Mapping cardiac intensive care units in Greece: infrastructure, staffing ratios, and advanced support availability

Cardiac intensive care units (CICUs) have evolved to manage increasingly complex cardiovascular illnesses, yet national-level data on infrastructure, staffing, and advanced support in Greece are limited. The aim of this nationwide survey was to map CICUs in Greece.

The survey questionnaire was distributed to hospitals in the national health system across the country.

Of 81 hospitals, 74% reported the presence of a general intensive care unit, 25% an intermediate care unit, and 70% had a dedicated CICU. Among 57 CICUs, 53% operated with 6-10 beds; hospital bed number and tertiary hospital type were independent predictors of CICU bed number. Nursing coverage in most CICUs was at least 1 nurse per 3 patients (1:3) during the morning shift (72%), with declining percentages of the 1:3 ratio during the afternoon (47%) and night (44%) shifts. A nurse-to-patient ratio of less than 1:4 was frequent during the afternoon (32%) and night (37%) shifts, even in CICUs in tertiary centers. Staffing with a cardiologist-intensivist was observed in only 21% of all CICUs (24% in tertiary centers). Respiratory support (non-invasive/invasive: 95%/89%) was widely available. Availability of continuous renal replacement therapy (odds ratio [OR]:3.9; p = 0.019), Swan-Ganz use (OR:11.2; p = 0.010), intra-aortic balloon pump (OR:14.2; p < 0.001) and tracheotomy (OR:3.6; p = 0.043) was more frequent in CICUs in tertiary centers.

The survey identified potential actionable items for improvement, including an increase in nurse-to-patient ratios and cardiovascular intensivists in CICUs in Greek public hospitals. Aligning the operation/staffing of CICUs with international standards could be considered to advance acute/critical cardiac care at a national level.