Evolution of Critical Care Cardiology: An Update on Structure, Care Delivery, Training, and Research Paradigms: A Scientific Statement From the American Heart Association

2025/02/13 by Shashank S. Sinha, Bram J. Geller, Jason N. Katz +12 · 35 citations
Engineering · Medicine · Nursing · #Cardiac Arrest and Resuscitation #Cardiology #Coronary care unit #Critical care nursing #Family medicine #Health care #Intensive Care Unit Cognitive Disorders #Intensive care #Intensive care medicine #Intensive care unit #Mechanical Circulatory Support Devices #Medical emergency #Medicine #Myocardial infarction #Nursing #Population #Staffing #Subspecialty

paper · doi:10.1161/cir.0000000000001300

published in Circulation 151(10), e687-e707 (Lippincott Williams & Wilkins)

openalex publication_date 2025/02/13 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/27

Abstract

Critical care cardiology refers to the practice focus of and subspecialty training for the comprehensive management of life-threatening cardiovascular diseases and comorbid conditions that require advanced critical care in an intensive care unit. The development of coronary care units is often credited for a dramatic decline in mortality rates after acute myocardial infarction throughout the 1960s. As the underlying patient population became progressively sicker, changes in organizational structure, staffing, care delivery, and training paradigms lagged. The coronary care unit gradually evolved from a focus on rapid resuscitation from ventricular arrhythmias in acute myocardial infarction into a comprehensive cardiac intensive care unit designed to care for the sickest patients with cardiovascular disease. Over the past decade, the cardiac intensive care unit has continued to transform with an aging population, increased clinical acuity, burgeoning cardiac and noncardiac comorbidities, technologic advances in cardiovascular interventions, and increased use of temporary mechanical circulatory support devices. Herein, we provide an update and contemporary expert perspective on the organizational structure, staffing, and care delivery in the cardiac intensive care unit; examine the challenges and opportunities present in the education and training of the next generation of physicians for critical care cardiology; and explore quality improvement initiatives and scientific investigation, including multicenter registry initiatives and randomized clinical trials, that may change clinical practice, care delivery, and the research landscape in this rapidly evolving discipline.

Citations

• Will Cardiac Intensive Care Unit Admissions Warrant Appropriate Use Criteria in the Future?
• Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

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