Structuring cardiology services for the 21st century

Segregating patients into small coronary care units began in the 1960s. This step was deemed necessary for two reasons: (1) the high mortality and often profound morbidity of patients who had acute myocardial infarction and (2) the boom in treatment technologies, with the introduction of bedside oscilloscopes, defibrillation, and mechanical and pharmacological means of resuscitation and pacing. Another series of technology booms in cardiology has occurred in the 1990s. This new technology and other associated factors may signal the need for reviewing the cardiac care environment. This article presents the evolution of acute care in cardiology from the 1960s to 1996 and questions the continuing need for small, highly staffed cardiac care units. In the current climate of technological refinements, improved nursing education, and a large and diverse population of cardiovascular patients, these units may be redundant.