Editor’s Choice - Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function

Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper on acute cardiovascular care organisation, using a multinational working group. The patient population has changed, and intensive cardiovascular care units now manage a large range of conditions from those simply requiring specialised monitoring, to critical cardiovascular diseases with associated multi-organ failure. To describe better intensive cardiovascular care units case mix, acuity of care has been divided into three levels, and then defining intensive cardiovascular care unit functional organisation. For each level of intensive cardiovascular care unit, this document presents the aims of the units, the recommended management structure, the optimal number of staff, the need for specially trained cardiologists and cardiovascular nurses, the desired equipment and architecture, and the interaction with other departments in the hospital and other intensive cardiovascular care units in the region/area. This update emphasises cardiologist training, referring to the recently updated Acute Cardiovascular Care Association core curriculum on acute cardiovascular care. The training of nurses in acute cardiovascular care is additionally addressed. Intensive cardiovascular care unit expertise is not limited to within the unit’s geographical boundaries, extending to different specialties and subspecialties of cardiology and other specialties in order to optimally manage the wide scope of acute cardiovascular conditions in frequently highly complex patients. This position paper therefore addresses the need for the inclusion of acute cardiac care and intensive cardiovascular care units within a hospital network, linking university medical centres, large community hospitals, and smaller hospitals with more limited capabilities.

[1]  M. Sabbe,et al.  The emergency medical system , 2021, The ESC Textbook of Intensive and Acute Cardiovascular Care.

[2]  K. Huber,et al.  Systems of care for patients with acute ST elevation myocardial infarction (STEMI networks) , 2018 .

[3]  H. Bøtker,et al.  Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association , 2017, European heart journal. Acute cardiovascular care.

[4]  Cne,et al.  Cardiovascular Nursing: A Comprehensive Guide to Patient Care , 2017 .

[5]  K. Carriere,et al.  Association Between Presence of a Cardiac Intensivist and Mortality in an Adult Cardiac Care Unit. , 2016, Journal of the American College of Cardiology.

[6]  E. Krupinski,et al.  American Telemedicine Association Guidelines for TeleICU Operations. , 2016, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[7]  Coronary Care Unit to Cardiac Intensive Care Unit: Acute Medical Cardiac Care-Adapting With the Times. , 2016, The Canadian journal of cardiology.

[8]  C. Granger,et al.  From Coronary Care Units to Cardiac Intensive Care Units: Recommendations for Organizational, Staffing, and Educational Transformation. , 2016, The Canadian journal of cardiology.

[9]  Bohyoung Kim,et al.  Diagnostic performance of smartphone reading of the coronary CT angiography in patients with acute chest pain at ED. , 2016, The American journal of emergency medicine.

[10]  L. Newby,et al.  The Genesis, Maturation, and Future of Critical Care Cardiology. , 2016, Journal of the American College of Cardiology.

[11]  B. Lindahl,et al.  Consequences of implementing a cardiac troponin assay with improved sensitivity at Swedish coronary care units: an analysis from the SWEDEHEART registry. , 2016, European heart journal.

[12]  Deepak L. Bhatt,et al.  ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and The Society of Thoracic Surgeons. , 2015, The Annals of thoracic surgery.

[13]  M. Rich,et al.  Team-Based Care for Managing Noncardiac Conditions in Patients with Heart Failure. , 2015, Heart failure clinics.

[14]  P. Pronovost,et al.  Critical Care Delivery: The Importance of Process of Care and ICU Structure to Improved Outcomes: An Update From the American College of Critical Care Medicine Task Force on Models of Critical Care , 2015, Critical care medicine.

[15]  C. Vrints,et al.  The ESC Textbook of Intensive and Acute Cardiovascular Care , 2014 .

[16]  C. Di Mario,et al.  Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries. , 2014, European heart journal.

[17]  Marianna Diomidous,et al.  Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study , 2014, The Lancet.

[18]  U. Gidwani,et al.  PALLIATIVE CARE IN THE CARDIAC INTENSIVE CARE UNIT , 2014 .

[19]  Dylan S. Small,et al.  A randomized trial of nighttime physician staffing in an intensive care unit. , 2013, The New England journal of medicine.

[20]  Samuel M. Brown,et al.  Structure, Process, and Annual ICU Mortality Across 69 Centers: United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study* , 2014, Critical care medicine.

[21]  K. Swetz,et al.  Ethical issues and palliative care in the cardiovascular intensive care unit. , 2013, Cardiology clinics.

[22]  H. Wunsch,et al.  Do Intensivist Staffing Patterns Influence Hospital Mortality Following ICU Admission? A Systematic Review and Meta-Analyses* , 2013, Critical care medicine.

