Abstract 17163: Rise in Primary Non-cardiac Diagnoses Among Cardiac Intensive Care Unit Patients Over Time in the United States
Introduction: Reports suggest an increasing prevalence of patients with primary non-cardiac diagnoses in the cardiac intensive care unit (CICU). However, national data on the characteristics of CICU patients in the U.S. and their outcomes are limited.
Methods and Results: We performed a retrospective cohort study of fee-for-service Medicare beneficiaries aged 65 years or older using the Medicare Provider Analysis and Review files from 2003-2013. We identified all hospitalizations with a CICU stay, grouping CICU patients based on their primary diagnosis at discharge into categories of 1) primary non-cardiac diagnoses and 2) primary cardiac diagnoses. We examined changes in patient demographics, secondary comorbidities, organ failure, procedure use, and outcomes. Among 4.7 million admissions with a CICU stay from 2003-2013, primary non-cardiac diagnoses rose in prevalence over time from 39.1% to 51.8% with a parallel decline in primary cardiac diagnoses largely associated with a decrease in coronary artery disease (30.5% to 18.9%) (p<0.001 for both). The rise in primary non-cardiac diagnoses was attributable to several conditions with the largest increases associated with infectious diseases (8.2% to 15.2%) and respiratory diseases (6.2% to 7.5%) (p<0.001 for both) (Figure). We observed an increase in secondary cardiovascular comorbidities like heart failure (14.3% to 34.3%), pulmonary vascular disease (1.3% to 7.0%), and valvular heart disease (5.1% to 9.7%) (p<0.001 for all). Patients with primary non-cardiac diagnoses had higher rates of organ failure, hemodialysis, transfusion use, non-invasive ventilation, central venous catheter use and risk-adjusted in-hospital mortality (10.7% vs. 6.4%) (p<0.001 for all).
Conclusions: More than half of all elderly CICU patients across the U.S. have primary non-cardiac diagnoses at discharge. These patients are sicker, receive different types of care, and have worse risk-adjusted in-hospital mortality.
Author Disclosures: S.S. Sinha: None. M.W. Sjoding: None. D. Sukul: None. H.C. Prescott: None. T.J. Iwashyna: None. H.S. Gurm: None. C.R. Cooke: None. B.K. Nallamothu: Research Grant; Significant; NIH (1R01HL123980), VHA-HSRD (IIR 13-079).
- © 2016 by American Heart Association, Inc.