The intermediate coronary care unit. A stage in continued coronary care

Abstract

The concept of continued and progressive coronary care rather than intermediate coronary care is proposed. At each clinical stage the patient may be at risk and his management needs to be planned appropriately--prevention of the development of coronary disease, prehospital care, acute coronary care, subacute coronary care, and late hospital stay. Meticulous continued care once the patient leaves the hospital and returns home may be needed for a long time. Although the benefit of an intermediate coronary care unit has not yet been proved, significant patient risk continues beyond 12 days of hospital admission. High risk patient subsets are emerging requiring careful continued monitoring and the ability to undertake emergency measures as needed, and this is particularly so in patients suffering large anterior infarction, in those with infarction associated with cardiac failure, when infarction is associated with fascicular block and other types of conduction disturbances, and in patients who continue with rhythm disturbances after their admission to the hospital. Electrocardiograph leads III and VI displayed simultaneously should be routinely monitored in patients with fascicular blocks and acute anterior infarction as a guide to instituting prophylactic transvenous pacemaking. The continuation of intensive patient care and monitoring beyond the usual 2 to 5 days in a coronary care unit allows early mobilisation of patients in safety, thus speeding their ultimate rehabilitation. There is, as yet, no satisfactory study documenting the need for intermediate coronary care units, but much presumptive evidence is available to indicate that this is so. A carefully controlled randomised study would be invaluable.