Recently, intensive cardiac care units (ICCUs) have undergone a significant transformation related to the evolution in management of acute coronary syndrome and influenced by other factors such as the epidemiological transition, the increasing complexity of clinical cases, the technological advancement, and the growth of clinical and scientific expertise of cardiologists. In the context of this evolution, a functional reorganization of ICCUs in Italy has to be implemented in order to meet the changing needs of the population with cardiovascular disease requiring critical care. Therefore, the Italian Association of Hospital Cardiologists (ANMCO) proposes this position paper for the reorganization of CICUs into three levels with increasing functional complexity, based on the hospital characteristics, the available technology, and the clinical cases treated. The system would be functionally integrated into a regional ICCU organization modelled on a time-dependent care network. This proposed network aims to standardize diagnostic and therapeutic protocols and establish unified data collection registries to facilitate self-assessment and support clinical research. The document delineates specific requirements for each ICCU level, including the management of clinical cases, the expertise of intensive care cardiologists, the technological facilities, and the medical and nursing staff needed to ensure optimal care delivery.