Association Between Presence of a Cardiac Intensivist and Mortality in an Adult Cardiac Care Unit

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• 作者：Soo Jin Na ; MD^a ; Chi Ryang Chung ; MD ; PhD^a ; Kyeongman Jeon ; MD ; PhD^a ; ^b ; Chi-Min Park ; MD ; PhD^a ; ^c ; Gee Young Suh ; MD ; PhD^a ; ^b ; Joong Hyun Ahn ; MS^d ; Keumhee C. Carriere ; PhD^d ; ^e ; Young Bin Song ; MD ; PhD^f ; Jin-Oh Choi ; MD ; PhD^f ; Joo-Yong Hahn ; MD ; PhD^f ; Jin-Ho Choi ; MD ; PhD^f ; Seung-Hyuk Choi ; MD ; PhD^f ; Young Keun On ; MD ; PhD^f ; Hyeon-Cheol Gwon ; MD ; PhD^f ; Eun-Seok Jeon ; MD ; PhD^f ; Duk-Kyung Kim ; MD ; PhD^f ; Jeong Hoon Yang ; MD ; PhD^a ; ^f ; ^{jhysmc@gmail.com}
• 关键词：cardiac intensivist ; intensive care unit
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：20 December 2016
• 年：2016
• 卷：68
• 期：24
• 页码：2637-2648
• 全文大小：962 K
• 卷排序：68

文摘

Dedicated intensive care unit (ICU) physician staffing is associated with a reduction in ICU mortality rates in general medical and surgical ICUs. However, limited data are available on the role of a cardiac intensivist in the cardiac intensive care unit (CICU).ObjectivesThis study investigated the association of cardiac intensivist–directed care with clinical outcomes in adult patients admitted to the CICU.MethodsThis study analyzed 2,431 patients admitted to the CICU at Samsung Medical Center in Seoul, South Korea, from January 2012 to December 2015. In January 2013 the CICU was changed from a low-intensity staffing model to a high-intensity staffing model managed by a dedicated cardiac intensivist. Eligible patients were divided into either a low-intensity management group (n = 616) or a high-intensity management group (n = 1,815). One-to-many (1:N) propensity score matching with variable matching ratios was also performed. The primary outcome was death in the CICU.ResultsDeath in the CICU occurred in 55 patients (8.9%) in the low-intensity group versus 74 patients (4.1%) in the high-intensity group (p < 0.001). Of 135 patients who underwent extracorporeal membrane oxygenation, the CICU mortality rate in the high-intensity group was also lower than that in the low-intensity group (54.5% vs. 22.5%; p = 0.001). On propensity score matching, high-intensity staffing was found associated with a lower CICU mortality rate in the matched cohort of patients (7.5% vs. 3.7%; adjusted odds ratio: 0.53; 95% confidence interval: 0.32 to 0.86; p = 0.010). In overall and propensity-matched patients, there were no substantive differences in either median length of CICU stay or readmission rates between the 2 groups.ConclusionsThe presence of a dedicated cardiac intensivist was associated with a reduction in CICU mortality rates in patients with cardiovascular disease who required critical care.