500.12 Cardiac Critical Care in a Community Setting: Cardiologist-Led vs. Intensivist-Led Outcomes

Document Type

Conference Proceeding

Publication Date

2-24-2025

Publication Title

JACC Cardiovasc Interv

Keywords

acute coronary syndrome, adult, advanced cardiac life support, artificial ventilation, bilevel positive airway pressure, cardiologist, cardiovascular disease, community hospital, complication, conference abstract, critically ill patient, diagnosis, heart arrhythmia, heart disease, heart failure, hospital readmission, human, hypoxemic respiratory failure, intensive care, intensive care unit, intensivist, length of stay, major clinical study, male, prevalence, respiratory failure, retrospective study, risk factor, surgical patient, tachycardia

Abstract

Background: The complexity of cardiovascular conditions necessitates specialized cardiac care, yet current staffing models in many community settings lack dedicated critical care cardiologists. Globally, cardiologists specialized in critical care are more common and allow for expertise when managing conditions like acute coronary syndromes (ACS), severe heart failure, advanced cardiac life support, and life-threatening arrhythmias. There is growing recognition of the benefits of critical care cardiologists, especially as the population ages and the prevalence of complex cardiac cases increases. However, the US still lacks specialized programs that promote cardiologists in critical-care medicine. Objective: The study aims to assess two staffing models in cardiac critical care: cardiologist-led versus intensivist-led outcomes in response to the increased need for specialized critical care trained cardiologists. Methods: This is a retrospective review of patients admitted to the critical care unit in a community-hospital from March to November of 2022 who were admitted with a primary cardiac etiology. Non-cardiac and surgical patients were excluded. Cardiologists could choose to either admit the patients to their own service and consult an intensivist as needed such as in the setting of hypoxic respiratory failure where BiPAP/mechanical ventilation was used (collaborative model) or admit patients directly to an intensivist-led service (traditional model). Results: This study included 181 patients: 103 admitted to the intensivist-led model and 78 admitted to the cardiologist-led model. Both groups had similar demographics with no statistical significant difference in cardiac risk factors. The most common admitting diagnoses were ACS, structural heart diseases, and tachyarrhythmias. Overall, there was no statistical difference between complications or outcomes (length of stay (LOS), mortality, or 30-day readmissions) among cardiologist-led teams and the traditional, intensivist-led model. Conclusion: Cardiologist-led critical care in collaboration with an intensivist is not inferior to the traditional model. The current workforce in community critical care units is not meeting consensus guidelines due to increasing complexities and interplay of medical and cardiovascular conditions requiring specialized care. This creates a unique opportunity for cardiovascular expertise through fellowship and training that can enhance the quality of care in critically-ill patients.

Volume

18

Issue

4

First Page

S77

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