performed. Our goal was to evaluate the predictors of hospital stay within a large tertiary center ICCU.

Method: We valuated a cohort of 2103 consecutive patients who were admitted to our ICCU between the years 2014-2015. Patients were divided according to the median hospitalization stay. Cause of hospitalization, baseline characteristics, and hospitalization course, as well as procedures performed were evaluated.

Results: The median age of the total cohort was 66±15.14 years, most being males (73%, N=1528). The interquartile length of stay was 2-4 days, with a median of 2 days. Patients with longer ICCU hospitalization (>2 days) were more likely to be admitted due to heart failure exacerbation (20.8% vs 11.6%, p<0.001) and arrhythmias (21.0% vs 16.3%, p=0.005). These patients were more likely to have a history of prior stroke (12.7% vs. 8.5%, p=0.002), renal failure (20% vs. 12.8%, p<0.001), and prior CHF (21.7% vs 15.2%, p<0.001) and were in need of more invasive interventions such as: primary PCI mechanical ventilation (12.8% vs 6.9%, p<0.001), dialysis (3.5% vs 1.1%, p=0.001), blood transfusion (7.5% vs 2.2%, p<0.001), inotropic support (18.1%vs 9.3%, p<0.001), as well as VT ablation (2.2% vs 0.7%, p=0.003).

Conclusions: Patients admitted to an ICCU due to heart failure exacerbation and arrhythmias have longer periods of stay, and more associated comorbidities. These patients also require more invasive measures during hospitalization and pose a higher burden on ICCU staff.