Resident University of Toronto Toronto, Ontario, Canada
Background: Heart failure (HF) affects >800,000 Canadians with >100,000 new diagnosis/year and an increasing rate of hospitalization due to decompensated heart failure (ADHF) in the last 10 years. Historically, admissions for ADHF in the absence of cardiogenic shock (CS) has been the predominant indication for admission to the cardiac intensive care unit (CICU). However, it has been suggested that a significant proportion of these patients did not need CICU-restricted therapies. Frequent admissions for decompensation put immense strain on limited CICU resources and currently there are no reliable models to predict which patients may use CICU-restricted resource. In this retrospective study, we analyzed patients admitted to the CICU at University Health Network (UHN) in Toronto with ADHF (no CS), aiming to identify patient-specific characteristics associated with increased use of CICU-restricted resources.
METHODS AND RESULTS: We included 882 consecutive patients with ADHF from 2014-2024 and compared characteristics of patients that did not need critical resources (N = 344) to the rest of the cohort (N = 538). In our study, 39% of patients did not use CICU-restricted resources (Figure 1A). The most frequently used resources were vasopressors (30.5%) and central lines (21.7%,). Univariate analysis of baseline characteristics of patients with ADHF (no CS) that did not use CICU resources were older, had higher mean arterial pressure and sodium, lower brain natriuretic peptide, and shorter median hospital and CICU length of stay (Table 1). In-hospital mortality was significantly lower in patients not requiring CICU-restricted resources (8.75%) compared to the rest (14.9%). There was no significant difference in vital signs, hemoglobin or 30 and 90 day re-admission rates between the two groups. Bootstrapped multivariable logistic regression analysis indicated that patients with more comorbidities and a long-standing history of HF with device therapy (CRT-D) have higher odds ratio of using critical resources (Figure 1B). Our data suggest that higher creatinine levels are associated with increased odds of critical resource use—with each 25 umol/L rise linked to a 12% increase—while higher sodium levels appear protective, with each 5 mmol/L increase corresponding to a 15% reduction in odds.
Conclusion: Here were report detailed demographic, medical, clinical and laboratory results of patients admitted to CICU at UHN over 11-year period. We identified several key characteristics that are significantly associated with CICU resource use. These characteristics may serve as important considerations in CICU admission decisions, particularly in the context of resource limitations and appropriate resource allocation.
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