Cardiologia Croatica. 2019;14(11-12)

Ana Marinić, Vjera Pisačić, Valentina Jezl, Danijela Grgurević

At the University Hospital Centre Zagreb cardiology already began to stand out as a subspecialization when the Internal Medicine Clinic was opened, and the Institute for Cardiovascular Diseases itself was founded in 1974 and headed by Academician Vladimir Goldner. Forty-four years later, after many successes and the foundation of the first Laboratory for Heart Catheterization in Croatia, the institute became a referral center for heart failure and transplantation cardiology headed by Academician Davor Miličić. The Clinic for Cardiovascular Diseases is in many ways the leading cardiological institution in Croatia that performs the most complex treatment procedures for cardiological patients. The Institute for Intensive Cardiac Care, Arrhythmia, and Transplantation Cardiology continuously provides basic care as well as highly sophisticated medical procedures for patients from the Republic of Croatia and abroad. Ensuring high-quality care is certainly facilitated by the technological solutions and devices available at the institute, but it is made possible by highly specialized and educated healthcare professionals, especially 43 nurses headed by Danijela Grgurević, BN, who has headed the nursing service since 2010. Nurses participate in all the diagnostic and treatment procedures as equal members of the multidisciplinary team involved in the care for cardiological patients, including care after percutaneous coronary intervention, pre-transplantation processing and post-transplantation care, managing the patient before and after implantation of long-term mechanical circulation support, caring for patients on extracorporeal membrane oxygenation, temporary electrode and pacemaker implantation, and performing percutaneous tracheotomy, pericardiocentesis, and many other such procedures that cardiological patients require. Nurses also actively participate in the work of the Croatian Association of Cardiac Nurses, and the president and founder of that organization Ana Ljubas, MSN, also spends part of her working hours at the coronary unit. As part of the leading institution in the Republic of Croatia, our nurses have a duty to continuously adapt to innovations and new guidelines in the field in order to provide the best possible evidence-based care.

Marija Kasun

The Coronary Care Unit (CCU) at the Zadar General Hospital was founded in 1979. Today it has six hospital beds and is equipped with modern medical devices for intensive care. The CCU provides treatment for patients who require intensive cardiological treatment, percutaneous coronary interventions (PCIs), electrophysiology studies, radiofrequency ablation procedures, permanent pacemaker implantation, and implantation of cardioverter defibrillators and cardiac resynchronization devices. The CCU admits approximately 600 patients annually, and 208 primary PCIs were performed in 2018. Total patient mortality has been dropping every year and was 6.1% in 2018. The CCU employs 11 nurses with a head nurse in the morning shift and two medical nurses per shift.

