Top Things to Know: Top Things to Know
Published: February 13, 2025
Prepared by Sanjana Nagraj, MD, Cardiology Fellow, Montefiore Medical Center; Vanessa Blumer, MD, Advanced Heart Failure and Transplant Cardiology, Inova Schar Heart and Vascular
- Critical Care Cardiology (CCC) has evolved from its origins in the 1960s managing acute myocardial infarctions (AMIs) in Coronary Care Units (CCUs), to modern cardiac intensive care units (CICUs) that address a wide range of complex cardiovascular conditions, including cardiogenic shock, acute heart failure, arrhythmias, and complications requiring advanced mechanical circulatory support.
- CICUs operate under various staffing models, including open and high-intensity, ICU-based configurations. High-intensity, CICU-based staffing involves dedicated critical care-based physicians who provide continuous care for all patients and have been associated with lower mortality and shorter hospital stays.
- Research supports high-intensity CICU staffing models led by critical care cardiologists. Such models have been associated with significant improvements in patient survival, reduced ICU and hospital lengths of stay, fewer complications, and lower healthcare costs through more efficient and expert-driven care.
- Managing critically ill cardiac patients requires interdisciplinary collaboration among cardiologists, critical care specialists, nurses, pharmacists, respiratory therapists, social workers, and other health care professionals. Their combined expertise supports timely decision-making, comprehensive care, and effective management of complex medical conditions.
- Training models for CCC emphasize dual certifications in cardiovascular and critical care medicine. Emerging integrated training pathways aim to streamline education, with a view toward specialized fellowships that will prepare future cardiologists with both clinical and research competencies tailored to the needs of modern CICUs.
- Retaining skilled critical care nurses and other health care professionals is increasingly challenging due to burnout, emotional fatigue, and career transitions into advanced roles. Effective retention strategies include creating supportive work environments, fostering leadership involvement, ensuring adequate staffing ratios, recognizing professional achievements, and providing opportunities for career advancement and education.
- Enhancing patient safety in the CICU involves implementing standardized care protocols, conducting continuous quality monitoring, and leveraging electronic health record (EHR)-based dashboards that provide real-time data and actionable clinical feedback. These measures reduce preventable complications and improve overall care quality.
- Advances in CCC research are driven by large-scale multicenter registries, randomized clinical trials, and the integration of emerging technologies such as machine learning and predictive analytics. These innovations may improve clinical decision-making, optimize resource use, and support the development of personalized therapies for critically ill patients.
- Promoting diversity among CCC practitioners helps reduce health care disparities and improve patient outcomes by fostering a more inclusive health care environment. This effort includes recruiting and retaining individuals from underrepresented racial and ethnic groups, enhancing cultural competency and broadening perspectives in clinical practice and research.
- The future of CCC depends on continued innovation in care delivery models, the development of advanced training programs, and a sustained focus on patient-centered outcomes and basic, translational, and clinical research. Addressing evolving clinical challenges will require integrating cutting-edge technologies, fostering interdisciplinary teamwork, and prioritizing quality improvement initiatives.
Citation
Sinha SS, Geller BJ, Katz JN, Arslanian-Engoren C, Barnett CF, Bohula EA, Damluji AA, Menon V, Roswell RO, Vallabhajosyula S, Vest AR, van Diepen S, Morrow DA; on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular and Stroke Nursing; and Council on Kidney in Cardiovascular Disease. Evolution of critical care cardiology: an update on structure, care delivery, training, and research paradigms: a scientific statement from the American Heart Association. Circulation. Published online Thursday, February 13, 2025. doi: 10.1161/CIR.0000000000001300