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Hamzi K, Gall E, Roubille F, Trimaille A, Elbaz M, El Ouahidi A, Noirclerc N, Fard D, Lattuca B, Fauvel C, Goralski M, Alvain S, Chaib A, Piliero N, Schurtz G, Pommier T, Bouleti C, Tron C, Bonnet G, Nhan P, Auvray S, Léquipar A, Dillinger JG, Vicaut E, Henry P, Toupin S, Pezel T. Phenotypic clustering of patients hospitalized in intensive cardiac care units: Insights from the ADDICT-ICCU study. Arch Cardiovasc Dis 2024; 117:392-401. [PMID: 38834393 DOI: 10.1016/j.acvd.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Intensive cardiac care units (ICCUs) were created to manage ventricular arrhythmias after acute coronary syndromes, but have diversified to include a more heterogeneous population, the characteristics of which are not well depicted by conventional methods. AIMS To identify ICCU patient subgroups by phenotypic unsupervised clustering integrating clinical, biological, and echocardiographic data to reveal pathophysiological differences. METHODS During 7-22 April 2021, we recruited all consecutive patients admitted to ICCUs in 39 centers. The primary outcome was in-hospital major adverse events (MAEs; death, resuscitated cardiac arrest or cardiogenic shock). A cluster analysis was performed using a Kamila algorithm. RESULTS Of 1499 patients admitted to the ICCU (69.6% male, mean age 63.3±14.9 years), 67 (4.5%) experienced MAEs. Four phenogroups were identified: PG1 (n=535), typically patients with non-ST-segment elevation myocardial infarction; PG2 (n=444), younger smokers with ST-segment elevation myocardial infarction; PG3 (n=273), elderly patients with heart failure with preserved ejection fraction and conduction disturbances; PG4 (n=247), patients with acute heart failure with reduced ejection fraction. Compared to PG1, multivariable analysis revealed a higher risk of MAEs in PG2 (odds ratio [OR] 3.13, 95% confidence interval [CI] 1.16-10.0) and PG3 (OR 3.16, 95% CI 1.02-10.8), with the highest risk in PG4 (OR 20.5, 95% CI 8.7-60.8) (all P<0.05). CONCLUSIONS Cluster analysis of clinical, biological, and echocardiographic variables identified four phenogroups of patients admitted to the ICCU that were associated with distinct prognostic profiles. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05063097.
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Affiliation(s)
- Kenza Hamzi
- Inserm MASCOT - UMRS 942, Department of Cardiology, University Hospital of Lariboisière, Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; Department of Data Science, Machine Learning and Artificial Intelligence in Health, DATA-TEMPLE Laboratory, University Hospital of Lariboisière (AP-HP), 75010 Paris, France
| | - Emmanuel Gall
- Inserm MASCOT - UMRS 942, Department of Cardiology, University Hospital of Lariboisière, Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; Department of Data Science, Machine Learning and Artificial Intelligence in Health, DATA-TEMPLE Laboratory, University Hospital of Lariboisière (AP-HP), 75010 Paris, France
| | - François Roubille
- Inserm, CNRS, PhyMedExp, Cardiology Department, INI-CRT, Université de Montpellier, CHU de Montpellier, 34295 Montpellier, France
| | - Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Meyer Elbaz
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - Amine El Ouahidi
- Department of Cardiology, University Hospital of Brest, 29609 Brest cedex, France
| | - Nathalie Noirclerc
- Service de Cardiologie, Centre Hospitalier Annecy-Genevois, 74370 Épagny-Metz-Tessy, France
| | - Damien Fard
- Intensive Cardiac Care Unit, University Hospital Henri-Mondor, Créteil, France
| | - Benoit Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Charles Fauvel
- Inserm U1096, Department of Cardiology, Université de Rouen-Normandie, CHU de Rouen, 76000 Rouen, France
| | - Marc Goralski
- Service de Cardiologie, Centre Hospitalier d'Orleans, Orléans, France
| | - Sean Alvain
- Service de Cardiologie, Centre Hospitalier de Saintes, Saintes, France
| | - Aures Chaib
- Service de Cardiologie, Centre Hospitalier de Montreuil, Montreuil, France
| | - Nicolas Piliero
- Service de Cardiologie, CHU de Grenoble-Alpes, Grenoble, France
| | - Guillaume Schurtz
- Department of Cardiology, University Hospital of Lille, Lille, France
| | - Thibaut Pommier
- Department of Cardiology, University Hospital, Dijon, France
| | - Claire Bouleti
- Department of Cardiology, University Hospital of Poitiers, 86000 Poitiers, France
| | - Christophe Tron
- Inserm U1096, Department of Cardiology, Université de Rouen-Normandie, CHU de Rouen, 76000 Rouen, France
| | - Guillaume Bonnet
