[ANMCO Position paper: ANMCO States General 2024 - Continuing to improve outcomes for patients with acute heart disease].

In recent years, there has been a constant reduction in mortality and morbidity in numerous cardiovascular diseases. The advent of hospital networks has allowed for a reduction in the timing of reperfusion treatment in patients with acute coronary syndromes (ACS). However, to date, only the network for ST-elevation myocardial infarction, according to the latest Cardiological Census, is widely spread in Italy. Instead, there are several other acute heart diseases for which there is no equally widespread network, and there is still great heterogeneity among regions. The data from the National Outcome Plan of AGENAS confirms these gaps, particularly for non-ST-elevation ACS and for cardiogenic shock. This observation is further complemented by the profound transformation that the intensive cardiac care units (ICCUs) have undergone in recent years. Today's ICCUs are no longer just places for treating ACS, but should also care for and monitor other acute heart diseases, in particular heart failure, cardiogenic shock, intermediate-to-high-risk pulmonary embolism, and multiple cardiac complication of non-cardiac organ damage as well. This evolution requires significant developments in clinical skills, technological resources, and healthcare organization. The purpose of this work is therefore to describe this clinical and organizational evolution and identify the necessary pathways, interactions with the territory and system indicators to implement them with the aim to improve the prognosis of patients with acute heart diseases as well.