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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.