Tomislav Maričić

## History of the Institute for Cardiovascular Diseases The second Coronary Care Unit (CCU) in the Republic of Croatia was founded in April 1971 within the Internal Medicine Department (just nine years after the first such unit was opened globally). Chief Physician Dr Josip Vuletić, who was also the vice-president of the Croatian Cardiac Society for many years, was the unit’s head and the head of the cardiology department that developed from that initial basis. Between 1991 and 2001 the department was led by Chief Physician Dr Josip Halle, between 2001 and 2003 by Prof Dr Roman Urek, PhD, and between 2003 and 2011 the institute director was Prof Dr Jure Mirat, PhD. Since 2011 the institute was directed by Assist Prof Dr Jozica Šikić, PhD, the president of the Working Group for Valvular Diseases of the Croatian Cardiac Society. In 2003/2004 the Institute for Cardiovascular Diseases was fully renovated and restructured as part of a priority project at the level of the Republic of Croatia. The unit for intensive treatment of cardiological patients received modern equipment, as did the angiography hall for heart catheterization and performance of interventional procedures (percutaneous coronary interventions with stent implantation). The unit for intensive treatment of cardiological patients cares for patients with the most severe life-threatening conditions resulting from myocardial infarction, malignant arrhythmias, and acute and chronic heart failure in the acutization phase. A program was introduced in 2011 for heart transplants in patients with chronic heart failure, which includes pre-transplant processing and post-transplant monitoring and treatment. In addition to the transplantation program, the treatment of chronic heart failure employs the most advanced mechanical pumps to support the left ventricle (Heart Mate II and III). The Institute for Cardiovascular Diseases (**Figure 1**) is an educational base for the University of Zagreb Medical School and the Josip Juraj Strossmayer University Medical School in Osijek. FIGURE 1. A hallway in the Institute for Cardiovascular Diseases. The Department for Intensive Cardiological Treatment and Arrhythmias The Department for Intensive Cardiological Treatment and Arrhythmias (**Figure 2**) is an organizational subunit under the Institute for Cardiovascular Diseases of the Sveti Duh Clinical Hospital (CH) that provides 24-hour life support, emergency medical treatment, reanimation at the level of advanced life support, intensive treatment, continuous hemodynamic invasive and non-invasive monitoring and constant supervision, and high-quality healthcare. FIGURE 2. Entrance to the Coronary Care Unit. The Department for Intensive Cardiological Treatment and Arrhythmias has 6 bed units available. Every bed allows the provision of the highest level of intensive care. The CCU (**Figure 3**) admits and treats patients in life-threatening critical conditions with severe loss of one or more vital functions, and must therefore provide intensive treatment, monitoring, and care for such life-threatening conditions. FIGURE 3. The Coronary Care Unit. ## Department structure The department head is Prof Dr Goran Miličević, PhD, and the head nurse is Tomislav Maričić, BN. The Department has 15 employees: 2 male nurses with a master’s degree in nursing, 4 female nurses with master’s degree in nursing, and 9 nurses with vocational nursing school of which currently only one is attending a nursing course at a university of healthcare sciences. The average employee age is 31 years. Two nurses work per shift (based on the “12-24-12-48” principle), and the morning shift (07-15h) also includes the head nurse or one additional nurse with vocational school education. ## Work organization The central monitoring unit – all monitors are networked and connected with the central monitoring unit at the nurse desk, where patient vital functions are monitored 24 hours per day. The central monitoring unit consists of a central server, a PC, 1 monitor, and a printer to print data on rhythm dysfunction. Every disorder or deviation is registered and stored by the monitoring center, and the archive of alarms and other data can be accessed at any time. In case of heart rhythm disorder, cardiac arrest, or some other deviation from previously defined standard values the monitor will provide a auditory and visual warning to the team of nurses and automatically present one or more of the previously established ECG leads and other data such as: bed number and patient name, date and time, ECG interpretation and pulse value, the emergence and number of ventricular extrasystoles, blood pressure, and other monitored parameters that have been assigned. Nurses are responsible for the parameters – alarm values, and it is also their duty to adjust the alarm values to the specific needs of the patient upon admission. For instance, this includes determining the values at which the monitor will produce an alarm for bradycardia, tachycardia, hypertonia and hypotonia, oxygen saturation loss, increase or drop in temperature, and for other parameters monitored in individual patients. All monitor alarms must be on during the entire duration of a patient’s stay at the CCU because they otherwise cannot fulfil their purpose, i.e. a possible disorder may not be observed in time which may lead to a lethal outcome for the patient. Ever alarm by the central monitor must be addressed seriously by the nurses: they must go to the patient, turn off the alarm, check the condition of the patient, determine the reason for the alarm, resolve the cause of the alarm (if it is within the domain of nurse duties or call a physician if it is not), reset the alarm, alert a physician if needed, and if necessary start cardiopulmonary reanimation measures. Cardiopulmonary reanimation (CPR) at the University Hospital “Sveti Duh” Coronary Care Unit is performed according to the algorithm for advanced life support of the European Resuscitation Council (ERC) with adherence to ethical and moral principles. Nurses at the CCU independently start and perform the CPR procedure until the arrival of the on-call physician and anesthesiologist if they are required, and continue to provide CPR as part of the team after their arrival. The most common cause of CPR initiation at the CCU are bradycardia and asystole (with or without P-wave presence) followed by ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), which manifest in patients with previous cardiac issues or in patients with serious electrolyte disbalance. Some of the procedures nurses are educated in: - Cardiopulmonary reanimation (ERC guidelines) - Defibrillator – correct handling and defibrillation - Electrocardiography – rapid and high-quality imaging with a 12-lead ECG, including right and posterior leads, as well as knowing how to enter data and determine printing speed and amplitude size - Recognizing conditions and rhythm disorders that threaten the life of the patient - Temporary electric stimulation of the heart - The basic of ultrasound diagnostics (highly educated nurses) - Proper handling of sterile materials, samples (blood, other diagnostic materials), and all the tools in the CCU - Approaching the patient (education, providing information – written/oral) ## Equipment at the Department for Intensive Cardiological Treatment and Arrhythmias The coronary unit is equipped with one reanimation cart placed in a designated location. The reanimation cart is equipped with a defibrillator that includes monitoring cables, ECG electrodes for continuous heart action monitoring, electroconductive gel, and self-adhesive leads (for pacing, monitoring and defibrillation). The equipment (**Figure 4**) at the Department consists of: 6 Nihon Kohden monitors connected to a central monitoring system, a 12-lead ECG device, 6 infusion pumps, 6 perfusion pumps, 2 non-invasive ventilators, a bispectral index (BIS) device, an inhaler, a portable ultrasound device (cardiological and vascular probe), 4 batteries for temporary electrical heart stimulation, 6 aspirators, a medication cart, an invasive procedures cart, a treatment preparation cart, and a patient healthcare cart. FIGURE 4. Equipment at the Coronary Care Unit. Department statistics are shown in **Table 1**. ### TABLE 1: Department statistics between 2017 and May 2019. | **CORONARY UNIT** | **2014** | **2015** | **2016** | **2017** | **2018** | **May 2019** | | --- | --- | --- | --- | --- | --- | --- | | **Total patients** | 770 | 771 | 694 | 711 | 758 | 218 | | **Daily average** | 2.55 | 2.51 | 2.78 | 2.77 | 2.69 | 2.8 | | **Total days** | **1961** | **1939** | **1910** | **1955** | **2016** | **612** | | **STEMI*** | **122** | **147** | **142** | **107** | **138** | **47** | | **NSTEMI*** | **117** | **95** | **102** | **127** | **135** | **43** | | **Death** | **51** | **50** | **55** | **54** | **72** | **18** | | **Urinary catheter** | **347** | **312** | **242** | **274** | **324** | **85** | | **Respirator** | **42** | **93** | **94** | **95** | **136** | **30** | | **CVC*** | **155** | **135** | **147** | **111** | **136** | **50** | [†] STEMI = ST segment elevation myocardial infarction; NSTEMI = non-ST segment elevation myocardial infarction; CVC = central venous catheter The Coronary Care Unit tomorrow – education of personnel, synchronization, and working together to prevent life-threatening conditions and provide rapid and high-quality care for all individuals!

