Association Between Nursing Diagnoses and Mortality in Patients with Cardiac Disease: A Retrospective Cohort Study

TL;DR

This study found that certain nursing diagnoses in cardiac patients are linked to higher or lower in-hospital mortality risks, offering potential for better risk assessment in intensive care.

Contribution

The study identifies specific nursing diagnoses as independent predictors of mortality in cardiac patients, a novel approach for risk stratification in critical care.

Findings

Diagnoses like fluid volume excess and impaired cardiac output were strongly linked to higher mortality risks.

Anxiety and impaired psychological comfort were associated with lower mortality risks.

Nursing diagnoses may serve as clinical markers for predicting outcomes in cardiac intensive care.

Abstract

Background/Objectives: Cardiovascular diseases represent a considerable burden on healthcare systems. In coronary intensive care units (CICU), nursing staff play a key role in the care of critically ill patients. Nursing diagnoses (NDs) based on the NANDA-I (North American Nursing Diagnosis Association-International) taxonomy enable the identification of human responses to various clinical conditions. However, their association with adverse outcomes, such as in-hospital mortality, remains understudied. Therefore, we evaluated the association between NDs and in-hospital mortality in patients with cardiac disease. Methods: A retrospective cohort study was conducted in a tertiary care hospital. The paper clinical records of 195 patients admitted to the CICU for at least 48 h between January 2023 and March 2025 were reviewed. The association of interest was assessed using Poisson regression models adjusted for confounding variables. Results: Mortality was 24.1%. NDs focusing on cardiac and extracardiac responses, such as fluid volume excess (risk ratio [RR] = 2.67; 95% confidence interval [CI] = 1.23, 5.76), impaired cardiac output (RR = 1.84; 95% CI = 1.50, 2.25), risk of shock (RR = 3.12; 95% CI = 1.91, 5.11), risk for impaired cardiovascular function (RR = 2.01; 95% CI = 1.28, 3.17), and impaired gas exchange (RR = 2.67; 95% CI = 1.64, 4.34) were significant predictors of mortality. In contrast, diagnoses such as anxiety (RR = 0.46; 95% CI = 0.23, 0.91), impaired psychological comfort (RR = 0.31; 95% CI = 0.09, 0.95), and risk of unstable glycemia (RR = 0.46; 95% CI = 0.23, 0.91) were associated with a lower risk of death. Conclusions: NDs are independently associated with in-hospital mortality in critically ill patients with cardiac disease and may represent useful clinical markers for risk stratification in intensive care settings.

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