Redefining the coronary care unit: an observational study of patients admitted to hospital in England and Wales in 2003.
BACKGROUND
Coronary care units were developed in the 1960s as specially equipped and staffed areas where patients with acute myocardial infarction could be monitored and offered rapid resuscitation from life-threatening arrhythmias. Awareness of the morbidity and mortality of the wider spectrum of acute coronary ischaemia was unrecognized at that time.


OBJECTIVE
To examine the relative frequencies with which thrombolytic treatment and resuscitation from cardiac arrest are provided for patients with myocardial infarction in cardiac care units (CCUs), emergency departments (EDs) and other medical wards.


METHODS
Observational study.


METHODS
We analysed records from the National Audit of Myocardial Infarction Project (MINAP) for 61 688 patients admitted to 230 acute hospitals in England and Wales during 2003, and who received a final diagnosis of myocardial infarction, for locations of initiation of thrombolytic therapy and of first cardiac arrest within hospital.


RESULTS
Overall, 84% of 27 881 patients with ST-segment-elevation infarction, but only 42% of 30 382 patients with non-ST-elevation infarction, were admitted to a CCU. Of those receiving thrombolytic treatment for ST-elevation infarction, 68.3% of 21 595 did so in the ED. Within the first 4 h after arrival, the majority of episodes of cardiac arrest occurred in the ED: 709 (57%) vs. 488 (39%) in CCU, and 49 (4%) in medical wards.


CONCLUSIONS
The traditional role of the CCU in providing early resuscitation and thrombolytic treatment for patients with ST elevation infarction has largely been devolved to the ED. The role of the CCU should be re-evaluated, and the service re-designed to provide specialist care for all presentations of acute coronary syndrome.
Quinn
T
T
Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, UK.
Weston
C
C
Birkhead
J
J
Walker
L
L
Norris
R
R
D000368:Aged; D000369:Aged, 80 and over; D003325:Coronary Care Units / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D004739:England; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006753:Hospital Records / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D012151:Resuscitation / Q000706:statistics & numerical data*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D014852:Wales