Size matters: a critical appraisal of current acute cardiac care unit sizing in a real-world Italian scenario

Current sizing in terms of beds and the territorial distribution of acute cardiac care units (ACCUs) is presently defined in Italy by Ministerial Decree 70/2015. The performance of this model of care based on one ACCU with coronary-angioplasty facilities for every 150 000-300 000 inhabitants has been poorly evaluated in the real world so far.

This study is based on a real-world, single-center, cohort of patients urgently admitted to the ACCU (and annexed cardiology ward) for acute cardiovascular disease: admission diagnosis, hospital stay, and outcome were recorded and compared to the Ministerial Decree 70/2015 model and standards.

A total of 2210 consecutive patients were urgently admitted to the ACCU and annexed cardiology ward for acute cardiovascular disease in the 2 years of the study: 62% were male, mean age of admission was 68 ± 15 years, mortality rate was 4.5%, mean hospital stay was 7.7 ± 7 days.The admission diagnosis was acute coronary syndrome in 42% of cases, acute heart failure in 12.8%, brady-arrhythmias in 7.6%, ventricular tachycardia in 3.9%, and pulmonary embolism in 3.1%. The multivariable logistic regression analysis, age and admission by emergency medical service were significant predictors of mortality.The mean daily admission rate was 3 patients/day, 1.3 for ACS, and 0.55 for ST-elevation acute myocardial infarction; the number of ACCU beds required for ACS (8.1 days of mean hospital stay) was 10.5, and for overall admissions (7.7 days of mean hospital stay) 23.4.

The present ACCU model (beds per ACCU for every 150 000-300 000 inhabitants, Ministerial Decree 70/2015) is undersized for present admission rates and workloads and should be revised.