The official beginning of hospital work in Bjelovar was in 1845, whereas the Department of Internal Medicine was formed on June 7, 1925. The acquisition of the first electrocardiography device in 1957 is considered the beginning of the development of cardiological work within the Department of Internal Medicine. Since then cardiovascular diseases have been and unfortunately still remain the dominant cause of morbidity and mortality in the wider Bjelovar area, and the Bjelovar-Bilogora County has for many years been a frontrunner in cardiovascular mortality. This situation required rapid and dynamic development of cardiological care. A significant first step was the opening of the Coronary Care Unit (CCU) in 1974, with only two beds at the time (1). The CCU was equipped with three monitors, two printers, one fixed-rate pacemaker, and one defibrillator. The first successful defibrillation at the Department of Internal Medicine was conducted in 1975 (2).

Since Bjelovar cardiologists were closely monitoring the epidemiological situation and were well-aware of the fact that cardiovascular diseases were the main healthcare issue, they also started working on systemic cardiological prevention (3). Under the leadership of internal medicine cardiologist and chief physician Stipe Brzović, MD, the “Heart Society” for Cardiovascular Protection was founded in 1996 with the aim of preventing cardiovascular diseases, and two years later the society published a booklet titled “Prevention of Coronary Diseases in the Bjelovar-Bilogora County”. Monthly meetings of interested citizens were organized in the facilities of the society with the goal of controlling arterial pressure as well as education through attendance of numerous lectures on the methods of preventing the development of coronary diseases and the risk factors for their development (4).

The physicians of the Department of Internal Medicine of the Bjelovar GH, led by Dr Ivanuša, formed the Bjelovar registry for acute myocardial infarction in 2001. The registry contains digital record of specific medical history data, laboratory findings, and clinical and pharmacotherapy data gathered during the presentation, treatment, and release of patients since September 1996 (3). An interesting fact is that at the time of its formation the Bjelovar registry for acute myocardial infarction was, along with the registry of the Zagreb Institute for Cardiovascular Prevention and Rehabilitation, the only registry for patients suffering for myocardial infarction in Croatia and the only hospital registry containing data on pharmacotherapy (1). Since 2009 the Registry has been led by Dr Čleković-Kovačić as the head of the CCU.

After several architectural and technical reconstructions (in 1983 and 2004), the CCU has been expanded (as part of the Internal Medicine Intensive Treatment Unit), and now comprises seven beds with an additional seven beds for postintensive/postcoronary care. It is equipped with modern monitoring devices for central monitoring as well as mandated and repeatedly modernized mechanical equipment (1). Thanks to the efforts of Dr Ivanuša and with the help of sponsors, two personal computers were acquired for the CCU significantly ahead of hospital-wide digitalization. The hospital network allowed the transfer of data and test results, which provided access to the central monitoring system for Postcoronary/postintensive Care via the hospital network. At the same time, the quality of the care being provided was improved on several levels. The InternPol software system was integrated in September 2005, which provided data on the treatment of patients at the Internal Medicine Department as well as all other internal medicine diagnostic processing (5).

Thanks to the efforts of Dr Ivanuša, the Bjelovar-Bilogora County joined the Croatian Network for the Interventional Treatment of Acute Myocardial Infarction in 2005. This allowed more effective treatment of patients with acute myocardial infarction with ST-segment elevation (STEMI) using percutaneous coronary intervention (PCI) with stent implantation. Patients were referred for PCI to the University Hospital Dubrava in Zagreb as early as the start of 2006. However, patients were later referred to the University Hospital Centre (UHC) Zagreb, which remains the standard practice today. Since 2009, all patients with acute myocardial infarction without ST-segment elevation (NSTEMI) are also referred to the UHC Zagreb with prior arrangements over fax or e-mail (all arrangements had previously done been by phone). The whole process of transporting the patients was organized with the support of the Bjelovar-Bilogora County in cooperation with the Bjelovar-Bilogora County Health Centre, which provided an ambulance vehicle and a driver, while the Bjelovar General Hospital provided then accompanying physician and nurse. The return trip for patients with myocardial infarction was also covered by physicians and nurses of the Internal Medicine Department of the Bjelovar GH. The efforts and work of these physicians was widely recognized, and in 2006 Dr Ivanuša became the editor of “Kardio list”, the official journal of the Croatian Cardiac Society, and a member of the committee of national cardiology journal editors of the European Society of Cardiology (6).

