InterviewwithDrIainSimpson,Presidentofthe British Cardiovascular Society

Transcription

1 European Heart Journal (2014) 35, doi: /eurheartj/eht541 Changing times in cardiology I InterviewwithDrIainSimpson,Presidentofthe British Cardiovascular Society Cardiology is one of the fastest paced specialties in medicine. In a series of two articles, Dr Shouvik Haldar interviews Dr Iain Simpson, British Cardiovascular Society President, and Professor Panos Vardas (forthcoming issue) European Society of Cardiology President, to ascertain their views on the ever-changing landscape of cardiology from a personal and societal perspective. Change is the only constant (from all entities move and nothing remains still Heraclitus, 401 BC) 1. Modern cardiology owes much of its success to important technological advances alongside evolving procedural techniques. What do you see as important advances that are on the horizon for cardiology? Who could have predicted the extraordinary advances in imaging, device technology, and drug therapy in the last few decades? Genomics and stem cell therapy appear to be the most promising advances on the horizon, but new therapeutic options, for example in cardiovascular prevention, may also change the treatment landscape. Change is also required in the delivery of healthcare. We need to be smarter in identifying at-risk individuals and populations, and ensuring important evidence-based treatments get to all those who will benefit, not just a proportion, to reap the greatest benefits. 2. In the recent adverse economic climate, there has been declining industry funding and sponsorship for cardiologists and cardiology trainees to attend conferences. How has the BCS acknowledged this and what measures have been taken to support cardiologists to attend important conferences such as the ESC Annual Congress and BCS Annual Conference? For clinicians, difficulty in attending conferences is not purely financial as there is also increasing time. Recognizing this, BCS has provided members with webcasts of virtually all the educational sessions of the BCS Annual Conference, similar to the ESC365 programme, ideal for those unable to attend in person. However, there is still real value in attending high-quality conferences, manifest by the increasing number of delegates coming to the BCS Annual Conference over the past 5 years. BCS has introduced travel bursaries, targeted at junior cardiologists presenting scientific papers, and has kept the registration for the Annual Conference free to all our members. Developing and delivering a high-quality, educationally autonomous Annual Conference is costly yet fundamental to fulfilling the educational needs of cardiologists. BCS is fortunate in having a very close relationship with the British Heart Foundation who supports our Annual Conference, ensuring we can attract high-quality international speakers and deliver an excellent educational programme across a range of basic, translational, and clinical science in conjunction with a programme of curriculum-based education. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author For permissions please journals.permissions@oup.com

2 202 CardioPulse 3. Due to changes in industry rulings, there is a changing relationship between industry and cardiology. How do we as cardiologists better engage with industry and what plans does the BCS have to do so? Reliance on industry to provide financial support for educational activities is not a sustainable situation, either morally or professionally, yet they are an important partner in the delivery of world-class healthcare for patients. Not only does industry drive many of the new therapeutic and device developments in conjunction with the cardiovascular community but it also has considerable expertise in many areas of healthcare delivery as well as a responsibility to train cardiologists in the use of their therapies and devices. Industry should not have undue or inappropriate influence on delivery of clinical care and changes in industry rulings are there to protect everyone from a small minority of industry partners who might act otherwise. At BCS we see this as an opportunity to redefine our industry relationships especially where we can work together to develop a new type of transparent, mutually beneficial educational strategy devoid of any potential conflicts of interest. 4. The BCS has made significant progress in its educational agenda in recent years, and now has an impressive annual programme of events. You have been instrumental in this development. What are the key factors necessary to ensure that both individual educational events and the programme as a whole are a success? Give cardiologists the education they want and need to deliver high-quality patient care. Doctors need to be up to date with evidence-based practice in both general cardiology and subspecialties, which needs to be demonstrated for re-licensing. At BCS we have developed a portfolio of educational activities to address knowledge, skills, and professionalism. For example, at the BCS Annual Conference, we now have a track specifically dedicated to Education for Revalidation (E4R), which covers the well-developed UK Cardiology Curriculum over a 5-year cycle. Throughout the year we have courses for trainees, update courses for trained cardiologists including the highly successful Year in Cardiology programme. We have also led a programme of non-technical team simulation training programmes, recognizing that we increasingly work as a coordinated team rather than individuals. Driving forward on education is one of the great success stories of the modern BCS. The Netherlands Heart Foundation The Foundation celebrates its 50th anniversary this year and Dr Maarten L. Simoons discusses its achievements Netherlands Heart Foundation Herman Snellen The Netherlands Heart Foundation (Nederlandse Hartstichting) was created in 1964 by Professor Herman Snellen from Leiden, a former president ofthe ESC, and othercardiologists. At that timein The Netherlands, cardiovascular disease was the main cause of death. Often, death was premature, caused by myocardial infarction in middle age. The focus of the Heart Foundation was, and still is, threefold: first, information and education of the public about cardiovascular disease, in particular prevention; second, improvement of care for patients 1982 Balloon with cardiovascular disease; third, promotion of research on prevention, diagnosis, and treatment of cardiovascular disease, including basic science. Several successful programmes initiated by the Heart Foundation can be mentioned. Resuscitation by the general public. Since 1977 courses in resuscitation have been organized throughout the country. So far, over 5 million persons, 40% of theadult population, and high school students

