Many societies or association of physicians, whether generalist or specialist are struggling to come to terms with the professional and public demands for the accountability and continuing education of their members. In this issue the Italian Association of Hospital Cardiologists (AMNCO) have shown us one way in which such organisations can make a dramatic and rapid impact on the delivery of health care.1

AMNCO mainly comprises the non-academic cardiologists in community rather than university hospitals; the latter form the bulk of the Italian Society of Cardiology, although there is some overlap and recent moves for more integration between the two.

Most national cardiac societies have concerned themselves with issuing guidelines or consensus statements, supplemented by seminars or teach-ins; but we have to admit that these strategies influence practice only slowly, if at all. The Italian strategy went much further than this in a stepwise and well planned fashion.

First they chose a condition—heart failure—which in all urbanised societies was an important and growing problem, and where there …