000			05384nam a22006377a 4500
008			190823s20192019 xxu||||| |||| 00| 0 eng d
024			_a10.1001/jamacardio.2019.2467 [doi]
024			_a2739025 [pii]
040			_aOvid MEDLINE(R)
099			_a31339509
245			_aDemographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units: The Critical Care Cardiology Trials Network Prospective North American Multicenter Registry of Cardiac Critical Illness.
251			_aJAMA Cardiology. 4(9):928-935, 2019 09 01.<251. >
252			_aJAMA Cardiol. 4(9):928-935, 2019 09 01.
252			_zJAMA Cardiol. 2019 Jul 24
253			_aJAMA cardiology
260			_c2019
260			_fFY2020
265			_saheadofprint
265			_sppublish
266			_d2019-08-23
268			_aJAMA Cardiology. 2019 Jul 24
520			_aConclusions and Relevance: In a contemporary network of tertiary care CICUs, respiratory failure and shock predominated indications for admission and carried a poor prognosis. While patterns of practice varied considerably between centers, a substantial, low-risk population was identified. Multicenter collaborative networks, such as the CCCTN, could be used to help redesign cardiac critical care and to test new therapeutic strategies.
520			_aDesign, Setting, and Participants: This study established the Critical Care Cardiology Trials Network (CCCTN), an investigator-initiated multicenter network of 16 advanced, tertiary CICUs in the United States and Canada. For 2 months in each CICU, data for consecutive admissions were submitted to the central data coordinating center (TIMI Study Group). The data were collected and analyzed between September 2017 and 2018.
520			_aImportance: Single-center and claims-based studies have described substantial changes in the landscape of care in the cardiac intensive care unit (CICU). Professional societies have recommended research to guide evidence-based CICU redesigns.
520			_aMain Outcomes and Measures: Demographics, diagnoses, management, and outcomes.
520			_aObjective: To characterize patients admitted to contemporary, advanced CICUs.
520			_aResults: Of 3049 participants, 1132 (37.1%) were women, 797 (31.4%) were individuals of color, and the median age was 65 years (25th and 75th percentiles, 55-75 years). Between September 2017 and September 2018, 3310 admissions were included, among which 2557 (77.3%) were for primary cardiac problems, 337 (10.2%) for postprocedural care, 253 (7.7%) for mixed general and cardiac problems, and 163 (4.9%) for overflow from general medical ICUs. When restricted to the initial 2 months of medical CICU admissions for each site, the primary analysis population included 3049 admissions with a high burden of noncardiovascular comorbidities. The top 2 CICU admission diagnoses were acute coronary syndrome (969 [31.8%]) and heart failure (567 [18.6%]); however, the proportion of acute coronary syndrome was highly variable across centers (15%-57%). The primary indications for CICU care included respiratory insufficiency (814 [26.7%]), shock (643 [21.1%]), unstable arrhythmia (521 [17.1%]), and cardiac arrest (265 [8.7%]). Advanced CICU therapies or monitoring were required for 1776 patients (58.2%), including intravenous vasoactive medications (1105 [36.2%]), invasive hemodynamic monitoring (938 [30.8%]), and mechanical ventilation (652 [21.4%]). The overall CICU mortality rate was 8.3% (95% CI, 7.3%-9.3%). The CICU indications that were associated with the highest mortality rates were cardiac arrest (101 [38.1%]), cardiogenic shock (140 [30.6%]), and the need for renal replacement therapy (51 [34.5%]). Notably, patients admitted solely for postprocedural observation or frequent monitoring had a mortality rate of 0.2% to 0.4%.
546			_aEnglish
650			_a*Coronary Care Units/sn [Statistics & Numerical Data]
650			_a*Critical Illness/ep [Epidemiology]
650			_a*Disease Management
650			_a*Heart Diseases/ep [Epidemiology]
650			_a*Hospitalization/sn [Statistics & Numerical Data]
650			_a*Registries
650			_a*Risk Assessment/mt [Methods]
650			_aAged
650			_aCanada/ep [Epidemiology]
650			_aFemale
650			_aFollow-Up Studies
650			_aHeart Diseases/th [Therapy]
650			_aHospital Mortality/td [Trends]
650			_aHumans
650			_aIncidence
650			_aMale
650			_aMiddle Aged
650			_aProspective Studies
650			_aRisk Factors
650			_aSurvival Rate/td [Trends]
650			_aUnited States/ep [Epidemiology]
651			_aMedStar Heart & Vascular Institute
657			_aJournal Article
700			_aBarnett, Christopher F
790			_aAlviar CL, Baird-Zars VM, Barnett CF, Barsness GW, Bhattal G, Bohula EA, Burke JA, Cremer PC, Critical Care Cardiology Trials Network, Cruz J, Daniels LB, DeFilippis A, Granger CB, Hollenberg S, Horowitz JM, Katz JN, Keller N, Kontos MC, Lawler PR, Menon V, Metkus TS, Morrow DA, Ng J, Orgel R, Overgaard CB, Park JG, Phreaner N, Roswell RO, Schulman SP, Snell RJ, Solomon MA, Ternus B, Tymchak W, van Diepen S, Vikram F
856			_uhttps://dx.doi.org/10.1001/jamacardio.2019.2467 _zhttps://dx.doi.org/10.1001/jamacardio.2019.2467
942			_cART _dArticle
999			_c4493 _d4493