Top Things to Know: Cardiac Intensive Care Unit Appropriate Patient Selection and Triage
Updated: May 21, 2026
Prepared by Garima Dahiya, MD, Mayo Clinic
- Optimizing cardiac intensive care unit (CICU) admission practices through standardized, evidence-informed triage pathways represents an important opportunity to reduce care variation, alleviate capacity strain, lower costs, and achieve optimal patient-centered outcomes.
- A pragmatic 4-step framework to inform CICU triage practices includes: (1) need for critical care–restricted therapies/monitoring, (2) goals-of-care and therapeutic beneficence, (3) risk of early clinical deterioration using diagnosis-specific risk-stratification tools, and (4) institutional level-of-care staffing and capabilities.
- Regionalized systems of care and American Heart Association Level 1–3 CICU designations should guide transfer decisions, aligning patient complexity with institutional capabilities, centralizing high-acuity cases at Level 1 centers, and repatriating patients to level 2/3 centers during their convalescence.
- Patients requiring life-sustaining cardiac or respiratory therapies, including vasoactive medications, advanced ventilatory support, continuous renal replacement therapy, or temporary mechanical circulatory support must be prioritized for CICU admissions.
- Routine CICU admission is no longer warranted for patients with low-risk ST-segment elevation myocardial infarction (Zwolle score ≤3) following primary percutaneous coronary intervention. High-risk patients (Zwolle score ≥6), those requiring rescue PCI or with evidence of hemodynamic instability, ongoing ischemia, or refractory arrhythmias may be triaged to the CICU, with individualized disposition for intermediate-risk patients based on clinical stability, anticipated deterioration risk, and institutional resources.
- Patients with acute decompensated heart failure without cardiogenic shock or advanced respiratory failure, Society for Cardiovascular Angiography Interventions (SCAI) stages A–B may be managed in step-down or ward settings with appropriate monitoring and escalation pathways. In contrast, patients with cardiogenic shock (SCAI stages C–E) or those requiring vasoactive therapy, invasive hemodynamic monitoring, advanced respiratory support, or anticipated mechanical circulatory support may be triaged to the CICU.
- Patients presenting with high-risk pulmonary embolism, severe pulmonary hypertension with low cardiac output, and clinical pericardial tamponade at substantial risk for rapid hemodynamic deterioration may be triaged to the CICU for close clinical monitoring and timely intervention.
- Acute aortic syndromes requiring immediate intravenous impulse control and invasive hemodynamic monitoring, and complicated infective endocarditis—when associated with valvular shock, decompensated heart failure, multiple embolic events, or need for emergent surgical intervention—often require triage to the CICU due to high mortality and risk of rapid clinical deterioration.
- Patients with complex adult congenital heart disease, and high-risk pregnancy-related cardiovascular diseases, must be evaluated by multidisciplinary teams for appropriate triage, with transfer to specialized or Level 1 centers when there is risk of rapid deterioration or anticipated need for advanced critical care therapies.
- As cardiovascular therapies advance, many historically routine CICU admissions may be safely managed in lower-acuity settings, underscoring the need for validated triage tools that predict risk of in-hospital clinical deterioration to better optimize resource utilization.
Citation
van Diepen S, Rampersad P, Luk A, Dahiya G, Zern EK, Alviar CL, Barnett CF, Bohula EA, Bartos JA, Slater TM, Tavazzi G, Gage A; on behalf of the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation (3CPR); Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Cardiovascular Surgery and Anesthesia. Cardiac intensive care unit appropriate patient selection and triage: a scientific statement from the American Heart Association. Circulation. Published online May 21, 2026. doi: 10.1161/CIR.0000000000001438