Trends in Cardiac Critical Care
Reshaping the Cardiac Intensive Care Unit
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Coronary care units originated for the singular purpose of rapidly resuscitating patients from arrhythmic complications of acute myocardial infarction (MI) but have transformed into cardiac intensive care units (CICUs) that deliver comprehensive critical care for patients with cardiovascular diseases.1 Forged by a common clinical experience, recognition of this evolution by practitioners in the CICU preceded data that have quantified this transition.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.3–6 Now, in this issue of Circulation: Cardiovascular Quality and Outcomes, Sinha et al7 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.
See Article by Sinha et al
Transformation of the CICU
At its core, this transformation of the CICU has been marked by a progressive decline in the need for critical care among patients with acute MI and expansion of other patient populations requiring cardiac critical care (Figure). Quinn et al3 first called attention to the diminishing role of the CICU in the care of ST-segment–elevation MI (STEMI) and quantified a shift in early resuscitation and reperfusion from the CICU to the Emergency Department in the United Kingdom. Katz et al4 then described associated changes in CICU practice with substantially more granularity in a retrospective examination of 29 275 patients admitted between 1989 and 2006 to the CICU at Duke University Medical Center. By the end of this period, although the median age remained 63 years, the demographics had swung toward greater representation of women (41%) and minorities (38%). Key findings were a decline in admissions for STEMI, from ≈40% of admissions in …