Prevalence of Noncardiac Multimorbidity in Patients Admitted to Two Cardiac Intensive Care Units and Their Association with Mortality
Copyright © 2020 Elsevier Inc. All rights reserved..
BACKGROUND: Current cardiac intensive care unit (CICU) practice has seen an increase in patient complexity, including an increase in noncardiac organ failure, critical care therapies, and comorbidities. We sought to describe the changing epidemiology of noncardiac multimorbidity in the CICU population.
METHODS: We analyzed consecutive unique patient admissions to 2 geographically distant tertiary care CICUs (n = 16,390). We assessed for the prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities (diabetes, chronic lung, liver, and kidney disease, cancer, and stroke/transient ischemic attack) and their associations with hospital and postdischarge 1-year mortality using multivariable logistic regression.
RESULTS: The prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities was 37.7%, 31.4%, 19.9%, and 11.0%, respectively. Increasing noncardiac comorbidities were associated with a stepwise increase in mortality, length of stay, noncardiac indications for ICU admission, and increased utilization of critical care therapies. After multivariable adjustment, compared with those without noncardiac comorbidities, there was an increased hospital mortality for patients with 1 (odds ratio [OR] 1.30; 95% confidence interval [CI], 1.10-1.54, P = .002), 2 (OR 1.47; 95% CI, 1.22-1.77, P < .001), and ≥3 (OR 1.79; 95% CI, 1.44-2.22, P < .001) noncardiac comorbidities. Similar trends for each additional noncardiac comorbidity were seen for postdischarge 1-year mortality (P < .001, all).
CONCLUSIONS: In 2 large contemporary CICU populations, we found that noncardiac multimorbidity was highly prevalent and a strong predictor of short- and long-term adverse clinical outcomes. Further study is needed to define the best care pathways for CICU patients with acute cardiac illness complicated by noncardiac multimorbidity.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:134 |
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| Enthalten in: |
The American journal of medicine - 134(2021), 5 vom: 01. Mai, Seite 653-661.e5 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Miller, P Elliott [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiac intensive care unit |
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| Anmerkungen: |
Date Completed 22.06.2021 Date Revised 03.05.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.amjmed.2020.09.035 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM316982342 |
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| 100 | 1 | |a Miller, P Elliott |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Prevalence of Noncardiac Multimorbidity in Patients Admitted to Two Cardiac Intensive Care Units and Their Association with Mortality |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Revised 03.05.2022 | ||
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Current cardiac intensive care unit (CICU) practice has seen an increase in patient complexity, including an increase in noncardiac organ failure, critical care therapies, and comorbidities. We sought to describe the changing epidemiology of noncardiac multimorbidity in the CICU population | ||
| 520 | |a METHODS: We analyzed consecutive unique patient admissions to 2 geographically distant tertiary care CICUs (n = 16,390). We assessed for the prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities (diabetes, chronic lung, liver, and kidney disease, cancer, and stroke/transient ischemic attack) and their associations with hospital and postdischarge 1-year mortality using multivariable logistic regression | ||
| 520 | |a RESULTS: The prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities was 37.7%, 31.4%, 19.9%, and 11.0%, respectively. Increasing noncardiac comorbidities were associated with a stepwise increase in mortality, length of stay, noncardiac indications for ICU admission, and increased utilization of critical care therapies. After multivariable adjustment, compared with those without noncardiac comorbidities, there was an increased hospital mortality for patients with 1 (odds ratio [OR] 1.30; 95% confidence interval [CI], 1.10-1.54, P = .002), 2 (OR 1.47; 95% CI, 1.22-1.77, P < .001), and ≥3 (OR 1.79; 95% CI, 1.44-2.22, P < .001) noncardiac comorbidities. Similar trends for each additional noncardiac comorbidity were seen for postdischarge 1-year mortality (P < .001, all) | ||
| 520 | |a CONCLUSIONS: In 2 large contemporary CICU populations, we found that noncardiac multimorbidity was highly prevalent and a strong predictor of short- and long-term adverse clinical outcomes. Further study is needed to define the best care pathways for CICU patients with acute cardiac illness complicated by noncardiac multimorbidity | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Cardiac intensive care unit | |
| 650 | 4 | |a Comorbidity | |
| 650 | 4 | |a Multimorbidity | |
| 700 | 1 | |a Thomas, Alexander |e verfasserin |4 aut | |
| 700 | 1 | |a Breen, Thomas J |e verfasserin |4 aut | |
| 700 | 1 | |a Chouairi, Fouad |e verfasserin |4 aut | |
| 700 | 1 | |a Kunitomo, Yukiko |e verfasserin |4 aut | |
| 700 | 1 | |a Aslam, Faisal |e verfasserin |4 aut | |
| 700 | 1 | |a Damluji, Abdulla A |e verfasserin |4 aut | |
| 700 | 1 | |a Anavekar, Nandan S |e verfasserin |4 aut | |
| 700 | 1 | |a Murphy, Joseph G |e verfasserin |4 aut | |
| 700 | 1 | |a van Diepen, Sean |e verfasserin |4 aut | |
| 700 | 1 | |a Barsness, Gregory W |e verfasserin |4 aut | |
| 700 | 1 | |a Brennan, Joseph |e verfasserin |4 aut | |
| 700 | 1 | |a Jentzer, Jacob |e verfasserin |4 aut | |
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