Organizational Structure, Staffing, Resources, and Educational Initiatives in Cardiac Intensive Care Units in the United States: An American Heart Association Acute Cardiac Care Committee and American College of Cardiology Critical Care Cardiology Working Group Cross-Sectional Survey

Contemporary cardiac intensive care units (CICU) have evolved into intensive care units for patients with a primary cardiovascular diagnosis.1,2 In response to this changing clinical environment, the American Heart Association (AHA) published a scientific statement advocating for organizational, staffing, and educational evolution in CICUs.3 The AHA statement also provided a roadmap for the future of acute cardiovascular care delivery, which included (1) CICU care delivery in advanced units with unit-based physician staffing (historically referred to as closed units), (2) dedicated cardiac intensivist training, and (3) a descriptive 3-tiered CICU categorization.3 Herein, we describe the current organizational structures, professional staffing, and medical and technological resources available in CICUs in the United States. A 16-question cross-sectional web-based survey (Methods in the Data Supplement; Qualtrics platform; Provo, UT) was first emailed to 542 Mission: Lifeline hospital coordinators with a request for the survey to be completed with help from the hospital’s CICU medical director or unit manager between October 2015 and April 2016. The survey was subsequently emailed to 1389 Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines CICU directors between May and November 2016. To preclude duplicate responses from hospitals present on both contact lists, all responding Mission: Lifeline hospitals were removed from the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines contact list before circulation. The study was approved by the Duke Institutional Review Board. A description of study programs, registries, and statistical methods is provided in the Methods in the Data Supplement. A total of 612 sites (31.7% response rate) completed the survey, including 138 Mission: Lifeline and 474 Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines sites. CICU organization, staffing, and resource characteristics stratified by hospital type are presented in Table …