Implementation of a Dedicated Cardiovascular and Stroke Unit in a Crowded Emergency Department of a Tertiary Public Hospital in Brazil: Effect on Mortality Rates

Abstract

Emergency department (ED) care for acute vascular diseases faces the challenge of overcrowding. A vascular unit is a specialized, protocol-oriented unit in the ED with a team trained to manage acute vascular disorders, including stroke, coronary syndromes, pulmonary embolism (PE), and aortic diseases. The objective was to compare case fatality rates for selected cardiovascular conditions before and after the implementation of a vascular unit. Patients with the selected diagnoses admitted to the ED in two different time periods, 2002 through 2005 (before unit opening) and 2007 to 2010 (after vascular unit opening), were identified by ICD-10 codes, and their electronic records were reviewed. Case fatality rates were calculated and compared for both time periods. The period prior to unit implementation (2002 through 2005) included 4,164 patients, and the vascular unit period (2007 to 2010) included 6,280 patients. Overall, the case fatality rate for acute vascular conditions decreased from 9% to 7.3% with vascular unit implementation (p=0.002). The in-hospital mortality rates for acute coronary syndrome (ACS) dropped from 6% to 3.8% (p=0.003), and for acute PE dropped from 32.1% to 10.8% (p<0.001). The stroke case-fatality rate did not decrease despite improvements in the quality of stroke health care indicators. The vascular unit strategy has the potential to reduce overall mortality for most acute vascular conditions.