The coronary care unit turns 25: historical trends and future directions.

In the 25 years since the introduction of coronary care units the management of acute myocardial infarction has become oriented toward reducing infarct size and treating ongoing ischemia. The coronary care unit has been widely accepted as the standard of care for patients with acute myocardial infarction and has been considered appropriate for monitoring patients with acute chest pain until acute myocardial infarction is diagnosed or excluded. However, rising health care costs have created pressures to increase the efficiency of coronary care units. Possible strategies seek to decrease resource use by identifying low-risk patients for initial triage or early transfer to lower levels of care. The application of management algorithms and the development of intermediate care units as alternative triage sites for low-risk patients may be important future trends as a distinction is made between intensive coronary care and careful coronary observation.