[23]  C. Granger,et al.  Organization and staffing practices in US cardiac intensive care units: a survey on behalf of the American Heart Association Writing Group on the Evolution of Critical Care Cardiology , 2013, European heart journal. Acute cardiovascular care.

[24]  Matthew D. McHugh,et al.  Hospital Nursing and 30-Day Readmissions Among Medicare Patients With Heart Failure, Acute Myocardial Infarction, and Pneumonia , 2013, Medical care.

[25]  C. Granger,et al.  Evolution of critical care cardiology: transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: a scientific statement from the American Heart Association. , 2012, Circulation.

[26]  Rosann Webb Collins,et al.  Telemedicine: Technology mediated service relationship, encounter, or something else? , 2012, Int. J. Medical Informatics.

[27]  Amber E Barnato,et al.  Nighttime intensivist staffing and mortality among critically ill patients. , 2012, The New England journal of medicine.

[28]  E. Lesaffre,et al.  The relationship between in-hospital mortality, readmission into the intensive care nursing unit and/or operating theatre and nurse staffing levels. , 2012, Journal of advanced nursing.

[29]  Barbara T. Unger,et al.  Has the Time Come for a National Cardiovascular Emergency Care System? , 2012, Circulation.

[30]  A. Pittard,et al.  Outreach: ‘the past, present, and future’ , 2012 .

[31]  A. Maggioni,et al.  Elderly patients with acute coronary syndromes admitted to Italian intensive cardiac care units: a Blitz-3 Registry sub-analysis , 2012, Journal of cardiovascular medicine.

[32]  J. Tu,et al.  Comparison of processes of care and clinical outcomes for patients newly hospitalized for heart failure attended by different physician specialists. , 2012, American heart journal.

[33]  J. Keenan From coronary care unit to acute cardiac care unit—the evolving role of specialist cardiac care , 2012 .

[34]  D. White,et al.  Quality in quality improvement research - a new benchmark , 2011, Critical care.

[35]  Andreas Valentin,et al.  Recommendations on basic requirements for intensive care units: structural and organizational aspects , 2011, Intensive Care Medicine.

[36]  R. Grilli,et al.  [The evolution of intensive cardiac care units and the effects of interhospital networks for reperfusion implementation. Analysis of the Emilia-Romagna regional data, 2002 to 2007]. , 2011, Giornale italiano di cardiologia.

[37]  A. Maggioni,et al.  Epidemiology and patterns of care of patients admitted to Italian Intensive Cardiac Care units: the BLITZ-3 registry , 2010, Journal of cardiovascular medicine.

[38]  Amber E Barnato,et al.  The effect of multidisciplinary care teams on intensive care unit mortality. , 2010, Archives of internal medicine.

[39]  J. Hartikainen,et al.  Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries , 2009, European heart journal.

[40]  S. Stewart,et al.  Multidisciplinary care for people with chronic heart failure : principles and recommendations for best practice , 2010 .

[41]  Christopher P Cannon,et al.  A Call to ACTION (Acute Coronary Treatment and Intervention Outcomes Network): A National Effort to Promote Timely Clinical Feedback and Support Continuous Quality Improvement for Acute Myocardial Infarction , 2009, Circulation. Cardiovascular quality and outcomes.

[42]  L. Aiken,et al.  The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: analysis of administrative data. , 2009, International journal of nursing studies.

[43]  PATIENT SAFETY AND CLINICAL GOVERNANCE , 2007 .

[44]  A. Parkhomenko,et al.  Recommendations for the structure, organization, and operation of intensive cardiac care units. , 2005, European heart journal.

[45]  A. Hewison,et al.  Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approaches. , 2004, Journal of nursing management.

[46]  Robert E. Fromm,et al.  Guidelines for the inter- and intrahospital transport of critically ill patients* , 2004, Critical care medicine.

[47]  M. Haupt,et al.  Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care* , 2003, Critical care medicine.

[48]  P. Austin,et al.  Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists , 2003, Circulation.

[49]  D Teres,et al.  Critical care delivery in the intensive care unit: Defining clinical roles and the best practice model , 2001, Critical care medicine.

[50]  J. Savino,et al.  Preparation and achievement of American College of Surgeons level I trauma verification raises hospital performance and improves patient outcome. , 2001, The Journal of trauma.

[51]  C. Cox,et al.  Effect of trauma system maturation on mortality rates in patients with blunt injuries in the Finger Lakes Region of New York State. , 2000, The Journal of trauma.

[52]  P. Spiers,et al.  Occupancy of a teaching hospital adult intensive care unit by high dependency patients , 1998, Anaesthesia.

[53]  M. Rotondo,et al.  The impact of true partnership between a university Level I trauma center and a community Level II trauma center on patient transfer practices. , 1998, The Journal of trauma.

[54]  J. E. Carceller Guidelines for intensive care unit design , 1995 .