- Inserm, Inrae, C2VN, Service de Cardiologie Interventionnelle, Aix-Marseille Université, CHU de Timone, AP-HM, Marseille, France
| | - Pascal Nhan
- Inserm UMR_S 938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, Paris, France; Service de Cardiologie, Hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Simon Auvray
- Department of Cardiology, Felix-Guyon University Hospital, Saint-Denis, Reunion
| | - Antoine Léquipar
- Inserm MASCOT - UMRS 942, Department of Cardiology, University Hospital of Lariboisière, Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; Department of Data Science, Machine Learning and Artificial Intelligence in Health, DATA-TEMPLE Laboratory, University Hospital of Lariboisière (AP-HP), 75010 Paris, France
| | - Jean-Guillaume Dillinger
- Inserm MASCOT - UMRS 942, Department of Cardiology, University Hospital of Lariboisière, Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; Department of Data Science, Machine Learning and Artificial Intelligence in Health, DATA-TEMPLE Laboratory, University Hospital of Lariboisière (AP-HP), 75010 Paris, France
| | - Eric Vicaut
- Department of Data Science, Machine Learning and Artificial Intelligence in Health, DATA-TEMPLE Laboratory, University Hospital of Lariboisière (AP-HP), 75010 Paris, France; Unité de Recherche Clinique, Hôpital Fernand-Widal, AP-HP, 75010 Paris, France
| | - Patrick Henry
- Inserm MASCOT - UMRS 942, Department of Cardiology, University Hospital of Lariboisière, Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; Department of Data Science, Machine Learning and Artificial Intelligence in Health, DATA-TEMPLE Laboratory, University Hospital of Lariboisière (AP-HP), 75010 Paris, France
| | - Solenn Toupin
- Inserm MASCOT - UMRS 942, Department of Cardiology, University Hospital of Lariboisière, Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; Department of Data Science, Machine Learning and Artificial Intelligence in Health, DATA-TEMPLE Laboratory, University Hospital of Lariboisière (AP-HP), 75010 Paris, France
| | - Théo Pezel
- Inserm MASCOT - UMRS 942, Department of Cardiology, University Hospital of Lariboisière, Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France; Department of Data Science, Machine Learning and Artificial Intelligence in Health, DATA-TEMPLE Laboratory, University Hospital of Lariboisière (AP-HP), 75010 Paris, France.
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Gall E, Pezel T, Lattuca B, Hamzi K, Puymirat E, Piliero N, Deney A, Fauvel C, Aboyans V, Schurtz G, Bouleti C, Fabre J, El Ouahidi A, Thuaire C, Millischer D, Noirclerc N, Delmas C, Roubille F, Dillinger JG, Henry P. Profile of patients hospitalized in intensive cardiac care units in France: ADDICT-ICCU registry. Arch Cardiovasc Dis 2024; 117:195-203. [PMID: 38418306 DOI: 10.1016/j.acvd.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Intensive cardiac care units (ICCU) were initially developed to monitor ventricular arrhythmias after myocardial infarction. In recent decades, ICCU have diversified their activities. AIM To determine the type of patients hospitalized in ICCU in France. METHODS We analysed the characteristics of patients enrolled in the ADDICT-ICCU registry (NCT05063097), a prospective study of consecutive patients admitted to ICCU in 39 centres throughout France from 7th-22nd April 2021. In-hospital major adverse events (MAE) (death, resuscitated cardiac arrest and cardiogenic shock) were recorded. RESULTS Among 1499 patients (median age 65 [interquartile range 54-74] years, 69.6% male, 21.7% diabetes mellitus, 64.7% current or previous smokers), 34.9% had a history of coronary artery disease, 11.7% atrial fibrillation and 5.2% cardiomyopathy. The most frequent reason for admission to ICCU was acute coronary syndromes (ACS; 51.5%), acute heart failure (AHF; 14.1%) and unexplained chest pain (6.8%). An invasive procedure was performed in 36.2%. "Advanced" ICCU therapies were required for 19.9% of patients (intravenous diuretics 18.4%, non-invasive ventilation 6.1%, inotropic drugs 2.3%). No invasive procedures or advanced therapies were required in 44.1%. Cardiac computed tomography or magnetic resonance imaging was carried out in 12.3% of patients. The median length of ICCU hospitalization was 2.0 (interquartile range 1.0-4.0) days. The mean rate of MAE was 4.5%, and was highest in patients with AHF (10.4%). CONCLUSIONS ACS remains the main cause of admissions to ICCU, with most having a low rate of in-hospital MAE. Most patients experience a brief stay in ICCU before being discharged home. AHF is associated with highest death rate and with higher resource consumption.
