Acute Cardiac Care: Subspecialty Accreditation ante Portas

Abstract

Coronary Care Units (CCUs) appeared in 1961 and their importance in the treatment of fatal arrhythmias in patients with an acute myocardial infarction was immediately confirmed (1). However, cardiology is rapidly changing and the role of CCUs today is totally different. In the era of early invasive reperfusion, the natural history of myocardial infarction has changed and most patients need a short CCU stay. On the other hand, the population is aging; patients with cardiac conditions live much longer and present with many comorbidities requiring longer and more complex critical cardiac care. Thus, the cardiologist should be able to understand the patient’s pathophysiology and provide treatment in the CCU in complex cases with, among other things, heart failure and renal failure, diabetes, respiratory failure on mechanical ventilation, sepsis and bleeding. Indeed, CCUs should be called intensive cardiac care units (ICCUs) because cardiac patients suffering from multisystem diseases are treated in these units. These changes are also reflected in the recommendations for the structure, organization, and operation of intensive cardiac care units (ICCUs). (2) In consequence, training a new type of cardiologist with expertise in intensive cardiac care is urgently needed on both sides of the Atlantic (3). Today these patients are treated by different specialists, often intensivists or anesthesiologists, without proper cardiology training, who do not use all the resources that modern cardiology could offer the patient. Currently, there is no formal training in acute cardiac care and to the best of our knowledge none of the National Cardiac Societies in Europe has developed any training program with these objectives. Nevertheless, the Working Group (WG) on Acute Cardiac Care of the European Society of Cardiology has recognized the need for better training of the cardiologists working in ICCUs. To work towards that end, the WG has prepared the Core Curriculum for a subspecialty on Acute Cardiac Care and the Accreditation will start later this year. The complexity of this subspecialty is reflected also in the contents of every issue of our journal (4–13). In the current issue a broad spectrum of subjects is presented, from acute coronary syndromes to arrhythmias, acute heart failure, hyponatremia and ventricular assist devices. It is clear that in the future Acute Cardiac Care will be one of the most important subspecialties of cardiology. And probably, the future is now!