Assessing the Value of the Cardiac Intensive Care Unit Remains Difficult
Abstract
examined patients hospitalized for cardiovascular emergencies after ambulance transport between April 2016 and March 2024.After excluding deaths within 24 h, 888,416 admissions were analyzed, including patients initially admitted to an ICU, HCU, or general ward.In-hospital mortality rates were 10.8%, 9.7%, and 12.2%, respectively.After multivariable adjustment, initial admission to the ICU and HCU was associated with lower odds of in-hospital death compared with general ward admission.The association was consistent across AMI, acute heart failure, aortic dissection, and pulmonary embolism.Importantly, a higher number of board-certified cardiologists was also independently associated with lower mortality rates.The investigators attempted to reduce bias from very early death and end-of-life care pathways by excluding deaths within 24 h.In addition, the study incorporated hospital cardiologist staffing, thereby moving beyond a simple comparison of ward categories toward an assessment of care structure.The findings should not be interpreted as proof that ICU or HCU admission itself causally reduces deaths in all cardiovascular emergencies.Residual confounding remains unavoidable in observational registry analyses, such as illness severity, laboratory data, granular hemodynamics, and treatment limitations.The exposure was the initial admission ward, whereas subsequent transfers and time-dependent changes in care intensity were not modeled.These limitations are not weaknesses unique to this study; they are precisely why assessing the value of the CICU remains difficult.Nevertheless, the study offers an important signal.Higher-acuity care environments and greater cardiovascular staffing appear to be associated with better survival.Patients with acute cardiovascular emergencies may deteriorate abruptly from arrhythmia, shock, respiratory failure, bleeding or mechanical complications.Units with continuous monitoring, experienced nurses, rapid access to invasive procedures, and cardiologists familiar with MCS are better positioned to detect deterioration and rescue patients before irreversible organ injury occurs.In this sense, ICU and HCU admission may be a Article p ????
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BibTeX
@article{nakashima2026assessing,
title = {{Assessing the Value of the Cardiac Intensive Care Unit Remains Difficult}},
author = {Takahiro Nakashima},
journal = {Circulation Journal},
year = {2026},
month = aug,
doi = {10.1253/circj.cj-26-0695},
url = {https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0695/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Assessing the Value of the Cardiac Intensive Care Unit Remains Difficult
AU - Takahiro Nakashima
PY - 2026
DA - 2026/08/11
JO - Circulation Journal
DO - 10.1253/circj.cj-26-0695
UR - https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0695/_article
AB - examined patients hospitalized for cardiovascular emergencies after ambulance transport between April 2016 and March 2024.After excluding deaths within 24 h, 888,416 admissions were analyzed, including patients initially admitted to an ICU, HCU, or general ward.In-hospital mortality rates were 10.8%, 9.7%, and 12.2%, respectively.After multivariable adjustment, initial admission to the ICU and HCU was associated with lower odds of in-hospital death compared with general ward admission.The association was consistent across AMI, acute heart failure, aortic dissection, and pulmonary embolism.Importantly, a higher number of board-certified cardiologists was also independently associated with lower mortality rates.The investigators attempted to reduce bias from very early death and end-of-life care pathways by excluding deaths within 24 h.In addition, the study incorporated hospital cardiologist staffing, thereby moving beyond a simple comparison of ward categories toward an assessment of care structure.The findings should not be interpreted as proof that ICU or HCU admission itself causally reduces deaths in all cardiovascular emergencies.Residual confounding remains unavoidable in observational registry analyses, such as illness severity, laboratory data, granular hemodynamics, and treatment limitations.The exposure was the initial admission ward, whereas subsequent transfers and time-dependent changes in care intensity were not modeled.These limitations are not weaknesses unique to this study; they are precisely why assessing the value of the CICU remains difficult.Nevertheless, the study offers an important signal.Higher-acuity care environments and greater cardiovascular staffing appear to be associated with better survival.Patients with acute cardiovascular emergencies may deteriorate abruptly from arrhythmia, shock, respiratory failure, bleeding or mechanical complications.Units with continuous monitoring, experienced nurses, rapid access to invasive procedures, and cardiologists familiar with MCS are better positioned to detect deterioration and rescue patients before irreversible organ injury occurs.In this sense, ICU and HCU admission may be a Article p ????
SN - 1347-4820
SN - 1346-9843
ER -