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Affiliation(s)
- Emmanuel Gall
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Théo Pezel
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Benoît Lattuca
- Department of Cardiology, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Kenza Hamzi
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Etienne Puymirat
- Department of Cardiology, hôpital européen Georges-Pompidou (HEGP), Paris, France
| | - Nicolas Piliero
- Department of Cardiology, CHU de Grenoble-Alpes, Grenoble, France
| | - Antoine Deney
- Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - Charles Fauvel
- Department of Cardiology, CHU de Rouen, University, UNIROUEN, U1096, 76000 Rouen, France
| | - Victor Aboyans
- Dupuytren University Hospital, Inserm 1094, Limoges, France
| | - Guillaume Schurtz
- Department of Cardiology, University Hospital of Lille, Lille, France
| | | | - Julien Fabre
- Department of Cardiology, University Hospital of Martinique, 97261 Fort-de-France, France
| | - Amine El Ouahidi
- Department of Cardiology, University Hospital of Brest, 29609 Brest cedex, France
| | - Christophe Thuaire
- Department of Cardiology, centre hospitalier de Chartres, 28630 Le Coudray, France
| | - Damien Millischer
- Department of Cardiology, hôpital Montfermeil, 93370 Montfermeil, France
| | - Nathalie Noirclerc
- Department of Cardiology, centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Epagny Metz-Tessy, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - François Roubille
- Department of Cardiology, INI-CRT, CHU de Montpellier, PhyMedExp, université de Montpellier, Inserm, CNRS, 3429 Montpellier, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France
| | - Patrick Henry
- Department of Cardiology, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, University of Paris, Inserm U-942, 10, rue Ambroise-Paré, 75010 Paris, France.
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Dillinger JG, Pezel T, Delmas C, Schurtz G, Trimaille A, Piliero N, Bouleti C, Lattuca B, Andrieu S, Fabre J, Rossanaly Vasram R, Dib JC, Aboyans V, Fauvel C, Roubille F, Gerbaud E, Boccara A, Puymirat E, Toupin S, Vicaut E, Henry P. Carbon monoxide and prognosis in smokers hospitalised with acute cardiac events: a multicentre, prospective cohort study. EClinicalMedicine 2024; 67:102401. [PMID: 38261914 PMCID: PMC10796965 DOI: 10.1016/j.eclinm.2023.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
Background Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events. Methods From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097). Findings Among 1379 patients (63 ± 15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; p < 0.001). Similar results were found after adjustment for comorbidities (hazard ratio [HR] [95% confidence interval (CI)]): 5.92 [2.43-14.38]) or parameters of in-hospital severity (HR 6.09, 95% CI [2.51-14.80]) and propensity score matching (HR 7.46, 95% CI [1.70-32.8]). CO > 11 ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56-44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06-28.04]). In the overall population, CO > 11 ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33-6.98] and 1.66 [0.96-2.85] respectively). Interpretation Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events. Funding Grant from Fondation Coeur & Recherche.
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Affiliation(s)
- Jean-Guillaume Dillinger
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Théo Pezel
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, 31000, Toulouse, France
| | | | | | | | | | | | | | - Julien Fabre
- University Hospital of Fort de France, Fort De France, Martinique
| | | | - Jean-Claude Dib
- Clinique Medico-Chirurgicale Ambroise Pare, Neuilly Sur Seine, France
| | | | - Charles Fauvel
- Rouen University Hospital, INSERM EnVI 1096, 76000, Rouen, France
| | - Francois Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295, Montpellier, France
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and, Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Bordeaux, France
| | | | - Etienne Puymirat
- Université Paris Cité, Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), France
| | - Solenn Toupin
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
| | - Eric Vicaut
- Unité de recherche clinique – Hopital Lariboisiere, Paris, France
| | - Patrick Henry
- Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010, Paris, France
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Ono S, Shimizu K. Analysis of the Association Between the Number of Intensivists and the Use of Cardiovascular Agonists: An Ecological Study Using Data From National Databases of Japan. Cureus 2023; 15:e48912. [PMID: 38024012 PMCID: PMC10653938 DOI: 10.7759/cureus.48912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background Previous studies have demonstrated a correlation between management by intensivists and a decrease in hospital stay and mortality, yet the underlying reason remains unknown. Using open data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and other databses, the present study aimed to explore the relationship between inotrope and vasoconstrictor use and the number of intensivists. Materials and methods Cardiovascular agonists listed in the 2020 NDB for which the total dose was known were included for analysis. Trends in cardiovascular agonist use over six years were then graphically assessed, and a linear regression model with the use of each target drug per prefecture as the objective variable in the 2020 data was created to analyze the impact of intensivists on drug use. Results A total of 61 drugs were classified into eight groups based on their composition, and drug use in each of the 47 prefectures was tabulated. Both the rate of use and cost showed a yearly decrease for dopamine but a yearly increase for norepinephrine. Multivariable analysis indicated that the number of intensivists was only significant for dopamine, which had a coefficient of -310 (95% CI: -548 to -72, p = 0.01) but that no such trend was evident for the other drugs. Conclusions The results demonstrated that an increasing number of intensivists in each prefecture correlated with decreasing use of dopamine, possibly explaining the improved outcomes observed in closed ICUs led by intensivists. Further research is warranted to establish causality.
