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October 1982

The Intermediate Coronary Care Unit: A Promise Unfulfilled

Author Affiliations

Coronary Care Unit Good Samaritan Hospital Dayton, OH 45402

Arch Intern Med. 1982;142(10):1794-1795. doi:10.1001/archinte.1982.00340230034006

In the late 1960s, after soundly based and virtually universal enthusiasm for the coronary care unit (CCU), interest developed in the, then, new concept of the intermediate coronary care unit (ICCU). Perhaps, the earliest advocates of intermediate coronary care were Gotsman and Schrire1 of South Africa. These authors assumed, without substantiating data, that monitoring of the patient's condition during the latter hospital phase, after myocardial infarction, might prevent unexpected deaths.

I made a similar observation in 1969.2 At that time, I thought that continuous monitoring might substantially reduce the number of deaths after discharge from the CCU. Grace3 and, subsequently, Frieden and Cooper4 somewhat unconvincingly reported reduced mortality through post-CCU monitoring. Several other authors advocated protracted monitoring in areas staffed with specially trained nurses and equipped with resuscitation facilities.5-7 In 1975, in England, the ICCU described by Reynell8 showed no reduced mortality, although