Željka Stojkov, Blaženka Miškić, Vesna Ćosić, Barica Stanić, Katica Cvitkušić Lukenda

The development of the Coronary Care Unit (CCU) in Slavonski Brod started in 1960. Until then, patients diagnosed with stenocardia would be prescribed strict bed rest at the department over five to six weeks and would then be sent for further diagnostic processing to hospital centers in Zagreb in order to diagnose their existing coronary artery disease. Due to the efforts to improve quality of treatment and the development of diagnostic and treatment options, in the 1970s the CCU received a new space and staff that was specially educated for the treatment of coronary patients. During the Homeland War, the CCU was temporarily transferred to the north side of the Internal Medicine Department to protect it from the ravages of war. At the start of 2002, the construction of an addition to the old hospital building provided the Cardiology Department with a new CCU with seven hospital beds and equipped with central monitoring and the necessary medical devices for intensive treatment. The number of medical staff educated in administering intensive care was also increased. Treatment quality was also improved by the introduction of interventional cardiology that improved the quality of treatment and reduced morbidity and hospitalization. The opening of the arrhythmology unit completed the cycle of introducing all the interventional cardiology methods currently applied in the Republic of Croatia, especially in hospitals of this level of quality.

Tihana Ivanušec

The Division of Advanced Internal Medicine with a Coronary Care Unit is part of the Internal Medicine Department of the Sisak General Hospital (GH). It has ten beds and houses patients with critical internal medicine conditions. Patients are tended by eighteen nurses and three cardiologists. The department is equipped with all the medical devices and medications required for reanimation. Cardiovascular patients comprise a large part of the patients treated at the department. Prior to the founding of the Croatian Network for Interventional Treatment of Acute Myocardial Infarction patients with acute myocardial infarction (AMI) were treated with fibrinolysis, but this method is rarely applied today. Patients with AMI are transported to the University Hospital Centre “Sestre milosrdnice” for percutaneous coronary intervention, after which they return to Sisak GH to continue treatment.

