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

作者：Na Soo Jin; Chung Chi Ryang; Jeon Kyeongman; Park Chi Min; Suh Gee Young; Ahn Joong Hyun; Carriere Keumhee C; Song Young Bin; Choi Jin Oh; Hahn Joo Yong; Choi Jin Ho; Choi Seung Hyuk; On Young Keun; Gwon Hyeon Cheol; Jeon Eun Seok; Kim Duk Kyung; Yang Jeong Hoon^*

来源：Journal of the American College of Cardiology, 2016, 68(24): 2637-2648.

DOI：10.1016/j.jacc.2016.09.947

• cardiac intensivist
• intensive care unit

BACKGROUND 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).
OBJECTIVES This study investigated the association of cardiac intensivist-directed care with clinical outcomes in adult patients admitted to the CICU.
METHODS This 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.
RESULTS Death 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.
CONCLUSIONS The presence of a dedicated cardiac intensivist was associated with a reduction in CICU mortality rates in patients with cardiovascular disease who required critical care.

• 出版日期2016-12-20