The impact of daylight and window views on length of stay among patients with heart disease:A retrospective study in a cardiac intensive care unit

Background:Heart disease is the leading cause of death in the United States.The length of stay(LOS)is a well-established parameter used to evaluate health outcomes among critically ill patients with heart disease in cardiac intensive care units(CICUs).While evidence suggests that the presence of daylight and window views can positively influence patients’LOS,no studies to date have differentiated the impact of daylight from window views on heart disease patients.Also,existing research studies on the impact of daylight and window views have failed to account for key clinical and demographic variables that can impact the benefit of such interventions in CICUs.Methods:This retrospective study investigated the impact of access to daylight vs.window views on CICU patients'LOS.The study CICU is located in a hospital in the southeast United States and has rooms of the same size with different types of access to daylight and window views,including rooms with daylight and window views(with the patient bed located parallel to full-height,south-facing windows),rooms with daylight and no window views(with the patient bed located perpendicular to the windows),and windowless rooms.Data from electronic health records(EHRs)for the time-period September 2015 to September 2019(n=2936)were analyzed to investigate the impact of room type on patients’CICU LOS.Linear regression models were developed for the outcome of interest,controlling for potential confounding variables.Results:Ultimately,2319 patients were finally included in the study analysis.Findings indicated that patients receiving mechanical ventilation in rooms with access to daylight and window views had shorter LOS durations(16.8 h)than those in windowless rooms.Sensitivity analysis for a subset of patients with LOS≤3 days revealed that parallel bed placement to the windows and providing access to both daylight and window views significantly reduced their LOS compared to windowless rooms in the unit(P=0.007).Also,parallel bed placement to the window significantly reduced LOS in this patient subset for those with an experience of delirium(P=0.019),dementia(P=0.008),anxiety history(P=0.009),obesity(P=0.003),and those receiving palliative care(P=0.006)or mechanical ventilation(P=0.033).Conclusions:Findings from this study could help architects make design decisions and determine optimal CICU room layouts.Identifying the patients who benefit most from direct access to daylight and window views may also help CICU stakeholders with patient assignments and hospital training programs.

Anemia in patients with high-risk acute coronary syndromes admitted to Intensive Cardiac Care Units

Background Little information exists about the role of anemia in patients with acute coronary syndromes(ACS)admitted to Intensive Cardiac Care Units(ICCU).The aim of this study was to assess the prevalence of anemia and its impact on management and outcomes in this clinical setting.Methods All consecutive patients admitted to eight different ICCUs with diagnosis of non-ST segment elevation ACS(NSTEACS)were prospectively included.Anemia was defined as hemoglobin<130 g/L in men and<120 g/L in women.The association between anemia and mortality or readmission at six months was assessed by the Cox regression method.Results A total of 629 patients were included.Mean age was 66.6 years.A total of 197 patients(31.3%)had anemia.Coronary angiography was performed in most patients(96.2%).Patients with anemia were significantly older,with a higher prevalence of comorbidities,poorer left ventricle ejection fraction and higher GRACE score values.Patients with anemia underwent less often coronary angiography,but underwent more often intraaortic counterpulsation,non-invasive mechanical ventilation and renal replacement therapies.Both ICCU and hospital stay were significantly longer in patients with anemia.Both the incidence of mortality(HR=3.36,95%CI:1.43–7.85,P=0.001)and the incidence of mortality/readmission were significantly higher in patients with anemia(HR=2.80,95%CI:2.03–3.86,P=0.001).After adjusting for confounders,the association between anemia and mortality/readmission remained significant(P=0.031).Conclusions Almost one of three NSTEACS patients admitted to ICCU had anemia.Most patients underwent coronary angiography.Anemia was independently associated to poorer outcomes at 6 months.

A case report of chylous ascites after cardiac surgery

Background:Chylous ascites(CA),an emulsion rich in triglycerides,is a rare type of ascites,especially after cardiac surgery.Also,there are few reports of the occurrence of CA after mitral valve replacement,aortic valve replacement,tricuspid valvuloplasty,and coronary artery bypass grafting.Case presentation:We report the case of a 53-year-old man who underwent surgery for a diagnosis of mitral incompetence,aortic incompetence,tricuspid incompetence,and coronary atherosclerotic heart disease.Fifteen days after surgery,3000 mL of milky-yellow ascites appeared in the abdominal cavity,diagnosed as CA by laboratory examination.The ascites gradually disappeared after being drained,and the patients improved.The curative was objective,but the exact cause is not clear.Conclusion:Although CA is rare,it may occur during the surgical intervention in cardiac surgery.