Key result
Initial ICU admission for CV emergencies is linked to ~28% lower in-hospital mortality vs general ward.
Why the study?
Although intensive care is considered important for cardiovascular emergencies, large-scale evidence comparing outcomes by initial admission ward remains limited in Japan.
Does initial admission to an intensive care unit or high care unit reduce in-hospital mortality in patients hospitalized for cardiovascular emergencies compared to a general ward?
Cohort (n=888,416)
Yes
Does initial admission to an intensive care unit or high care unit reduce in-hospital mortality in patients hospitalized for cardiovascular emergencies compared to a general ward?
Odds Ratio: 0.718 (95% CI 0.703–0.734)
Absolute Event Rate: 10.8% vs 12.2%
p-value: p=<0.001
Initial admission to an intensive care unit or high care unit, as well as higher hospital cardiologist staffing, is independently associated with lower in-hospital mortality among patients with cardiovascular emergencies.
Supports higher-acuity initial admission for cardiovascular emergencies; leaves open whether ICU/HCU improves outcomes or reflects selection bias in observational data.
Background: Although intensive care is considered important for cardiovascular emergencies, large-scale evidence comparing outcomes by initial admission ward remains limited in Japan. Methods and Results: Using the JROAD database, we identified patients hospitalized for cardiovascular emergencies after ambulance transport between April 2016 and March 2024 and classified patients by initial ward (intensive care unit [ICU], high care unit [HCU], or general ward [GW]). Deaths within 24 h were excluded. Multivariable logistic regression analysis was performed with adjustment for demographics, comorbidities, acute therapies, and hospital cardiologist staffing. Among 1,211,636 admissions, there were 323,220 (26.7%) deaths within 24 h; thus, 888,416 admissions (ICU, 212,059; HCU, 124,468; GW, 551,889) were analyzed. In-hospital mortality was 10.8%, 9.7%, and 12.2% for patients admitted to the ICU, HCU, and GW, respectively. Compared with the GW, the adjusted odds of death were lower for the ICU (odds ratio [OR] 0.718; 95% confidence interval [CI] 0.703–0.734) and HCU (OR 0.928; 95% CI 0.906–0.950). A higher number of board-certified cardiologists was independently associated with lower in-hospital mortality (OR 0.977 per additional board-certified cardiologist; 95% CI 0.976–0.978). Findings were consistent for acute myocardial infarction, acute heart failure, aortic dissection, and pulmonary embolism. Conclusions: Higher-acuity admission and a higher number of cardiologists were independently associated with lower in-hospital mortality, supporting optimization of critical care access for high-risk cardiovascular emergencies in Japan.
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Kuwabara et al. (2026) conducted a cohort in Cardiovascular emergencies (n=888,416). Initial admission to intensive care unit (ICU) vs. General ward (GW) was evaluated on In-hospital mortality (OR 0.718, 95% CI 0.703-0.734, p=<0.001). Initial admission to an intensive care unit for cardiovascular emergencies was associated with lower in-hospital mortality compared with admission to a general ward (OR 0.718).
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