The American Heart Association (AHA) has issued a new scientific statement to modernize patient selection in cardiac intensive care units (CICUs)—highly specialized environments designed for critically ill cardiovascular patients. Authored by a multidisciplinary writing group and chaired by CVC faculty member Dr. Sean van Diepen, the publication addresses a longstanding structural gap in cardiac care. While six decades of therapeutic advances have vastly improved survival rates, many hospitals maintain legacy admission practices, leaving stable patients occupying resource-intensive beds when they could be safely managed in wards with continuous cardiac monitoring. These triage practices stem in part from a historic lack of standardized guidance from international societies.
To address this need, the authors consolidated evidence to ease hospital capacity strain, lower costs, and reduce admission disparities through a four-part framework:
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Patient Care Needs: Identifying individuals who will directly benefit from intensive care-restricted interventions.
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Risk of Deterioration: Utilizing objective, disease-specific prediction scores to assess risk of sudden early complications, while recognizing that these tools predict mortality well but must supplement rather than replace multidisciplinary clinical judgment.
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Goals of Care: Assessing advanced care planning early to ensure high-intensity resources align with the patient’s overall prognosis and personal wishes.
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Institutional Capabilities: Adapting admission decisions to individual hospital setups, making full use of step-down or intermediate care units for stable patients who only require moderate monitoring.
Finally, the authors outline health services research priorities: validating triage-specific prediction tools, evaluating non-CICU ward capabilities, and tracking long-term outcomes. With an aging, more complex patient population straining CICU capacity, and optimal care levels for more stable patients remaining understudied, the proposed framework establishes an operational blueprint to better align clinical innovation with efficient, population-level care.
