{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T09:34:18Z","timestamp":1778319258633,"version":"3.51.4"},"reference-count":35,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,5,19]],"date-time":"2024-05-19T00:00:00Z","timestamp":1716076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Patient care in Cardiac Intensive Care Units (CICU) has evolved but data on patient characteristics and outcomes are sparse. This retrospective observational study aimed to define clinical characteristics and risk factors of CICU patients, their in-hospital and 30-day mortality, and compare it with established risk scores. Methods: Consecutive patients (n = 294, mean age 70 years, 74% males) hospitalized within 15 months were studied; APACHE II, EHMRG, GWTG-HF, and GRACE II were calculated on admission. Results: Most patients were admitted for ACS (48.3%) and acute decompensated heart failure (ADHF) (31.3%). Median duration of hospitalization was 2 days (IQR = 1, 4). In-hospital infection occurred in 20%, 18% needed mechanical ventilation, 10% renal replacement therapy and 4% percutaneous ventricular assist devices (33%, 29%, 20% and 4%, respectively, for ADHF). In-hospital and 30-day mortality was 18% and 11% for all patients (29% and 23%, respectively, for ADHF). Established scores (especially APACHE II) had a good diagnostic accuracy (area under the curve-AUC). In univariate and multivariate analyses in-hospital intubation and infection, history of coronary artery disease, hypotension, uremia and hypoxemia on admission were the most important risk factors. Based on these, a proposed new score showed a diagnostic accuracy of 0.954 (AUC) for in-hospital mortality, outperforming previous scores. Conclusions: Patients are admitted mainly with ACS or ADHF, the latter with worse prognosis. Several patients need advanced support; intubation and infections adversely affect prognosis. Established scores predict mortality satisfactorily, but larger studies are needed to develop CICU-directed scores to identify risk factors, improve prediction, guide treatment and staff training.<\/jats:p>","DOI":"10.3390\/jcm13102982","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T06:31:58Z","timestamp":1716186718000},"page":"2982","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Role of Prognostic Scores in Assessing the Prognosis of Patients Admitted in the Cardiac Intensive Care Unit: Emphasis on Heart Failure Patients"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3578-1009","authenticated-orcid":false,"given":"Aidonis","family":"Rammos","sequence":"first","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1721-2539","authenticated-orcid":false,"given":"Aris","family":"Bechlioulis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefania","family":"Chatzipanteliadou","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spyros Athanasios","family":"Sioros","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos D.","family":"Floros","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilektra","family":"Stamou","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9401-3125","authenticated-orcid":false,"given":"Lampros","family":"Lakkas","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petros","family":"Kalogeras","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5761-5311","authenticated-orcid":false,"given":"Vasileios","family":"Bouratzis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7638-9217","authenticated-orcid":false,"given":"Christos S.","family":"Katsouras","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lampros K.","family":"Michalis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9900-9659","authenticated-orcid":false,"given":"Katerina K.","family":"Naka","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, 45110 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1161\/CIR.0b013e31826890b0","article-title":"Evolution of critical care cardiology: Transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: A scientific statement from the American Heart Association","volume":"126","author":"Morrow","year":"2012","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"D\u2019amato, A., Prosperi, S., Severino, P., Myftari, V., Labbro Francia, A., Cesti\u00e8, C., Pierucci, N., Marek-Iannucci, S., Mariani, M.V., and German\u00f2, R. (2024). Current Approaches to Worsening Heart Failure: Pathophysiological and Molecular Insights. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25031574"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1177\/2048872619872129","article-title":"Sex differences in crude mortality rates and predictive value of intensive care unit-based scores when applied to the cardiac intensive care unit","volume":"9","author":"Herscovici","year":"2020","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e021940","DOI":"10.1161\/JAHA.121.021940","article-title":"Are Unselected Risk Scores in the Cardiac Intensive Care Unit Needed?","volume":"10","author":"Miller","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1177\/2048872619883997","article-title":"Organization of intensive cardiac care units in Europe: Results of a multinational survey","volume":"9","author":"Claeys","year":"2020","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1007\/s00392-012-0421-9","article-title":"Mortality in a cardiac intensive care unit","volume":"101","author":"Zobel","year":"2012","journal-title":"Clin. Res. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1016\/j.jacc.2017.02.033","article-title":"Acute Noncardiovascular Illness in the Cardiac Intensive Care Unit","volume":"69","author":"Holland","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/MCA.0000000000000043","article-title":"Mortality in the coronary care unit","volume":"25","author":"Ratcliffe","year":"2014","journal-title":"Coron. Artery Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e001708","DOI":"10.1161\/JAHA.114.001708","article-title":"Variation in critical care unit admission rates and outcomes for patients with acute coronary syndromes or heart failure among high- and low-volume cardiac hospitals","volume":"4","author":"Bakal","year":"2015","journal-title":"J. Am. Heart Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1007\/s00134-017-5008-5","article-title":"Cardiac intensive care unit organisation in an economically less developed European country","volume":"44","author":"Pavlov","year":"2018","journal-title":"Intensive Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2637","DOI":"10.1016\/j.jacc.2016.09.947","article-title":"Association Between Presence of a Cardiac Intensivist and Mortality in an Adult Cardiac Care Unit","volume":"68","author":"Na","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2338","DOI":"10.1016\/j.jacc.2023.08.061","article-title":"Role of Advanced Practice Providers in the Cardiac Intensive Care Unit Team","volume":"82","author":"Tennyson","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e004010","DOI":"10.1161\/CIRCOUTCOMES.117.004010","article-title":"Trends in Cardiac Critical Care: Reshaping the Cardiac Intensive Care Unit","volume":"10","author":"Morrow","year":"2017","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.cardfail.2021.09.013","article-title":"Full-Time Cardiac Intensive Care Unit Staffing by Heart Failure Specialists and its Association with Mortality Rates","volume":"28","author":"Sims","year":"2022","journal-title":"J. Card. Fail."