3 CardioPulse 203 have been trained, including relatives of patients with heart disease. In the 1960s and 1970s the Heart Foundation promoted and supported the introduction of defibrillators in ambulance vehicles. More recently, a programme has been initiated to further reduce the time until resuscitation in a suspected cardiac arrest. In several regions, a registry is kept of those persons who can provide basic life support. If the 112-alarm service receives a call about a possible cardiac arrest in that region, caregivers nearby are instructed by telephone SMS service to go to the victim and start resuscitation and defibrillation with an automated external defibrillator, covering the time until the emergency ambulance service arrives. The first successes of this unique system have been reported. Rehabilitation of patients after a myocardial infarction has been promoted bythe Heart Foundationin close collaborationwiththenetherlands Society of Cardiology. More recently, this has been extended to patients with other types of heart disease, including heart failure. Special programmes were created for children operated on for congenital heart disease, including holidays with medical supervision. For many years a dedicated holiday-centre de Hartenark was run by the Heart Foundation. The Hartenark was located in the woods, close to a hospital. The care for patients with stroke has improved by the creation of stroke-units in many hospitals, following the earlier creation of coronary care units. Public campaigns have been organized to create awareness among the population of the signs and symptoms of a heart attack and stroke. The message was, every second counts in such situations. This has certainly contributed to the reduction of mortality from cardiovascular disease in the country. Annually the Heart Foundation publishes a report on cardiovascular disease in the Netherlands, including figures on mortality and morbidity, cardiac surgery, hospital admissions, interventions, myocardial infarction, stroke, and pacemaker and ICD implantations. Attention has also been given in these reports to congenital heart disease in children and adults, heart disease in women, heart failure, peripheral vascular disease, valvular heart disease, and many other topics. Research in cardiovascular disease is supported by various grants. In 1972, E was spent on research, increasing to E in 1992 and E in The necessary funds are collected as gifts from the public during the annual campaign and through the Friends of the Heart Foundation organization. Currently, three types of grants are awarded: large programme grants, personal grants, and grants for specific topics, which are identified by the Scientific Advisory board of the Heart Foundation. (1) The programme grants amount to E Proposals submitted by consortia from three or more universities and including basic as well as clinical research are evaluated and prioritized by an international advisory committee. The programme grants are awarded in consultation with the Royal Netherlands Academy of Science and the Netherlands Federation of Universities. (2) Personal grants are available at different levels, from research fellow to established investigator, in basic science and in clinical science. It may be noted that most established investigators subsequently were appointed professors of cardiology or in related sciences. (3) Special topic grants have been awarded in different subjects, including molecular cardiology, imaging, neuro-vascular disease, paediatric cardiology, and research in gender-related aspects of cardiovascular disease. The Heart Foundation collaborates with other similar organizations in Europe in the European Heart Network to increase awareness of cardiovascular disease in the European Union, and to promote measures for prevention as well as research at the European level. In 50 years, mortality from cardiovascular disease in The Netherlands has declined. It is now the second most frequent cause of mortality. Many factors have contributed to this decline, including the results of research in hospitals, universities, and other institutes throughout the world, better understanding of the pathophysiology, the development of better imaging methodologies, and the introduction of new drugs and devices. Investigators in The Netherlands have contributed significantly to these developments, supported in part by The Netherlands Heart Foundation. Patients, physicians, and other healthcare providers are grateful for the gifts from the public, which enable the Heart Foundation to support important programmes for prevention, public education, and research in cardiovascular disease.

