GUIDELINES FOR ADMISSION TO CORONARY CARE UNIT AND INTERMEDIATE CORONARY CARE UNITS. (8 BEDS EACH)

Source of admission – E.T.U

1. Acute STEMI 2. Acute NSTEMI 3. Unstable Angina 4. Complicated cardiac arrythmias (CAD, Rheumatic

Heart Disease, Kanero Poisoning) 5. Severe Cardiac failure (CAD, CRHD, Cardiomyopathy) 6. Others – Myocarditis, Pericardial effusion, Chronic

complete heart block (Symptomatic)

Number of admissions to CCU & ICCU (November, December – 2005 & January – 2006)

Nov. Dec. Jan. Total No. of Admissions 178 197 214Males 125 135 159Females 53 62 55

No of Deaths 9 14 12

0

50

100

150

200

250

Nov. Dec. Jan.

Total No. of AdmissionsMales FemalesNo. of Deaths

Age Distribution

No. of Males & Females

Age Nov. Dec. Jan.

30-40 7/ 5 11/4 12/-

41-50 18/4 34/4 20/3

51-60 46/14 39/13 41/15

61-70 33/18 28/15 48/16

71 < 23/11 23/27 41/18

Diagnosis on admission

Nov. Dec. Jan. STEMI 70 67 65NSTEMI / unstable angina 74 113 126CRHD 11 6 6

Others

Myocarditis Pericardial effusion 13 14 17Cardiomyopathy Kaneru Poisoning

Major risk factors detected on admission

Nov. Dec. Jan.Diabetes mellitus 27 27 40Hypertension 36 35 51Smoking 20 31 31Dyslipidaemia NA NA NA Family history 10 12 14

Main objectives for prevention in patients with established CVD and in high risk people

- No smoking - Make healthy food choices- Be physically active - Body mass index <25 kg / m2- Bloody pressure < 140/90 mmHg in most, < 130/80 mmHg in

particular groups*- Total cholesterol < 5 mmol/l (190 mg /dl) in most. <2.5 mmol/l

(100 mg / dl) in particular groups* - LDL-cholesterol < 3mmol/l (115 mg / dl) in most. <2.5 mmol/l

(100 mg/dl) in particular groups* - Good glycaemic control in all persons with diabetes- Consider other prophylactic drug therapy in particular patient

groups*

What priorities to set, given limited resources ?The priorities for CVD prevention in clinical practice are: 1. Patients with established coronary heart disease, peripheral artery

disease and cerebrovascular atheroscierotic disease. 2. Asymptomatic individuals who are at high risk of developing

atherosclerotic cardiovascular disease because of a. multiple risk factors resulting in a 10 year risk of > 5% now (or if extrapolated to age 60) for developing a fatal CVD event. b. markedly raised levels of single risk factors

cholesterol > 8 mmol/l (320 mg/dl), LDL cholesterol > 6 mmol/l (240 mg/dl), blood pressure > 180/110 mmHg

c. Diabetes type 2 diabetes type 1 with microalbuminuria

3. Close relatives of a. patients with early onset atheroscierotic cardiovascular

disease b. asymptomatic individuals at particularly high risk

4. Other individuals encountered in routine clinical practice

Why screen close relatives?

Close relatives of patients with premature coronary heart disease (men <55 years and women < years) and persons who belong to families with familial hypercholesterolemia or other inherited dyslipidemias should be examined for cardiovascular risk factors, because all of these persons are al increased risk of developing cardiovascular disease.