Heart attack and stroke, Italy's vademecum for managing acute coronary syndromes

Cardiovascular disease, of which acute coronary syndromes are one of the main acute manifestations with approximately 7 million cases per year worldwide and 135,000 in our country, is the leading cause of death globally. According to estimates by the World Health Organisation (WHO), about 18 million people die each year from cardiovascular diseases, accounting for about 31% of all global deaths, and 85% of these deaths are attributable to acute myocardial infarction and ischemic stroke. Similarly, in Italia, ischaemic heart disease is responsible for a significant proportion of total deaths, with an estimated contribution of about 11% of all fatal events and higher incidences in males than in females.

The National Association of Hospital Cardiologists (Anmco), the leader of more than 40 scientific societies, at the request of the Istituto Superiore di Sanità (Iss), which promotes the development of decision-support tools aimed at improving the appropriateness, safety and quality of health care, in line with the provisions of the 'Gelli-Bianco' law, has just concluded its work on Good Clinical Practices to be adopted in patients with acute coronary syndrome. This is an area of high clinical, epidemiological and organisational relevance, characterised by a continuous evolution of scientific knowledge and significant variability in clinical practice. Despite the availability of international guidelines, there are still numerous decision-making areas in which the evidence is incomplete, conflicting or difficult to apply in different care contexts, making integrative and contextualised decision-making support necessary.

The Iss has given clear indications to scientific societies for the development of Recommendations of Good Clinical Practice on some particularly important topics. Anmco has been given the task of coordinating those on acute coronary syndromes. The Association has always been at the forefront on this topic, from the 'Gissi Study' to the most recent Eyeshot observational studies, bringing the in-hospital mortality rate for acute myocardial infarction down from 30% in the 1970s to 2.8% in 2024 ( Eyeshot 2 Study). More than 90% of the cardiology intensive care units (ICUs) in Italy are Anmco. The significant clinical, organisational and economic impact on the National Health Service of acute coronary syndromes makes it essential to adopt standardised diagnostic-therapeutic paths, based on the best available evidence and adapted to the national clinical context. The Recommendations of Good Cardiological Clinical Practice (Rbpca) represent a fundamental clinical governance tool, which supports healthcare professionals in their decision-making processes.

These new Recommendations addressed to acute coronary syndromes (ACS) aim to provide operational indications to improve the quality of clinical decisions, to coordinate care pathways within the different care settings, and to reduce management variability, with the ultimate goal of optimising patient outcomes and the efficiency of the NHS in this field. The Recommendations provide cardiologists and all healthcare professionals with more realistic decision-making tools, helping to reduce variability in clinical behaviour and improve equity and quality of care throughout the country.

Once again the Association confirms itself as a reference point and privileged partner of the institutions, demonstrating its ability to be a forerunner among scientific societies in promoting innovation, appropriateness and quality of cardiological care in Italia.