The recent evolution of coronary care units into intensive cardiac care units: the experience of a tertiary center in Florence

Objectives To evaluate the evolution of intensive cardiac care units (ICCUs) in the third millenium by assessing the activity and the workload of our ICCU which is a Hub center, from 1 January 2004 to 30 June 2005. Methods Among the 1397 patients consecutively admitted to our ICCU, 40.5% came from Spokes. Patients with ST elevation myocardial infarction comprised 29.5% of the entire population: all of them were admitted to ICCU after mechanical reperfusion. Results The incidences of ventricular fibrillation (1%) and complete AV block (0.6%) are low in our patients. The most frequent complications were acute renal failure requiring renal replacement therapy (4.4%) and vascular and hemorrhagic complications (4.3%). Conclusions Our ICCU is a post-reperfusion unit for treating complications of therapy and older and more complex patients who require more intensive care. This is why the cardiac intensivists also need to be skilled in general intensive care. In the Integrated Cardiac Network (Hub-and-Spoke model), ICCUs play a crucial role in the management of all cardiac emergencies, and in maintaining a continuous and strict interplay with Spokes, they have a prominent and unique role in the selection and early treatment of acute cardiac patients and their follow-up.