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/j.jcrc.2015.04.014","article-title":"Comparative evaluation of Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scoring systems in patients admitted to the cardiac intensive care unit","volume":"30","author":"Argyriou","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.medin.2022.03.009","article-title":"ICA-UCI study group. Clinical presentation and outcomes of acute heart failure in the critically ill patient: A prospective, observational, multicenter study","volume":"47","author":"Zapata","year":"2023","journal-title":"Med. Intensiv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1016\/j.jacc.2017.01.061","article-title":"The Evolving Medical Complexity of the Modern Cardiac Intensive Care Unit","volume":"69","author":"Dudzinski","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_18","unstructured":"Khan, Z.H., Sasaa, M., Mohammadi, M., Alipour, A., and Hajipour, A. (2020). Mortality Related to Intubation in Adult General ICUs: A Systematic Review and Meta-Analysis. Arch. Neurosci., in press."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e0637","DOI":"10.1097\/CCE.0000000000000637","article-title":"Concomitant Sepsis Diagnoses in Acute Myocardial Infarction-Cardiogenic Shock: 15-Year National Temporal Trends, Management, and Outcomes","volume":"4","author":"Jentzer","year":"2022","journal-title":"Crit. Care Explor."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e011991","DOI":"10.1161\/JAHA.119.011991","article-title":"Cardiogenic Shock","volume":"8","author":"Vahdatpour","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e003616","DOI":"10.1161\/CIRCOUTCOMES.117.003616","article-title":"Changes in Primary Noncardiac Diagnoses over Time Among Elderly Cardiac Intensive Care Unit Patients in the United States","volume":"10","author":"Sinha","year":"2017","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/S0735-1097(19)30896-4","article-title":"Incidence and Outcomes of Cardiogenic Shock in Patients with Sepsis Complicated by Acute Myocardial Infarction","volume":"73","author":"Kobbari","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zhang, Y., McCurdy, M.T., and Ludmir, J. (2023). Sepsis Management in the Cardiac Intensive Care Unit. J. Cardiovasc. Dev. Dis., 10.","DOI":"10.3390\/jcdd10100429"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e379","DOI":"10.1161\/CIR.0000000000000909","article-title":"Prevention of Complications in the Cardiac Intensive Care Unit: A Scientific Statement from the American Heart Association","volume":"142","author":"Fordyce","year":"2020","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1053\/j.jvca.2021.01.049","article-title":"Prevention of Complications in the Cardiac Intensive Care Unit","volume":"35","author":"Shelton","year":"2021","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"384","DOI":"10.7326\/0003-4819-154-6-201103150-00003","article-title":"What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study","volume":"154","author":"Curry","year":"2011","journal-title":"Ann. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1177\/0885066615624664","article-title":"The Cardiovascular Intensive Care Unit-An Evolving Model for Health Care Delivery","volume":"32","author":"Loughran","year":"2017","journal-title":"J. Intensiv. Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/2048872612472063","article-title":"Organization and staffing practices in US cardiac intensive care units: A survey on behalf of the American Heart Association Writing Group on the Evolution of Critical Care Cardiology","volume":"2","author":"Olenchock","year":"2013","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.healun.2023.09.014","article-title":"Consensus Conference participants. Heart failure related cardiogenic shock: An ISHLT consensus conference content summary","volume":"43","author":"Kanwar","year":"2024","journal-title":"J. Heart Lung Transplant."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1161\/CIRCULATIONAHA.118.039125","article-title":"Will Cardiac Intensice Care Unit Admissions Warrant Appropriate Use Criteria in the Future?","volume":"140","author":"Katz","year":"2019","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1161\/CIRCULATIONAHA.112.001088","article-title":"Variation exists in rates of admission to intensive care units for heart failure patients across hospitals in the United States","volume":"127","author":"Safavi","year":"2013","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1093\/ehjacc\/zuab121","article-title":"End-of-life care in the cardiac intensive care unit: A contemporary view from the Critical Care Cardiology Trials Network (CCCTN) Registry","volume":"11","author":"Fagundes","year":"2022","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/eurjhf\/hfp041","article-title":"Palliative care in heart failure: A position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology","volume":"11","author":"Jaarsma","year":"2009","journal-title":"Eur. J. Heart Fail."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1089\/jpm.2010.0038","article-title":"Hospital-based palliative care consultation: Effects on hospital cost","volume":"13","author":"Penrod","year":"2010","journal-title":"J. Palliat. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e13982","DOI":"10.1111\/eci.13982","article-title":"Effect of a quality-improvement intervention on end-of-life care in cardiac intensive care unit","volume":"53","author":"Sacco","year":"2023","journal-title":"Eur. J. Clin. Investig."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/10\/2982\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:44:41Z","timestamp":1760107481000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/10\/2982"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,19]]},"references-count":35,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["jcm13102982"],"URL":"https:\/\/doi.org\/10.3390\/jcm13102982","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,19]]}}}