The Mayo Cardiac Intensive Care Unit Admission Risk Score is Associated with Medical Resource Utilization During Hospitalization

Thomas J Breen; Courtney E Bennett; Sean Van Diepen; Jason Katz; Nandan S Anavekar; Joseph G Murphy; Malcolm R Bell; Gregory W Barsness; Jacob C Jentzer

doi:10.1016/j.mayocpiqo.2020.12.009

The Mayo Cardiac Intensive Care Unit Admission Risk Score is Associated with Medical Resource Utilization During Hospitalization

Mayo Clin Proc Innov Qual Outcomes. 2021 Sep 2;5(5):839-850. doi: 10.1016/j.mayocpiqo.2020.12.009. eCollection 2021 Oct.

Authors

Thomas J Breen¹, Courtney E Bennett^{1

2

3}, Sean Van Diepen⁴, Jason Katz⁵, Nandan S Anavekar², Joseph G Murphy², Malcolm R Bell², Gregory W Barsness², Jacob C Jentzer^{1

2

3}

Affiliations

¹ Department of Internal Medicine, Mayo Clinic, Rochester, MN.
² Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
³ Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
⁴ Department of Cardiovascular Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁵ Department of Cardiovascular Medicine, Duke University, Durham, NC.

Abstract

Objective: To determine whether the Mayo Cardiac Intensive Care Unit (CICU) Admission Risk Score (M-CARS) is associated with CICU resource utilization.

Patients and methods: Adult patients admitted to our CICU from 2007 to 2018 were retrospectively reviewed, and M-CARS was calculated from admission data. Groups were compared using Wilcoxon test for continuous variables and χ² test for categorical variables.

Results: We included 12,428 patients with a mean age of 67±15 years (37% female patients). The mean M-CARS was 2.1±2.1, including 5890 (47.4%) patients with M-CARS less than 2 and 644 (5.2%) patients with M-CARS greater than 6. Critical care restricted therapies were frequently used, including mechanical ventilation in 28.0%, vasoactive medications in 25.5%, and dialysis in 4.8%. A higher M-CARS was associated with greater use of critical-care therapies and longer CICU and hospital length of stay. The low-risk cohort with M-CARS less than 2 was less likely to require critical-care-restricted therapies, including invasive or noninvasive mechanical ventilation (8.0% vs 46.1%), vasoactive medications (10.1% vs 38.8%), or dialysis (1.0% vs 8.2%), compared with patients with M-CARS greater than or equal to 2 (all P<.001).

Conclusion: Patients with M-CARS less than 2 infrequently require critical-care resources and have extremely low mortality, suggesting that the M-CARS could be used to facilitate the triage of critically ill cardiac patients.

Keywords: ACS, acute coronary syndrome; APACHE, Acute Physiology and Chronic Health Evaluation; BUN, blood urea nitrogen; CA, cardiac arrest; CCCTN, Critical Care Cardiology Trials Network; CCI, Charlson Comorbidity Index; CICU, cardiac intensive care unit; CRRT, continuous renal replacement therapy; CS, cardiogenic shock; CVC, central venous catheter; ECMO, extracorporeal membrane oxygenation; HF, heart failure; IABP, intra-aortic balloon pump; ICU, intensive care unit; IMCU, intermediate care unit; LOS, length of stay; M-CARS, Mayo Cardiac Intensive Care Unit Admission Risk Score; PAC, pulmonary arterial catheter; PCI, percutaneous coronary intervention; RBC, red blood cell; RDW, red blood cell distribution width; SOFA, Sequential Organ Failure Assessment; VF, ventricular fibrillation.