Current Status and Future Directions of Cardiovascular Intensive Care in Japan: Workforce, Structure, Education, and Regional Disparities　- Report of the Japan Critical Care Cardiology Committee (J4CS).

Rapid population aging has increased the number of patients with severe acute cardiovascular diseases requiring intensive care. Contemporary cardiovascular intensive care has evolved beyond traditional management of acute coronary syndromes to encompass hemodynamic instability, multiple organ dysfunction, and advanced life-support technologies. Accordingly, cardiovascular intensive care units (CICUs) must provide comprehensive, tailored critical care for increasingly complex clinical conditions. In Japan, cardiovascular intensive care remains heterogeneous, with critically ill patients managed in various critical care settings. Structured care systems and specialist training remain underdeveloped. To clarify the current status, we reviewed nationwide survey data from the JROAD-DPC database. Substantial variability in institutional care systems, limited availability of dedicated cardiac care units/CICUs, and marked regional disparities in infrastructure and human resources were identified. Intensive care unit admission was associated with lower in-hospital mortality in cardiovascular emergencies, although these observational findings should be interpreted with caution because of potential residual confounding, differences in patient characteristics, and end-of-life care pathways. These findings support the need for appropriate triage and resource allocation according to patient acuity and institutional capability, rather than the uniform establishment of dedicated CICUs. Addressing these challenges will require optimized resource allocation, strengthened regional coordination, and structured training programs to establish sustainable cardiovascular intensive care systems in Japan.