title: [From the coronary care unit to the intensive cardiac care unit: the evolution of the Cardiovascular Department of a tertiary center].
abstract: BACKGROUND
  Substantial changes have occurred over time in the diagnoses, procedures and characteristics of patients admitted to coronary care units (CCU). Following the introduction of cardiac surgery activity in our hospital in December 2009, the aim of this study was to evaluate the changes in activity, processes of care and outcomes of patients consecutively admitted to our CCU after the reorganization of the Cardiovascular Department.
  
  
  METHODS
  All 1674 consecutive patients admitted to the CCU from January 2009 to December 2010 were enrolled in this retrospective registry.
  
  
  RESULTS
  In 2010, the number of patients referred from other hospitals or wards significantly increased (from 17.2% to 28.3%; p<0.001). Significant was also the increase of patients with ST-elevation myocardial infarction (n=190 to n=230, p<0.001), shock (n=20 to n=50, p<0.001), pulmonary edema (n=47 to n=64, p<0.05), cardiac arrest (n=2 to n=8, p<0.05), aortic dissection (n=0 to n=12; p<0.001). Conversely, the number of patients admitted for acute coronary syndromes without ST-segment elevation and GRACE risk score <140 significantly decreased (n=169 to n=52, p<0.001). In parallel, a significant increase in the use of intra-aortic balloon pump (2.0% to 5.6%, p<0.001), continuous hemofiltration (0.3% to 3.1%, p>0.001), non-invasive ventilation (5.6% to 10.5%, p<0.001) and mechanical ventilation (0% to 4.1%, p<0.001) was observed. Intensive care devices were more frequently used in the subgroups affected by shock, acute coronary syndromes without ST-segment elevation and GRACE risk score >200, and heart failure. Interestingly, despite the increase in high-risk clinical conditions the intra-CCU mortality did not change (3.1 vs 2.9%).
  
  
  CONCLUSIONS
  Patients admitted to the CCU have high-risk acute clinical conditions. A model based on the sharing of cardiological, cardiac anesthesiological and surgical expertise is effective in increasing admission appropriateness and improving standards of care in a short period of time.
authors: Unità Coronarica, Ospedale A. Manzoni, 23990 Lecco, Italy. la.ferri@ospedale.lecco.it
authors: Luca
authors: L
authors: Ferri
authors: Andrea
authors: A
authors: Farina
authors: Laura
authors: L
authors: Lenatti
authors: Cristina
authors: C
authors: Malafronte
authors: Franco
authors: F
authors: Ruffa
authors: Luigi
authors: L
authors: Piatti
authors: Stefano
authors: S
authors: Maggiolini
authors: Giovanni
authors: G
authors: Lorenzi
authors: Amando
authors: A
authors: Gamba
authors: Emanuele
authors: E
authors: Catena
authors: Felice
authors: F
authors: Achilli
mesh_terms: D000368:Aged; D003325:Coronary Care Units; D005260:Female; D006748:Hospital Departments; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy; D012189:Retrospective Studies