Under the sponsorship of the Bjelovar-Bilogora County, Dr Klobučić initiated the formation of the County Team for the Prevention of Cardiovascular Diseases in 2009 (1).

In addition to the Coronary and Postcoronary Unit, the Department of Internal Medicine of Bjelovar GH encompasses cardiological, pulmonological, gastroenterological, endocrinological, oncological, hematological, and nephrological treatment, hemodialysis, and outpatient healthcare. The Department currently has a total of 81 beds, of which 67 are department beds, 14 are coronary and postcoronary beds, and 14 are day hospital beds.

Outpatient cardiac care covers all non-invasive diagnostics: 12-lead ECG, exercise stress test, 24-hour ECG monitoring, 24-hour ambulatory blood pressure monitoring, transthoracic echocardiography, and transesophageal echocardiography.

Cardiological work at the Department of Internal Medicine of Bjelovar GH is performed by four cardiologists, three cardiology residents, and one physician currently completing her subspecialization.

The Bjelovar GH CCU has 7 beds and 7 beds for postcoronary care (Figure 1). As most other units, the CCU is equipped with a central oxygen and vacuum system, Philips monitors for continuous vital function monitoring, two Zoll defibrillators (Figure 2), Braun infusion devices and perfusion pumps (Figure 3), an Oxylog machine, cardiac ultrasound, and aspirators. It is fully equipped for central oversight of invasive and non-invasive monitoring of arterial pressure, oxygen saturation, electrocardiograms, malign heart rhythm disorders, and monitoring the state of hemodynamically unstable patients with acute heart failure and all other internal medicine patients who require intensive care (e.g. various states of sepsis, pulmonary embolism, gastrointestinal bleeding, acute hemodialysis, etc.) (5).

In 2011, the Dräger central unit with 14 monitors was replaced with a Philips central unit (Figure 4) with 7 MP20 monitors for the coronary unit (Figure 5) and 7 MP2 monitors (Figure 6) for the postcoronary unit, which allowed the unit to connect with the cardiological laboratory and conduct Holter ECG monitoring for patients in the coronary/postcoronary unit. This allows faster diagnostics and adequate treatment selection, thus reducing patient hospitalization time.

As can be seen from data shown in Table 1, over the last few years there has been a significant increase in the number of patients treated in the Bjelovar GH CCU (coronary/postcoronary care), with the total number of patients ranging from 300 to 400 per year and an average hospitalization time at the CCU of 5.5 days per patient.

Continuous monitoring of patients referred for invasive procedures to the UHC Zagreb, the University Hospital “Merkur”, the Special Hospital Magdalena, and the University Hospital Dubrava from 2010 to 2018 showed a relatively stable number of referred patients, with an average of about 200 patients per year (Figure 7).

Invasive procedures conducted at the CCU are as follows: central venous catheter implantation (both for treatment and dialysis), temporary intravenous pacemaker implantation, electrocardioversion, and transesophageal echocardiography. Hospitalized patients are provided with all necessary medication treatment (anti-ischemic, anti-aggregation, and anti-coagulation medication, unfractioned and low molecular weight heparins, etc.).

In addition to the unit chief, the Coronary/postcoronary Unit currently employs 13 nurses and medical technicians working in shifts, of which four have a bachelor’s degree in nursing and three nurses currently in the process of graduating from the University of Applied Health Sciences.

In addition to their daily tasks and activities, the medical staff of the CCU constantly engages in educating patients suffering from myocardial infarction (mostly orally and through written instructions and instructional materials for patients). The education comprises informing patients about cardiovascular risk factors, treatment, lifestyle habits, diet, and other aspects of everyday life in their current state of health.

The CCU has achieved long-lasting and successful cooperation with the University Hospital “Merkur” in Zagreb regarding elective coronarography and cardiac electrophysiology. Continuous cooperation has also been established with the Koprivnica GH (and Dr Fucak specifically) regarding pacemaker implantation, as well as cooperation with many other healthcare institutions in Croatia.