4 204 CardioPulse Personalized atrial fibrillation management needed to close mortality gap Personalized management is the only way to close the mortality gap for patients with atrial fibrillation (AF), according to an European Society of Cardiology (ECS) consensus paper presented at ESC Congress 2013 by Professor Paulus Kirchhof (UK). ESC Congress Amsterdam. (Photo credit Sam Rogers) Paulus Kirchhof The Atrial Fibrillation competence NETwork (AFNET) and European Heart Rhythm Association (EHRA) consensus paper was published online in the European Journal of Pacing, Arrhythmias, and Cardiac Electrophysiology (EP-EuroPace) and presented during the ESC Congress session on personalized cardiology. Professor Kirchhof said: Acute and 1-year mortality after myocardial infarction has dropped by two-thirds in the last 10 to 15 years primarily because of medical interventions aimed at the principal pathophysiology causing the disease. For example acute revascularization procedures are used to treat a thrombotic blockage of the artery while statins prevent the development and rupture of coronary plaques. But he added: We are in an intermediate position with AF. With the introduction of oral anticoagulant therapy we can prevent about two-thirds of all strokes in AF. But patients with AF still have a higher mortality compared to their age and cardiovascular risk matched peers without AF, and we are not able to reduce that mortality by much even when we apply all the evidence based therapies. The fourth AFNET/EHRA consensus conference was convened to discuss how to identify the underlying main pathophysiology of AF in individual patients so that more targeted therapies could be developed to close the mortality gap. Professor Kirchhof said: This requires understanding the disease mechanisms and translating them into parameters we can measure in patients. This is particularly difficult for AF because the left atrium is a small part of the heart located posteriorly in the body and difficult to access. A certain degree of personalization is already practiced in AF. Stroke risk scores based on clinically measurable risk factors aid decisions on anticoagulant therapy while the severity of AF symptoms help to determine rhythm control therapy. The consensus paper identifies three main ways to better characterize the underlying cause of AF in order to improve treatment: the ECG; imaging, especially Echo and MRI; and biomarkers (proteins or genes measured in blood to identify the type of AF). A new taxonomy of AF is proposed based on its pathophysiology. Prof Kirchhof said: The classification is imperfect because there are overlaps between categories and the majority of AF patients fall into the unclassified AF group. But it illustrates that we need a better understanding of why AF develops in an individual patient before we can classify them based on biomarkers, imaging or ECG, in addition to clinical parameters, and develop better therapies. He added: The hope is that within the next few years we will be able to propose personalized management of AF and thereby reduce the excess mortality associated with the disease. Professor Kirchhof continued: There is still plenty of room to improve the management of AF even if we apply all the evidence based therapies currently available for example, the new oral anticoagulants have improved mortality by just 5 10%. And every fourth patient with AF is admitted to hospital at least once a year due to AF, which illustrates the high morbidity and healthcare costs associated with the disease. He concluded: This is the first European consensus document on personalized management of AF, which is the most promising way to further improve morbidity and mortality in AF patients. Andros Tofield

5 CardioPulse 205 David Celermajer: new European Heart Journal International Associate Editor Professor David Celermajer joins the European Heart Journal editorial team in January 2014 Commonwealth Health Minister s Award for Excellence in Health and Medical Research, for outstanding lifetime contribution, 2002 Doctor of Science, University of Sydney 2006 Fellow of the Australian Academy of Science since 2006 NSW Health Minister s Award for lifetime contribution to heart health in Australia 2012 David Celermajer Professor David Celermajer MBBS MSc PhD DSc FRACP FAHA FCSANZ FHKCC FAA has just joined the European Heart Journal (EHJ) editorial team from Australia. He is currently Scandrett Professor of Cardiology and Head of Discipline of Cardiology, University of Sydney, and holds several other positions such as: Director of Echocardiography and Academic Cardiologist, Royal Prince Alfred Hospital Director of Adult Congenital Heart Services, Royal Prince Alfred Hospital Co-Director of Pulmonary Hypertension Services, Royal Prince Alfred Hospital Clinical Director, the Heart Research Institute, Sydney Graduating in 1983 from the Faculty of Medicine, University of Sydney, Australia, he obtained a Rhodes Scholarship for New South Wales and was World Debating Champion, Princeton New Jersey, USA the same year. The following year 1984 saw him as World Debating and Public Speaking Champion in Edinburgh, UK. Other major academic achievements include: Fellowship of Royal Australasian College of Physician, 1990 Doctor of Philosophy, Studies of early atherosclerosis, University of London, 1993 Fellowship of the American Heart Association, 1998 RT Hall Prize for most outstanding contribution by a senior cardiac investigator, awarded by the Cardiac Society of Australia and New Zealand, 1998 Eric Susman Medal for most outstanding contribution to any branch of Internal Medicine, award by the Royal Australasian College of Physicians, 1998 He has published over 300 manuscripts in peer review journals, including New England Journal of Medicine, Lancet, Journal of Clinical Investigation, and Circulation; is an editorialist for New England Journal of Medicine and Lancet; and is Scientific Reviewer for over 20 journals and grant-giving bodies. His current H-index is.75 and career citations number over (Google Scholar). He has extensive research experience in cellular/molecular biology; animal models of heart disease; clinical research; clinical trials; public health research; developing world research with active collaborations in Africa, China, Finland, France, India, Indonesia, and the UK. Since 2000 he has received over $15 million in competitive grant support for original research and continuous NHMRC Program Grant support since His areas of interest include pulmonary hypertension, adult congenital heart disease, endothelium, and vascular physiology. His current research activities include: in Basic Science the cell and molecular biology of atherosclerosis, especially endothelial adhesiveness and foam cell macrophage biology. In Clinical research mainly on non-invasive methods to assess arterial structure and function to detect early signs of vascular disease (in particular, endothelial dysfunction). In Public Health research in developing nations he is collaborating on projects dealing with atherosclerosis in China and India; Rheumatic Heart Disease in Africa and Asia; and malaria-related vascular dysfunction in Indonesia. To date he has given over 100 invited international presentations to learned societies worldwide. David Celermajer brings with him the experience from being an Editorial Board Member for Heart and Circulation. Andros Tofield

