Admission reasons, procedures, and mortality of elderly patients in CICU: the SAGE-CICU study (study on acute gaps in the elderly - cardiac intensive care unit)

The growing proportion of elderly patients admitted to cardiac intensive care units (CICUs) presents specific challenges, including complex comorbidity profiles, divergent diagnostic patterns, and reduced access to invasive therapies. Current guidelines, derived predominantly from younger cohorts, offer limited guidance for managing these high-risk patients. A better understanding of their acute cardiovascular care needs is crucial to support tailored clinical decision-making and effective resource allocation. We conducted a retrospective, single-center observational study including all CICU admissions at Fondazione Policlinico Universitario A. Gemelli IRCCS (Rome, Italy) from November 2020 to April 2024. Patients were stratified by age (< 75 and ≥ 75 years). Primary outcomes included admission diagnoses, in-hospital interventions, and CICU mortality. Secondary outcomes were length of stay (LOS) and survival at follow-up. Among 2,541 patients (mean age 69.3 ± 14.7 years), 41.4% were aged ≥ 75 years. Compared to younger patients, elderly individuals were more frequently admitted for atrioventricular block, valvular disease, atrial fibrillation and Takotsubo syndrome (TTS), and less often for STEMI, myocarditis and pulmonary embolism. The procedural approach also differed between groups: elderly patients underwent fewer coronary angiographies, percutaneous coronary interventions, Impella CP use, and transcatheter arrhythmia ablations, while receiving more frequent pacemaker implantations, transcatheter aortic valve replacement (TAVR), and aortic valvuloplasty. Length of stay was similar between the two groups, while it was significantly reduced in patients aged > 85 and > 90 years. CICU mortality was higher in patients over 75 years (9.7% vs. 4.1%, p < 0.001), particularly in the context of acute heart failure (13% vs. 5.6%, p < 0.001), STEMI (14.9% vs. 2.4%, p < 0.001)), NSTEMI (10.2% vs. 2.6%, p < 0.001), and cardiogenic shock (53.8% vs. 32.6%, p < 0.001). Survival times at follow-up were significantly reduced in older patients across most diagnoses, with the most adverse outcomes observed in patients with cardiogenic shock. Elderly patients admitted to CICU display distinct clinical characteristics, procedural patterns, and outcomes compared to younger individuals. These findings enhance our understanding of the acute cardiovascular care needs in older adults and provide a data-driven foundation to inform resource allocation, priority setting, and the development of age-specific management strategies in CICU practice.