الفهرس 
acknowledgementOnly 14 pages are availabe for public view
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Abstract
According to the .World Health Organization report (60) coronary heart disease (CHD) is a dominating cause of death in most industerialised counteries. It also causes consider able disability for survivors. , Since 1963, when Day( 12) and his colleagues instituted their first coronary care unit, this system is becoming widely propagated. Al though it looks very helpful to those wi th coronary heart disease, yet it is very expensive in comparison with ordinary type of services. As it is known the benefit of a C.C.U. is mainly during the early phase of symptomatisation, this will lead to many false diagnoses and abuse of coronary care units. The need for developing a clear protocol for admission and length of stay, both were underlying the idea of this work which aimed at: (1) Study of the characteristics of cases admitted to the C.C.U. in the Main Hospital of Alexandria University. (2) The study of pattern of bed occupancy in this unit. (3) Developing criteria for admission and stay. (4) Validation of these criteria. (5) Testing the criteria on cases admitted to the unit,as well as on those admitted in the general medical wards in the same hospital. ! I The steps of the work included a retrospective study of 281 patients admitted to the unit over a period of two years, (1981 and 1982) . This was done through revision of the patients file, including all informations needed.Develop- I ing criteria for admission was gained from literature review. These criteria have been put in the form, of questionnaire to be validated by group of cardiologists from dif’ferent centers met in the annual meeting of theE gyptian Society of Cardiology held at Cairo. Testing of the developed cri teria was carried out on patients admitted to the C.C.D. as well as on patients admitted to the general medical wards during six months period (start of April till the end of September 1983). The results of the retrospective study revealed the following: - The mean age was 53.6 years for males and 50.65 years for females and the majority of cases were above 45 years. - The mean age of cases with acute myocardial infarction was 56.4 years, while the mean age in the group of myo cardial ischaemia without infarction was 49.93 years. t Majority of patients were males (72.6),while the females constituted only (27.4 i). - Most of the males were suffering from acute myocardial infarction, while the majority of females were only suffering from myocardial ischaemia without infarction. * Most of cases were belonging to the group of coronary heart disease (93.95 ), while only (6.05 ) were suffering from other cardiac conditions. - Length of stay was related to the age as it was 4.34 days in the youngest age group and 13.05 days in the oldest group. , - The incidence of complications was increased with in crease of age, also the frequency of admissions was more in the older age group. - Length of stay in complicated cases was more than in the non complicated, whether with myocardial infarc tion or myocardial ischaemia. - The frequency of complications was in this order; Arr hythrnias, heart failure, hypotension, cardiogenic shock and the least was pulmonary embolism. - The mortality rate was higher in the older age group. - Most of the patients were referred from the emergency department. ~ The total mortality percentage was 18.86 during the years (1981 & 1982). The highest mortality was during the first 24 hours and 83.02 of deaths happened with in one week. - The repeatidly admitted patients were mostly belonging to the group of myocardial ischaemia without infarction and with complications. - As regards the electrical interferences presented to the patients; defibrillation was done in 66.66 of cases with (AMI) with complications, while cardioversion was performed in (84.62 ) of complicated cases of myocardial ischaemia without infarction. Tempora~y or permenant pacing was done more in cases of myocardial ischaemia. ~ - On discharge, 57.3 of patients were directly referred to home. Results of the propspective study were as follow: -/The average daily census was 2.24 which is equivalent to occupancy rate of 56 . This occupancy rate reached to Zero in 6.91 of the days during the period of eight months. Most of the cases admitted to the C.C.V. had absolute in dication for admission (62.5 ), while (31.25 ) were either moderate or least indicated, and only (6.25 )were not indicated. - Case admitted in the medical wards showed a percentage of -30.77 with absolute indication for admission tothe C.C.U from the medical ward cases with various degrees of in dication for admission in the C.C.V. only (2.88 ) were referred to the unit, while (97.12 ) were not referred. - The average length of stay in the general medical wards was longer than in the C.C.V. for cases with similar diagnosis; (12.51 and 7.61 days respectively). Mortality rate in the C.C.D. in the group with absolute indication was 37.5 , while it was 40.62 in the med ical ward. In the group of moderate indication it was 8.33 in the C.C.D. and 33.33 in the medical ward.In the least indicated group no deaths occurred in the C.C.D., while 5.83 died in the medical ward. J - The investigations were very much lacking in the medical ward, while in the C.C.D.; ECG was done daily to all patients. It was only done in 63.94 of patients in the medical wards. Cardiac enzymes estimation was done in 87.56 of patients in the C.C.D. while only 5.29 in the medical wards were checked for their serum cardiac enzymes. - In the group of absolute indication 77.59 in the C.C.D. were paying, 88.33 in the moderately indicated and 100 of the least indicated. The total percentage was 82.81 paying and 17.19 non paying.