[Clinical competence of the cardiologists working in coronary care units].

Since the early 1970s, intensive cardiac care has been given in coronary care units (CCUs) that were developed to treat lethal arrhythmias in patients with acute myocardial infarction (AMI). Later on, such units have expanded their attitude according to patients' needs. In fact, during the last decades, subjects have become progressively older, with an increasing number of comorbidities. In addition, growing numbers of patients with severe heart failure, rhythm disturbances, massive pulmonary embolism or severe valvular dysfunction need intensive care. Thus, at present admission to CCUs is not limited to patients with AMI, but has extended to a large number of severe cardiac conditions that need highly specialized care and very complex procedures. Therefore, it is not surprising that physicians in charge of these CCUs need to expand their skills. In fact, they should be able to recognize and treat a wide variety of acute cardiac conditions and different comorbidities. In addition, they should be familiar with all the diagnostic and therapeutic options available in a modern CCU (ECG, echocardiography, hemodynamic measurements and their interpretation, cardiac and coronary angiography, cardiac and non-cardiac pharmacotherapy, and interventional cardiology). In addition they should be able to use all the equipment needed like cardiac echocardiography, pulmonary artery catheters, cardiac pacemakers, defibrillators, mechanical ventilators, dialysis equipment, intra-aortic balloon pump and ventricular assist devices). Moreover, CCUs have a crucial role in the management of all cardiac emergencies according to an integrated cardiac network model. In this model, the CCU of a referring center (Hub) plays a central role in keeping continuous and tight relations with the other peripheral hospitals (Spoke) that have a prominent and unique role in the selection and early treatment of acute cardiac patients and their follow-up. Thus, all these evolving needs of acute cardiac patients look for skilled doctors and highly specialized CCUs. Therefore, both the University and the Scientific Societies should re-design the training process of the cardiologists working in the CCUs.