6 206 CardioPulse Ajay Shah: new European Heart Journal International Associate Editor Professor Ajay M. Shah, MD, FRCP, FMedSci joins the European Heart Journal editorial team in January 2014 Ajay M. Shah Ajay Shah is a British Heart Foundation Professor of Cardiology, Director of the Cardiovascular Division at King s College London, and Director of the King s British Heart Foundation Centre of Research Excellence, one of the two largest such centres in the UK. He is a Fellow of the UK Academy of Medical Sciences, the European Society of Cardiology, the American Heart Association, and the International Society for Heart Research. He is past-chair of the European Society of Cardiology Heart Failure Association Basic Sciences section. Professor Shah graduated in medicine from the University of Wales College of Medicine and also trained in Cardiology there. He undertook his doctoral research training in the laboratories of Andrew Henderson (Wales) and Dirk Brutsaert (Belgium) and won the British Cardiovascular Society Young Researcher of the Year Prize for this work. He then undertook postdoctoral research training in the laboratory of Edward Lakatta at the National Institute of Aging in Baltimore (USA). He was a UK Medical Research Council Senior Clinical Research Fellow in Cardiff prior to his appointment to the Chair of Cardiology at King s College London in He remains an active practicing cardiologist with interests in interventional cardiology and heart failure, as well as running a basic science research laboratory. The BHF Centre of Excellence led by Professor Shah focuses particularly on enhancing interactions between cardiovascular and non-cardiovascular scientists, with particular efforts in imaging, biophysics, high resolution microscopy, proteomics and functional genomics. Major emphasis is also placed on research training for clinical and non-clinical scientists. Professor Shah s own research interests are mainly in the role of redox signalling and NADPH oxidases in the pathophysiology of cardiac hypertrophy, and the roles of neuronal nitric oxide synthase (nnos) in human cardiovascular regulation. His lab was the first to identify the presence of NADPH oxidase isoforms in cardiac cells, discovered important roles in regulating cardiac remodelling, and more recently reported novel protective roles of certain NADPH oxidase isoforms in the heart. The work on nnos in humans is potentially paradigm-changing in that it has identified nnos-derived NO as an important regulator of basal microvascular tone in healthy humans. This suggests that abnormalities of nnos function may be as important as those affecting enos function in human vascular disease. He has published over 200 peer-reviewed scientific articles and serves on the Editorial Boards of several scientific journals. He is currently also a Consulting Editor for Cardiovascular Research and the Associate Editor of the American Journal of Physiology (Heart & Circulation). He is married with two children, a son starting medical school and a younger daughter. Interests outside work include current affairs and sports (football, rugby, and cricket) and he is also a keen skier. The latter led to long-standing involvement in the annual ESC Heart Failure Winter Research meeting which has evolved into one of the premier international heart failure meetings, combining very high quality science with leisure activities in the style of a Gordon Research Conference. Video interview of Ajay Shah with Thomas F. Lüscher at the AHA Annual Scientific Session in Dallas, November 2013, is available at EHJ Today: dallas_2013.html. Andros Tofield CardioPulse contact: Andros Tofield, Managing Editor. docandros@bluewin.ch