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The intermediate coronary care unit: a promise unfulfilled.

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 Schrire 1 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. Grace 3 and, subsequently, Frieden and Cooper 4 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 Reynell 8 showed no reduced mortality, although