ACVC goes global: a short history of a 10-year young association

Cardiologists stood at the origin of intensive care medicine by introducing, in the 1960s, the concept of the coronary care unit (CCU) after the successful implementation of open and then closed chest defibrillation and the development of continuous electrocardiographic monitoring equipment.1 The idea that prehospital treatment of dysrhythmias could prevent more myocardial infarction deaths led, in the mid-1960s, to introducing a mobile CCU in Belfast.2 While CCUs were initially aimed at optimizing cardiac arrest management, the introduction of the warning arrhythmias concept and the development of antiarrhythmics extended the focus to preventing cardiac arrest.3 As more patients survived by preventing early arrhythmic death, heart failure became the dominant complication of myocardial infarction. In addition, new insights into the muscle physiology of myocardial contractility led to new concepts such as preload and afterload reduction and the development of inotropes, which could be applied more successfully with the advent of bedside haemodynamic monitoring systems.4 More complex postoperative care emerged due to the expanding indications of modern surgery and the surge of car accident patients, the development of systems for prolonged mechanical ventilation initially triggered by the polio pandemic, blood gases, and pH monitoring systems, and the expansion of haemodialysis promoted by the experience with renal replacement therapy during the Korean War. This transformed the postoperative recovery rooms supervised by anaesthesiologists into critical care units managed by intensivists, a new clinical subspecialty. These units were initially staffed by specialized trauma surgeons and anaesthesiologists but later on also by internists, mainly pulmonologists.5 The improved outcome of myocardial infarction patients due to early reperfusion therapy6 resulted in shorter hospital stays with less intensive care. This led many hospitals to merge CCUs with the more general intensive care departments where cardiologists only functioned as consultants. To maintain, defend, and advance the role of cardiologists and the intensive cardiac care unit (ICCU) for the management of patients with acute cardiovascular diseases, in 2000 Yonathan Hasin, Marco Tubaro, Gerasimos Filippatos, and Nicolas Danchin founded the Working Group on Acute Cardiac Care within the European Society of Cardiology (ESC) after a scientific meeting in Rome. Significant progress in the diagnosis and management of acute cardiovascular conditions, supported by innovative technologies, more effective antithrombotics, and new subspecialties in cardiology, emergency medicine, and nursing—well beyond the boundaries of the ICCU—led a newly elected board in 2011 to redefine the scope of the working group. The new mission—‘to improve the quality of care and outcome of patients with acute cardiovascular diseases’—was intended to encompass the period between the prehospital phase up to the end of the first week of hospitalization. Furthermore, the board found that this ambitious objective would require the creation of a new scientific association aimed at integrating multidisciplinary experts and sharing innovative therapies and techniques to manage acute cardiovascular care across Europe and globally. This decision directly led to the ESC establishing the Acute Cardiovascular Care Association after a vote at the ESC Congress General Assembly in 2012. It became the Association for Acute CardioVascular Care (ACVC) last year. Acute CardioVascular Care, next year 10 years young, has evolved into a dynamic and unique association that provides a broad portfolio of educational and research activities to cardiologists, nurses, and all other health care professionals involved in managing patients with acute cardiovascular diseases. Significant milestones in the history of this young association are the publication of the ESC Textbook of Intensive and Acute Cardiovascular Care, now in its third edition,7 and the first impact factor for its journal, the European Heart Journal – Acute Cardiovascular Care, in 2018. In addition, the ACVC biomarkers study group was the driving force behind updating the universal definition of myocardial infarction8 and developing rapid rule-out acute myocardial infarction strategies using novel high-sensitivity cardiac troponin assays9—both have revolutionized the management of patients presenting with chest pain suspected of an acute coronary syndrome.10 Furthermore, the ACVC study group on quality of care has provided new quality indicators for assessing the management of acute myocardial infarction.11 Last but not least, ACVC members redefined the chest pain centre,12 the ICCU,13 the cardiac arrest centre,14 the heart team,15 and cardiogenic shock.16 Conflict of interest: none declared.