[Coronary care units: who to admit and how long]

Coronary care units (CCUs) should ensure the best intensive therapy for all critical cardiologic patients and not only for patients with acute coronary heart disease. Such structures apply the Hub & Spoke model, which consists of an integrated network of services allowing a health organization in which different realities interact and collaborate; this organization is composed of referral core centers (Hubs) and smaller structures (Spokes) referring to Hubs that are engaged in selection, channeling of patients in the acute phase, and for follow-up care of patients in the post-acute phase. The CCUs, based on the organizational reality in which they operate, must hospitalize and dismiss complex patients in a brief lapse of time. Criteria for CCU admission and length of stay are still ill-defined. Therefore, the following paper, summarizing the contents of the recent CCU convention at the ANMCO congress, attempts to define the priorities for hospitalization in the CCU, based on three different levels of evidence: level A indication (immediate mandatory admission); level B indication (immediate admission, the availability of beds allowing); level C indication (admission not indicated, but possible in the absence of other alternatives, e.g. limited bed availability in other intensive care units). Concerning the duration of stay within the CCU, clear-cut indications are difficult, but the concept is emphasized that the length of stay should be minimized, given the limited bed availability, in order to ensure the availability of intensive monitoring to all critical patients.