Post-intensive cardiac care outpatient long-term outreach clinic (PICCOLO clinic): Defining health care needs and outcomes among coronary care unit survivors.

Journal: American heart journal plus : cardiology research and practice

Volume: 38

Issue: 

Year of Publication: 

Affiliated Institutions:  Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America. Department of Pharmacy Service, University of Michigan, Ann Arbor, MI, United States of America. Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States of America. Department of Internal Medicine, Division of Pulmonary and Critical Care, Ann Arbor, MI, United States of America. Department of Internal Medicine, Division of Pulmonary and Critical Care, Johns Hopkins Medicine, Baltimore, MD, United States of America.

Abstract summary 

Patients who survive critical illness endure complex physical and mental health conditions, referred to as post-intensive care syndrome (PICS). The University of Michigan's post-intensive cardiac care outpatient long-term outreach (PICCOLO) clinic is designed for patients recently admitted to the coronary care unit (CCU). The long-term goal of this clinic is to understand post-CCU patients' needs and design targeted interventions to reduce their morbidity and mortality post-discharge. As a first step toward this goal, we aimed to define the post-discharge needs of CCU survivors.We retrospectively reviewed case-mix data (including rates of depression, PTSD, disability, and cognitive abnormalities) and health outcomes for patients referred to the PICCOLO clinic from July 1, 2018, through June 30, 2021 at Michigan Medicine.Of the 134 referred patients meeting inclusion criteria, 74 (55 %) patients were seen in the PICCOLO clinic within 30 days of discharge. Patients seen in the clinic frequently screened positive for depression (PHQ-2 score ≥3, 21.4 %) and cognitive impairment (MOCA 26, 38.8 %). Further, patients also reported high rates of physical difficulty (mean WHODAS 2.0 score 28.4 %, consistent with moderate physical difficulty). Consistent with medical intensive care unit (ICU) patients, CCU survivors experience PICS.This work highlights the feasibility of an outpatient care model and the need to leverage information gathered from this care model to develop treatment strategies and pathways to address symptoms of PICS in CCU survivors, including depression, cognitive impairment, and physical disability.

Authors & Co-authors:  Mason Adie Shea Konerman Thomas McSparron Iwashyna Prescott Thompson

Study Outcome 

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Statistics
Citations :  Zimmerman J.E., Kramer A.A., Knaus W.A. Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit. Care. 2013;17:R81.
Authors :  9
Identifiers
Doi : 100363
SSN : 2666-6022
Study Population
Male,Female
Mesh Terms
Other Terms
Critical care;Post intensive care syndrome;Recovery;Transitions of care
Study Design
Study Approach
Country of Study
Mali
Publication Country
United States