Abstract 4145943: Recidivism in the Cardiac Intensive Care Unit: Insights from the Multinational Critical Care Cardiology Trials Network

Background: Intensive Care Unit (ICU) readmission, or recidivism, can lead to increased resource use, longer hospital length-of-stay (LOS), higher costs,&worse survival. Given the potential clinical&financial impact of recidivism, it may be a useful quality metric for unit-&hospital-level comparisons. No prior studies, however, have comprehensively explored recidivism – its potential causes or consequences – across Cardiac Intensive Care Units (CICUs). Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter registry of advanced CICUs coordinated by the TIMI Study Group (Boston, MA). Consecutive admissions were captured (n=16,705)&those with > 1 readmission during the same hospitalization were identified. Multivariable logistic regression was used to determine baseline variables associated with recidivism, as well as the association of recidivism with in-hospital mortality. Results: A total of 1287 pts (7.7%) had CICU readmission. These pts were younger (p=0.015), had more diabetes (p=0.04), prior heart failure (HF)&chronic kidney disease (CKD) (p<0.001 for both), more frequently presented with decompensated HF or cardiogenic shock (p<0.001), were more often transferred from outside facilities (p<0.001), and had higher Sequential Organ Failure Assessment (SOFA) scores at presentation (p<0.001). Rates of CICU recidivism highly varied across institutions ( Fig-A ). Compared to those who were not readmitted, those readmitted to the CICU had greater critical care resource use during their 1 st CICU stay ( Fig-B ), along with longer initial CICU LOS (2.8 vs 2.2d)&hospital LOS (20.4 vs 7.6d) (both p<0.001). Hospital mortality was 20.3% in those readmitted to the CICU compared to 4.5% in those without readmission ( Fig-C ); adjusted odds ratio 6.22 (95% CI 5.25-7.38, p<0.001). This remained statistically significant after adjustment for code status. Conclusions: CICU recidivism varies significantly across centers and is associated with numerous comorbidities, higher illness severity, and greater resource use. One of every 5 pts readmitted to the CICU died in the hospital. Recidivism should be measured in future CICU-based studies, and could help to assess quality of CICU care.