Renata Čosić, Mihaela Ipša, Katarina Arbanas, Tamara Kožić, Zdravko Babić

The first coronary units were founded in the 1960s with the goal of ensuring optimal cardiopulmonary reanimation in patients with myocardial infarction. The Cardiac Care Unit at the University Hospital Centre “Sestre milosrdnice” was founded on September 23, 1970 and was the first and oldest intensive care unit for cardiological patients in southeastern Europe. Over the next several decades it developed in line with global trends and grew into the Department for Intensive Cardiac Care with ten intensive care beds, ensuring comprehensive intensive cardiological care. The team of nurses and physicians cares for approximately 1600 patients annually with an average hospital stay of 2.2 days, which puts us in line with European averages. Since 2005 we have been a part of the Croatian Network for Interventional Treatment of Acute Myocardial Infarction and have managed patients from parts of the City of Zagreb and Zagreb County as well as the Sisak-Moslavina County and the Karlovac County. Healthcare and treatment provided by our team of health professionals are facilitated by the sophisticated medical devices with which the institute is equipped.

Marina Jelinić

This short article describes the history and provides an overview of the work at the Pula General Hospital Coronary Care Unit. It provides insight into the methods and options for patient treatment and care. A new hospital is under construction, which will be even better equipped. It will allow even better working conditions and quality of patient care.