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Affiliation(s)
- Shohei Ono
- Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, Saitama, JPN
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Tokyo, JPN
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Pezel T, Dillinger JG, Trimaille A, Delmas C, Piliero N, Bouleti C, Pommier T, El Ouahidi A, Andrieu S, Lattuca B, Rossanaly Vasram R, Fard D, Noirclerc N, Bonnet G, Goralski M, Elbaz M, Deney A, Schurtz G, Docq C, Roubille F, Fauvel C, Bochaton T, Aboyans V, Boccara F, Puymirat E, Batisse A, Steg G, Vicaut E, Henry P. Prevalence and impact of recreational drug use in patients with acute cardiovascular events. Heart 2023; 109:1608-1616. [PMID: 37582633 DOI: 10.1136/heartjnl-2023-322520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/26/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVE While recreational drug use is a risk factor for cardiovascular events, its exact prevalence and prognostic impact in patients admitted for these events are not established. We aimed to assess the prevalence of recreational drug use and its association with in-hospital major adverse events (MAEs) in patients admitted to intensive cardiac care units (ICCU). METHODS In the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study, systematic screening for recreational drugs was performed by prospective urinary testing all patients admitted to ICCU in 39 French centres from 7 to 22 April 2021. The primary outcome was prevalence of recreational drug detection. In-hospital MAEs were defined by death, resuscitated cardiac arrest, or haemodynamic shock. RESULTS Of 1499 consecutive patients (63±15 years, 70% male), 161 (11%) had a positive test for recreational drugs (cannabis 9.1%, opioids 2.1%, cocaine 1.7%, amphetamines 0.7%, 3,4-methylenedioxymethamphetamine (MDMA) 0.6%). Only 57% of these patients declared recreational drug use. Patients who used recreational drugs exhibited a higher MAE rate than others (13% vs 3%, respectively, p<0.001). Recreational drugs were associated with a higher rate of in-hospital MAEs after adjustment for comorbidities (OR 8.84, 95% CI 4.68 to 16.7, p<0.001). After adjustment, cannabis, cocaine, and MDMA, assessed separately, were independently associated with in-hospital MAEs. Multiple drug detection was frequent (28% of positive patients) and associated with an even higher incidence of MAEs (OR 12.7, 95% CI 4.80 to 35.6, p<0.001). CONCLUSION The prevalence of recreational drug use in patients hospitalised in ICCU was 11%. Recreational drug detection was independently associated with worse in-hospital outcomes. CLINICAL TRIAL REGISTRATION NCT05063097.
