Clinical impact of a cardiac intensivist in an adult cardiac care unit from the RESCUE registry

Abstract

Funding Acknowledgements None. Purpose Dedicated intensive care unit (ICU) physician staffing is assocated with a reduction in ICU mortality rates in general medical and surgical ICUs. However, limited data area available on the role of cardiac intensivist in the cardiac intensive care unit (CICU). We investigated the association of cardiac intensivist-directed care with clinical outcomes in adult patients admitted to the CICU. Methods The SMART-RESCUE study is a multicenter, retrospective and prosective registry of patients that presented witth cardiogenic shock (CS). Between January 2014 and December 2018, 1,247 patients with CS were enrolled from 12 major centers in Korea. The study population was divided into 2 groups, according to the presence of a cardiac intensivist. The primary outcome was in-hospital mortality. Results THe analysis with SMART-RESCUE registry included 1,247 patients with CS (n=552 in the group with cardiac intensivist and n=695 in the group without cardiac intensivist) (Table 1). The in-hospital survival rate was significant higher in the group with intensivist than that in the group without intensivist (72.1% vs 59.2%, p < 0.001) (Figure 1). Cardiac intensive care with cardiac intensivist was associated with a reduction in risk-adjusted in-hospital mortality (adjusted odds ratio for in hospital death, 0.53; 95% confidence interval: 0.401 to 0.704; p < 0.001). Survival analysis also revealed significantly higher death free survival in te group with intensitivst. In multivariable analysis, cardiac intensivist, chronic kidney disease, ECMO-cardiopulmonary resuscitation, ST elevation myocardial infarction presentation and vasotrope-inotrope score were selected to be significant prognostic predictors for death in the CICU. Concluison: The presence of a dedicated cardiac intensivist was associated with a reduction in hospital mortality rates in patients with cardiovascular disease who required critical care.