Clinical Impacts of High-Intensity Care in the Cardiac Intensive Care Unit: Systematic Review and Meta-Analysis

ABSTRACTBackground The rise of novel cardiac interventions and complex cardiac cases necessitates modern cardiac intensive care units (CICUs) and dedicated critical care teams. A high-intensity staffing model includes either an intensivist or a closed model. The closed model involves ICU-based cardiologists managing the unit, though not all have critical-care training. The intensivist model mandates critical-care consultation or training, ensuring expertise in managing critically ill cardiac patients. Methods This meta-analysis compares in-hospital mortality rates in patients managed in high-intensity CICUs vs usual care. We searched multiple databases to retrieve studies published between January 2000 and November 2024. We included studies that assessed the impact of a high-intensity staffing model on in-hospital mortality rates of patients admitted to CICUs. The main outcome measure was in-hospital mortality. Results We included 6 studies of 12,595 patients; 7379 received high-intensity care, and 5216 received usual care (control group). The study demonstrated a significant reduction in in-hospital mortality rates (OR 0.67, 95% CI: 0.50–0.89; I2 =75%) in the high-intensity staffing model compared to the control group. Subgroup analysis revealed significant differences between the intensivist and closed staffing models (P = 0.04). The intensivist model reduced mortality rates by 49% (OR 0.51, 95% CI: 0.35–0.75; P = 0.0007, I² = 59%), whereas the closed model did not reach statistical significance (OR 0.81, 95% CI: 0.65–1.01; P = 0.06, I² = 40%). Conclusion This meta-analysis suggests that transitioning to a high-intensity staffing model, especially including intensivists, is linked to improved mortality outcomes in patients admitted to the CICU.