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Background With the aging of the US population, more elderly adults are being admitted to cardiac intensive care units (CICUs). However, their clinical presentation and outcomes have not been well described. We investigated the epidemiology of this important cohort. Methods The Critical Care Cardiology Trials Network (CCCTN) is a multicenter network of advanced CICUs in North America (n = 24) coordinated by the TIMI Study Group. Patients were divided by age <65, 65-<75, 75-<85 and >=85y. The outcome of interest was in-hospital mortality. Multivariable regression included sex, SOFA score, lactate, and eGFR. Results We analyzed 8230 patients by age category (n=2234 >=75y; Fig, top). Female sex, being underweight, and impaired renal function were more prevalent with advanced age. Severity of the acute illness by SOFA was shifted slightly toward moderate scores with advancing age (Fig, top). Admission diagnoses of cardiogenic shock and cardiac arrest were fewer with older age. Use of mechanical ventilation and other ICU therapies declined with age. Hospital mortality varied with age but with only a 3% absolute difference between the lowest and highest age groups (Fig, bottom). Conclusion Nearly 1 in 10 patients admitted to CICUs are >85 years old. While this group differs in clinical features from younger patients, their in-hospital mortality is qualitatively similar. Further research focusing on elderly CICU patients is warranted to guide treatment and decision-making for this important population. [Formula presented]
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BACKGROUND:Despite a temporal increase in respiratory failure in patients hospitalized with acute heart failure (HF), clinical trials have largely not reported the incidence or associated clinical outcomes for patients requiring mechanical ventilation. METHODS AND RESULTS/RESULTS:After pooling 5 acute HF clinical trials, we used multivariable logistic regression adjusted for demographics, comorbidities, examinations, and laboratory findings to assess associations between mechanical ventilation and clinical outcomes. Among the 8296 patients, 210 (2.5%) required mechanical ventilation. Age, sex, smoking history, baseline ejection fraction, HF etiology, and the proportion of patients randomized to treatment or placebo in the original clinical trial were similar between groups (all, P > 0.05). Baseline diabetes mellitus was more common in the mechanical ventilation group (P = 0.02), but other comorbidities, including chronic lung disease, were otherwise similar (all P > 0.05). HF rehospitalization at 30 days (12.7% vs 6.6%, P < 0.001) and all-cause 60-day mortality (33.3% vs 6.1%, P < 0.001) was higher among patients requiring mechanical ventilation. After multivariable adjustment, mechanical ventilation use was associated with an increased 30-day HF rehospitalization (odds ratio 2.03; 95% confidence interval, 1.29-3.21, P = 0.002), 30-day mortality (odds ratio 10.40; 95% confidence interval, 7.22-14.98, P < 0.001), and 60-day mortality (odds ratio 7.68; 95% confidence interval, 5.50-10.74, P < 0.001). The influence of mechanical ventilation did not differ by HF etiology or baseline ejection fraction (both, interaction P > 0.20). CONCLUSIONS:Respiratory failure during an index hospitalization for acute HF was associated with increased rehospitalization and all-cause mortality. The development of respiratory failure during an acute HF admission identifies a particularly vulnerable population, which should be identified for closer monitoring.

PURPOSE/UNASSIGNED:To describe the epidemiology, outcomes, and temporal trends of respiratory failure in the cardiac intensive care unit (CICU). MATERIALS AND METHODS/UNASSIGNED:Retrospective cohort analysis of 2,986 unique Mayo Clinic CICU patients from 2007 to 2018 with respiratory failure. Temporal trends were analyzed, along with hospital and 1-year mortality. Multivariable logistic regression was used to determine adjusted hospital mortality trends. RESULTS/UNASSIGNED:< 0.001 for trend), but was unchanged among patients receiving positive-pressure ventilation. CONCLUSIONS/UNASSIGNED:The prevalence of respiratory failure in CICU more than doubled during the last decade. The use of noninvasive respiratory support increased, while overall mortality declined over time. Cardiac arrest and shock accounted for the majority of deaths. Further research is needed to optimize the outcomes of high-risk CICU patients with respiratory failure.

Contemporary cardiac intensive care units (CICUs) have an increasing prevalence of noncardiovascular comorbidities and multisystem organ dysfunction. However, little guidance exists to support the development of best-practice principles specific to the CICU. This scientific statement evaluates strategies to avoid the potentially preventable complications encountered within contemporary CICUs, focusing on those that are most applicable to the CICU environment. This scientific statement reviews evidence-based practices derived in non-CICU populations, assesses their relevance to CICU practice, and highlights key knowledge gaps warranting further investigation to attenuate patient risk.

The medical complexity and critical care needs of patients admitted to cardiac ICUs are increasing, and prospective studies examining the underlying cardiac and noncardiac diagnoses, the management strategies, and the prognosis of cardiac ICU patients with respiratory failure are needed.