Zdenka Ćurić, Petra Kušter, Darko Počanić

Merkur, a Croatian trade association, was founded on January 19, 1873 in Zagreb with the goal of improving the socioeconomic position of merchants. As the number of members constantly grew, especially between 1920 and 1930, so did the desire to improve the healthcare for their members. An initiative to build a new sanatorium emerged within the Merkur society. Since the financial resources for the construction a new sanatorium could not be secured, the society decided to buy the Pogorelac villa on Florianski put, which is today called Zajčeva Street. The adaptation of the villa to the needs of the sanatorium began, and the Merkur sanatorium was opened on January 6, 1930 with 36 patient beds. After three expansions, the Merkur sanatorium, now with 333 beds, changed its name to the dr. Ozren Novosel General Hospital in 1959, and the first department founded in the sanatorium, the Internal Medicine Department, became the Internal Medicine Clinic. In 1974 the dr. Ozren Novosel General Hospital became the Internal Medicine Clinic, but went back to its original name, University Hospital (UH) “Merkur”, on May 30, 1992. The first clinic in UH “Merkur”, the Internal Medicine Clinic, continued its professional rise and opened the Intensive Care Unit (ICU) on November 11, 1970, from which the Coronary Care Unit (CCU) was formed in 1976. The CCU had five beds, four General Electric vital function monitors, one defibrillator, and one joint ECG device from the RIZ company. The First CCU head nurse was Milka Rogić who headed the CCU and ICU together with Štefica Čuljat until 1986 when Dubravka Rovčanić became head nurse. The first unit head for the CCU was Dr Dženana Rezaković. Another mobile vital function monitor was acquired during this period, as well as an EV-800 respirator and a new Siemens defibrillator. In 1989/90, Biserka Sedić became head nurse, and Dr Rezaković was replaced by Dr Stjepan Kranjčević. On October 1, 1993, Zdenka Ćurić became head nurse, and Dr Darko Počanić replaced Dr Stjepan Kranjčević in 1994. Since its foundation, the CCU accepted critically ill with acute coronary syndrome (ACS) or life-threatening arrhythmias. As soon as it was opened, the CCU performed implantation of both temporary and permanent pacemakers in addition to vital function monitoring and reanimation procedures. Permanent pacemakers were implanted in the surgical department’s operating halls and monitored in the CCU until the invasive procedure laboratory was opened in 2007. Over the course of 1996/1997 the CCU was completed renovated with money from grants collected by Dr Stjepan Kranjčević. In addition to changing the electrical and plumbing systems and completely replacing the furniture, a medical gas supply system was installed as well (O2, vacuum, and air). A new monitoring system was bought, as well as a new respirator, ECG, and an AT-10 ergometry machine from the Schiller company. Zdenka Ćurić and Dr Darko Počanić led the CCU until June 1, 2014. The CCU was reorganized and merged with the ICU into a new department called the Department for Arrhythmias, Acute Coronary Syndrome, and Intensive Medicine, whereupon Petra Kušter became the head nurse and Dr Darko Počanić the head of the new department. The department formally comprises 12 beds (5 CCU + 7 ICU). This department employs two subspecialist physicians, one cardiology resident, and the department head. The team includes 21 nurses (9 with bachelor’s degrees and 12 with vocational nursing school, of which 5 are attending the Zagreb Health Studies college, and the head nurse Petra Kušter). The healthcare team comprises: - Physicians: Darko Počanić, Helena Jerkić, Mario Stipinović, Maja Vučković - Nurses: Petra Kušter; Anita Brumen; Matea Brgles; Martina Jaković; Martina Kostanjčar; Dijana Marčec; Maja Puceković; Melita Starčević; Ana Barišić; Anđa Čondrić; Ivana Čukman; Antonija Gračak; Irena Ivančan; Katarina Ljubičić; Barbara Mateković; Nikolina Mizdrak; Iva Ožvačić; Ivana Stakor Jakšić; Marija Štajcar; Brankica Tuzla; Jelena Vindiš; Domana Vukman. The CCU is equipped with a monitoring system by the Dräger company, while the ICU has a monitoring system made by the Elektroničar company. Together they have four respirators, one Oxylog ventilator, three defibrillators, two electrocardiographs, two emergency carts, three single-lead and one dual-lead portable pacemaker, and one extracorporeal membrane oxygenation device that has been lended to the University Hospital for Infectious Diseases "Dr Fran Mihaljević", Zagreb due to lack of personnel trained to use it. The acquisition of a mobile echocardiography device for both units is planned because the transportation of patients to the echocardiographic laboratory can represent a life-threatening risk for patients. Within the hospital budget (every unit has its special limit), the CCU is responsible for patients with acute coronary syndrome, arrhythmias, and pacemaker (single-lead, dual lead, ICD, CRT) and loop recorder acquisition. We have recorded a constant increase in admissions over the past five years (**Table 1**), and the existing space has become too small, as has the financial limit which has been reduced by 20% in the last three years. ### TABLE 1: Number of admissions between 2014 and 2018. | **Year** | **2014** | **2015** | **2016** | **2017** | **2018** | | --- | --- | --- | --- | --- | --- | | **Coronary Care Unit** | 686 | 682 | 739 | 752 | 797 | | **Intensive Care Unit** | 399 | 412 | 490 | 558 | 632 | | **TOTAL** | **1085** | **1094** | **1209** | **1310** | **1429** | The ICU (which forms the new department with the CCU) treats the most critical patients with hematological, gastroenterological, and nephrological issues and consequently also patients with pre-transplant and post-transplant issues. Such patients require on-call specialists from all branches of internal medicine and nurses who have the knowledge and skills to respond to all the challenges of modern medicine. In order to improve monitoring and treatment quality for patients at our department, cardiologists have been organizing a readiness program over the last three years, with a tendency to also introduce call duty for cardiologists. The members of the Merkur society were proud of their sanatorium. The Merkur newsletter published (in November of 1937) an editorial article titled “Our Pride” which said: “The Merkur sanatorium is an expression of our virtues. It is a document of our love for one another, our self-sacrifice, and our altruistic work. It is the strongest proof of our social consciousness. It is the burning focus of our humane efforts.” True to this quote, the staff of the Department for Arrhythmias, Acute Coronary Syndrome, and Intensive Medicine (**Figure 1**) strive to create a center of excellence that will improve the overall quality of the clinic and of the hospital as a whole. FIGURE 1. The staff of the Department for Arrhythmias, Acute Coronary Syndrome, and Intensive Medicine.

Katarina Mihičinac, Anita Bišćan

The Coronary Care Unit at the Karlovac General Hospital was opened in 1978. Several generations of medical staff have been educated there with the cooperation of numerous Clinics in Zagreb. Developments in medicine and technological advancements have been followed and implemented over the years with the goal of providing adequate care for cardiological patients.

