Shifting Trends in Intensive Cardiovascular Care Unit Admission Patterns: Retrospective Insights and Prospective Implications

<b>Background</b>: Intensive Cardiovascular Care Units (ICCUs) are critical in managing high-acuity cardiovascular conditions, yet contemporary data on evolving admission patterns and their association with outcomes are limited. <b>Methods</b>: We conducted a retrospective cohort study of all patients admitted to a tertiary-care ICCU between July 2019 and December 2024. Patients were stratified by admission period: early (2019-2021) and late (2022-2024). Baseline characteristics, index diagnosis, interventions, complications, and mortality outcomes were compared. The primary endpoints were in-hospital and one-year mortality. <b>Results</b>: The study included 6266 patients (median age 69 years, 32% female). Of them, 3125 and 3141 patients were admitted in the early and late periods, respectively. Patients in the later period exhibited a higher burden of co-morbidities, including increased rates of atrial fibrillation, cognitive impairment, and dialysis (<i>p</i> < 0.05 for all). The pattern of index diagnoses shifted, showing an increase in heart failure (5.6% vs. 3.7%, <i>p</i> = 0.001) and malignant arrhythmia admissions (13.9% vs. 9.3%, <i>p</i> < 0.001), alongside a decline in cases of NSTEMI and pulmonary embolism. The use of urgent percutaneous coronary intervention, transcatheter valvular interventions, and microaxial pumps increased, whereas intra-aortic balloon pump usage declined. In-hospital mortality remained consistent between the periods at 2.7%. However, adjusted one-year mortality was significantly reduced in the later period (adjusted HR 0.84, 95% CI 0.71-0.98, <i>p</i> = 0.037). <b>Conclusions</b>: Over five years, ICCU admissions showed increasing complexity and evolving procedural trends. Despite higher acuity, adjusted one-year survival improved, highlighting care advances and the value of continuous data-driven ICCU optimization.