Background: The aim of this study was to evaluate the impact of the implementation of the interhospital network focused on reperfusion of ST-elevation myocardial infarction (STEMI) on the activity of intensive cardiac care units (ICCUs) of the Emilia-Romagna Region (Italy).
Methods: From the Emilia-Romagna Region databank of hospital discharge records, all consecutive admissions to ICCUs from January 1, 2002 to December 31, 2007 were derived. The main discharge diagnoses were classified into three groups: ST-elevation acute coronary syndromes (STE-ACS) (ICD-9 410, with the fourth digit other than 7), non-STE ACS (ICD-9 410.7 and all code 411), and hospitalizations for other diagnosis unrelated to ACS (non-ACS).
Results: During the study period, 92 545 patients were hospitalized in ICCUs (on average, almost 15 000 patients/year). In 2007, as compared to 2002, a 14% reduction in the overall admissions for STEMI was observed, with a 26% increase for non-STE ACS. The number of non-ACS admissions was stable. Interestingly, a significant increase (+15%) in direct admissions to the ICCUs of Hub centers was reported (+17% STEMI, +26% non-STE ACS and +6% non-ACS, respectively). Within these ICCUs, a significant increase in coronary angiography and angioplasty procedures in patients with STEMI or non-STE ACS was observed. Furthermore, the median hospital length of stay was shorter in the ICCUs of Hub centers. Over the same period, a substantial decline (-14%) in admissions to the ICCUs of Spoke centers was recorded, largely due to a 57% decrease in STEMI, not offset by a 20% increase in admissions for non-STE ACS or by the number of patients transferred back from Hub centers after reperfusion or stabilization. A reduction in hospitalizations for non-ACS was also observed, as well as an increase in the number of patients sent from the Spoke centers to the cath lab of the Hub centers for outpatient procedures. In the Spoke centers, the median length of stay in the ICCU did not vary over the whole study period.
Conclusions: Although administrative data suffer from several limitations, this survey shows substantial variations in the ICCU activity after the implementation of the interhospital network for the treatment of STEMI. This finding should stimulate a critical reconsideration of the role and function of the ICCUs involved in acute cardiac care.