Coronary Care and the Community

Coronary care units appear to have reduced by about one third the death rate of patients admitted to hospitals with acute myocardial infarction. It does not seem likely that currently foreseeable methods will lead to any further substantial reduction in mortality. Only a small proportion of patients with acute coronary disease are receiving intensive care, and further expansion of facilities will be permanently restricted by the continuing shortage of medical and nursing personnel. If the best use is made of the limited facilities, medical administrators must attempt to ensure the admission of patients within the first few hours of their illness, particularly if they are in the younger age groups. It is usually possible after a period of observation of 48 hr to identitfy those patients who will deteriorate subsequently, and these should be retained within the unit, but the remaining patients should be discharged to areas of less intensive care. The major problem in coronary care is the prevention of sudden death outside the hospital. Mobile intensive care units can lead to some saving of life in this group, but they are expensive in skilled labor. There is an urgent need for research into the identification of those liable to sudden death and to the development of antiarrhythmic regime suitable for the prevention of ventricular fibrillation in such individuals.