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Affiliation(s)
- Théo Pezel
- Department of Cardiology, Hôpital Lariboisière, Assistance Publique - Hopitaux de Paris, Université Paris Cité, INSERM U 942, Paris, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, Hôpital Lariboisière, Assistance Publique - Hopitaux de Paris, Université Paris Cité, INSERM U 942, Paris, France
| | - Antonin Trimaille
- Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, University Hospital of Rangueil, Toulouse, France
| | - Nicolas Piliero
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Claire Bouleti
- Cardiology, University of Poitiers, Clinical Investigation Center (CIC) INSERM 1402, Poitiers University Hospital, Poitiers, France
| | | | - Amine El Ouahidi
- Department of Cardiology, University Hospital of Brest, Brest, France
| | | | - Benoit Lattuca
- Cardiology, Centre Hospitalier Universitaire de Nîmes, Montpellier University, Nimes, France
| | | | - Damien Fard
- Intensive Cardiac Care Unit, Hopital Henri Mondor, Creteil, France
| | - Nathalie Noirclerc
- Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, Rhône-Alpes, France
| | - Guillaume Bonnet
- Assistance Publique Hopitaux de Marseille, Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, Provence-Alpes-Côte d'Azu, France
- Unité de Recherche Clinique, Groupe hospitalier Lariboisiere Fernand-Widal, Paris, Île-de-France, France
| | | | - Meyer Elbaz
- Intensive Cardiac Care Unit, University Hospital of Rangueil, Toulouse, France
| | - Antoine Deney
- University Hospital Centre Toulouse, Toulouse, Midi-Pyrénées, France
| | | | - Clemence Docq
- Department of Cardiology, University Hospital of Lille, Lille, France
| | - Francois Roubille
- Cardiology Department, INI-CRT, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Charles Fauvel
- Rouen University Hospital, INSERM EnVI 1096, Rouen, France
| | - Thomas Bochaton
- Intensive Cardiological Care Division, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital and Inserm 1094, Limoges, France
| | - Franck Boccara
- Cardiology, Sorbonne Université, GRC n°22, C²MV, Inserm UMR_S 938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire de Cardio-métabolisme et Nutrition (ICAN), Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine Service de Cardiologie, Paris, France
| | | | - Anne Batisse
- Centre d'évaluation et d'information sur la pharmacodépendence de Paris, GH Lariboisiere Fernand-Widal, Paris, Île-de-France, France
| | - Gabriel Steg
- Cardiology, Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, and Institut Universitaire de France, PARIS, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Groupe hospitalier Lariboisiere Fernand-Widal, Paris, Île-de-France, France
| | - Patrick Henry
- Department of Cardiology, Hôpital Lariboisière, Assistance Publique - Hopitaux de Paris, Université Paris Cité, INSERM U 942, Paris, France
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:993-1001. [DOI: 10.1177/2048872619883997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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7
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 9:993-1001. [DOI: mj claeys, f roubille, g casella, r zukermann, n nikolaou, l de luca, m gierlotka, z iakobishvili, h thiele, m koutouzis, a sionis, s monteiro, c beauloye, c held, d tint, i zakke, p serpytis, z babic, j belohlavev, a magdy, m sivagowry rasalingam, k daly, d arroyo, m vavlukis, n radovanovic, e trendafilova, t marandi, c hassenger, m lettino, s price, e bonnefoy, organization of intensive cardiac care units in europe: results of a multinational survey, european heart journal.acute cardiovascular care, volume 9, issue 8, 1 december 2020, pages 993–1001, https:/doi.org/10.1177/2048872619883997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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Yang Q, Du JL, Shao F. Mortality rate and other clinical features observed in Open vs closed format intensive care units: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16261. [PMID: 31277148 PMCID: PMC6635169 DOI: 10.1097/md.0000000000016261] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Nowadays most of the intensive care units (ICUs) operate as a closed format in comparison to an open format. The new concept of a closed ICU is where patients are admitted under the full responsibility of a trained intensivist, whereas an open ICU is where patients are admitted under the care of another attending physician and intensivists are just available for consultation. In this analysis, we aimed to systematically compare mortality rate and other clinical features observed in open vs closed ICU formats. METHODS Biomedical and pharmacological bibliographic database Excerpta Medica database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cochrane Central and www.ClinicalTrials.gov were searched for required English publications. Mortality, the frequency of patients requiring mechanical ventilation, central line, arterial line and pulmonary arterial catheter were assessed respectively. Statistical analysis was carried out by the RevMan software. Odds ratios (OR) with 95% confidence intervals (CIs) were used to represent the data following analysis. RESULTS Five studies with a total number of 6160 participants enrolled between years 1992 to 2007 were included. Results of this analysis showed that mortality rate was significantly higher in the open format ICU (OR: 1.31, 95% CI: 1.17-1.48; P = .00001) (using a fixed effect model) and (OR: 1.31, 95% CI: 1.09-1.59; P = .005) (using a random effect model). Closed format ICUs were associated with significantly higher number of patients that required central line (OR: 0.56, 95% CI: 0.34-0.92; P = .02). Patients requiring mechanical ventilation (OR: 1.08, 95% CI: 0.65-1.78; P = .77), patients requiring arterial line (OR: 1.05, 95% CI: 0.49-2.29; P = .89) and patients requiring pulmonary arterial catheter (OR: 0.86, 95% CI: 0.40-1.87; P = .71) were similar in the open vs the closed setting. CONCLUSION This analysis showed that mortality rate was significantly higher in an open as compared to a closed format ICU. However, the frequency of patients requiring mechanical ventilation, arterial line and pulmonary arterial catheter was similarly observed. Larger trials are expected to further confirm those hypotheses.
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