(P021) CREATION OF A POST CARDIAC INTENSIVE CARE UNIT RECOVERY CLINIC

Background: The reasons for admission and complexity of patients admitted to cardiac intensive care units (CICU) have changed significantly since the first coronary care units were founded in the 1960s. Multiorgan failure is common, and survivors of critical illness face significant sequalae from their hospital stay. Little is known regarding the long-term risk for CICU survivors to develop the collection of physical, cognitive, and mental health impairments which make up the post intensive care syndrome (PICS). At our centre, survivors of cardiac critical illness did not have centralized follow-up to ensure appropriate resolution of issues arising during their CICU stay. As part of a quality improvement initiative, we describe the creation of the first CICU Recovery Clinic in Canada. The clinic aimed to ensure follow-up for complex CICU survivors and to better understand the burden of PICS in this patient population.

METHODS AND RESULTS: CICU patients were screened twice weekly to identify patients matching our inclusion criteria. Patients with a CICU length of stay >7 days were invited for follow-up in Recovery Clinic and were seen by a cardiology resident and staff cardiologist. Patients discharged to palliative care, referred for cardiac surgery or followed in advanced heart failure clinic were excluded. Follow-up occurred 12 weeks after hospital discharge (Figure 1) in addition to routine cardiology follow-up. Patient reported quality of life (PR-QOL) was assessed with the 36-Item Short Form Survey (SF-36) with scores ranging from 0-100 with higher scores indicating improved patient reported health status. Functional capacity was assessed with a 6-minute walk test (6MWT). During follow-up, the CICU course and complications of critical illness were reviewed, and detailed discussions surrounding recovery and ongoing symptoms of PICS were discussed.

From July 2022-May 2024, 67 patients were invited for follow-up, 20 patients (29.9%) died prior to follow-up, and 36 (53.7%) were seen in Recovery Clinic. Median age was 72 years and 73% were male. Median SF-36 among survey responders was 35/100. Median 6MWT was 205 meters. Common symptoms of PICS that emerged at follow-up were persistent brain fog, fatigue, and traumatic memories of the CICU admission.

Conclusion: Follow-up of CICU survivors in a specialized recovery clinic appears feasible. PR-QOL appears low, and the burden of PICS is high in this vulnerable cohort of patients. Further study is required to better understand the prevalence of PICS in CICU survivors.