Improved criteria for admission to cardiac care units
R. Fuchs and S. Scheidt
Patients requiring specialized cardiac care unit interventions (CCUIs) were
identified from 414 consecutive admissions with known or suspected
myocardial infarction (Ml). Cardiac care unit interventions included
administration of lidocaine hydrochloride, atropine sulfate, sodium
nitroprusside, or vasopressors; Swan-Ganz or arterial catheterization;
insertion of temporary pacemaker; and electroshock. Almost all
interventions occurred in a high-risk group that had one or more of three
findings: (1) ongoing chest pain, (2) pulmonary rales, or (3) one or more
ventricular premature contractions (VPCs) on 12-lead ECG. Of 306 high-risk
patients, 41% received at least one CCUI, and 4% died in the CCU. In
contrast, of the 108 low-risk patients with none of the three criteria,
only 6% received any CCUI, and none died in the CCU. This study suggests
that patients who do not have ongoing pain, congestive heart failure, of
VPCs when first evaluated have a very low risk of early complications and
may not require intensive care.