Anita Miljas

The Cardiology Department of the Dubrovnik General Hospital (GH) has been independent from the Department for Internal Medicine since July 1, 2017, and it now represents one of the largest departments in the hospital. It consists of the following subunits: the Coronary Care Unit, the Cardiology Department, the Invasive Cardiology Laboratory, Cardiological Rehabilitation, and the Cardiological Polyclinic. This division is the result of many years of dedicated work and efforts by all our employees, which began with the pacemaker implantation program in 2007. This was followed by the formation of the Invasive Cardiology Laboratory in 2009 under the mentorship of Assist Prof Boris Starčević, MD, PhD and the University Hospital (UH) Dubrava. Cooperation was subsequently arranged with the Cardiac Surgery Clinic of the UH Dubrava, from which Prof Željko Sutlić, MD, PhD visited our institution once per month to perform pre-surgery consultations with potential candidates for cardiosurgical treatment, greatly contributing to the availability of treatment for cardiological patients, even those with the most severe conditions. Ten years after the establishment of invasive cardiology at the Dubrovnik GH, we perform approximately 500 coronarographies annually, of which 270 elective percutaneous coronary interventions and approximately 130 primary percutaneous coronary interventions in the course of acute coronary syndrome treatment. The Coronary Care Unit employs 11 nurses, with each shift having two nurses per 10 patients, including patients with mechanical respiratory support. Of these, 7 nurses simultaneously work at the Invasive Cardiology Laboratory and are on call between shifts. Considering the above, it can be concluded that significant advancements in the development of cardiology in the Dubrovnik GH have been achieved in the last decade, providing patients with timely and comprehensive cardiological care and largely due to the enthusiasm of our team of healthcare professionals

Biljana Hržić, Saška Bojanić

According to data from the World Health Organization, cardiovascular diseases are the leading cause of mortality and morbidity in the world. The Department for Intensive Cardiology Care at the University Hospital Dubrava was founded 20 years ago with the goal of providing intensive treatment and healthcare to cardiological patients in mortal danger. The Department for Intensive Cardiology Care has been renovated and expanded several times since its foundation with the goal of improving the healthcare provided to such patients. Their treatment and healthcare require a highly-educated professional team, high-quality medical devices, and precise organization of diagnostics and treatment.

Ljiljana Kralj

The Coronary Care Unit (CCU) at the Čakovec County Hospital manage patients suffering from heart diseases who require constant monitoring. The CCU is equipped with medical equipment and gear for performing various diagnostic and treatment procedures. When working with cardiac patients, teamwork and good communication skills are very important. Nurses are educated in recognizing arrhythmias and in cardiopulmonary reanimation, disease complications, and the administration and action of medication. The CCU performs many invasive and non-invasive diagnostic and treatment procedures, which requires being well-equipped with medical devices and trained staff.

Ružica Prpić, Andreja Čleković-Kovačić

The development of cardiological treatment as part of the Department of Internal Medicine at the Bjelovar General Hospital (GH) started in 1957 with the acquisition of the first electocardiography device. In order to improve care for cardiologic patients, the Coronary Care Unit was opened in 1974, with only two beds at the time. The Coronary Unit has since been expanded (as part of the Internal Medicine Intensive Treatment Unit), and now comprises seven beds with an additional seven beds for postintensive/postcoronary care. It is equipped with modern monitoring devices for central monitoring as well as mandated and repeatedly modernized mechanical equipment. The physicians at the Department of Internal Medicine at the Bjelovar GH formed the Bjelovar registry for acute myocardial infarction in 2001, which contains digital record of specific medical history data, laboratory findings, and clinical and pharmacotherapy data gathered during the presentation, treatment, and release of patients. At the time of its formation the Bjelovar registry was, along with the registry of the Zagreb Institute for Cardiovascular Prevention and Rehabilitation, the only registry for patients suffering for myocardial infarction in Croatia and the only hospital registry containing data on pharmacotherapy. Inclusion of the Bjelovar-Bilogora County in the Croatian Network for Interventional Treatment for Acute Myocardial Infraction in 2005 allowed treatment of patients in the most efficient way – with percutaneous coronary intervention. In the period between 2010 and 2018, an annual average of 200 patients were referred for invasive procedures to the University Hospital Centre Zagreb, the University Hospital “Merkur”, the Special Hospital Magdalena, and the University Hospital Dubrava. A significant increase in patients treated at the Bjelovar GH Coronary Unit (coronary/postcoronary care) has been observed over the past several years, with for example 402 patients having been treated in 2018.

Ana Ljubas

The aim of this article was to describe the key segments and new trends in the development of education and the position of cardiac nurses in global and Croatian cardiac practice. Nurses are the most numerous healthcare professionals and must be recognized as a key factor in shaping the social and healthcare policies in their countries, as they can provide a great contribution to reducing the burden of cardiovascular diseases. Recent examples and results in modern global medical practice are a good indication of how to position cardiac nursing within the Croatian healthcare system.