Young adults in the cardiac intensive care unit: insights from the Critical Care Cardiology Trials Network registry

While the aging cardiac intensive care unit (CICU) population has been well studied, young adults represent a distinct and underexplored subgroup. We aimed to characterize the demographics, clinical presentations, resource utilization, and outcomes of young adults admitted to contemporary CICUs.

We analysed consecutive adult CICU admissions from 2018 to 2023 within the Critical Care Cardiology Trials Network, a multicentre registry of advanced CICUs in North America. Patients aged 18–39 years were classified as ‘young adults’ and compared with those aged ≥40 years. Among 29 035 CICU admissions, 6.7% (n = 1959) were aged 18–39 years. Young adults were more likely to be female (40.0% vs. 36.4%, P = 0.001) and non-White (55.3% vs. 43.0%, P < 0.001), with fewer traditional cardiovascular risk factors. Heart failure was the leading admission diagnosis among young adults (26.4% vs. 19.5%, P < 0.001). Compared with older adults, young patients were more likely to present with cardiogenic shock (22.4% vs. 18.7%, P < 0.001) and cardiac arrest (12.7% vs. 10.6%, P = 0.003). Utilization of critical care therapies was higher, including mechanical circulatory support (13.1% vs. 11.4%, P = 0.02), with extracorporeal membrane oxygenation comprising a greater share (29.3% vs. 9.9%, P < 0.001). Young admissions had longer CICU stays [2.7 (1.2–5.8) vs. 2.2 (1.1–4.6) days, P < 0.001]. CICU mortality (6.5% vs. 10.5%, P < 0.001) and hospital mortality (9.5% vs. 14.4%, P < 0.001) were significantly lower in the young.

Young adults admitted to the CICU represent a clinically distinct population, with higher rates of high-acuity presentations and intensive resource use yet lower short-term mortality.