european cardiology: challenges and opportunities for...
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EUROPEAN CARDIOLOGY:Challenges and Opportunities
for the next decade
Pr Michel KOMAJDA
University Pierre et Marie CuriePARIS France
President European Society of Cardiology
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Declaration Of Interest 2010
Speaker :
Servier, Menarini, Sanofi, Boehringer Ingelheim,
Astra Zeneca, Glaxo SmithKline
Consultant / Trial Committee Member :
Servier, Johnson & Johnson, Sanofi,
Nile Therapeutics, Bristol Myers-Squibb
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European deaths by cause in men
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European deaths by cause in
women
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EUROPEAN CARDIOLOGY
The Context (I)
Heterogeneity of risk.
Heterogeneity of access to procedures.
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Male CHD death rates
35 –74 years
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Female CHD death rates
35 – 74 years
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SCORE
10 year risk of fatal CVD
• Gender
• Smoking status
• Age
• Systolic blood pressure
• Total cholesterol
Belgium, France, Greece, Italy, Luxembourg, Spain, Switzerland, Portugal
Base
d o
n C
onro
y et
al,
Eur
Hea
rt J
, 2003, 24:9
87
-1003 C
opyr
ight©
: 2003 E
uro
pea
n S
oci
ety
of
Card
iolo
gy.
All
rig
hts
res
erve
d.
Low Risk Chart High Risk Chart
The rest of Europe
Base
d o
n C
onro
y et
al,
Eur
Hea
rt J
, 2003, 24:9
87
-1003 C
opyr
ight©
: 2003 E
uro
pea
n S
oci
ety
of
Card
iolo
gy.
All
rig
hts
res
erve
d.
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0
200000
400000
600000
800000
1000000
1200000
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
PCI for onging MI Multivessel PCI Ad hoc PCI Total PCI
PCI Substrata 1992 - 2008
acute MI
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Stenting in Europe(Registry of the European Society of Cardiology)
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National Differences in ICD implantation
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National Differences in ICD implantation
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Europe : GDP/Health expenditure %
Country
Total expenditure on health as % of
GDP
GDP/head
($)
Austria 10.3 45,181
Croatia 7.7 14,414
France 10.5 41,511
Germany 10.6 40,415
Greece 9.9 33,433
Norway 9.7 83,922
Russia 6 9,075
Spain 8.1 32,066
Turkey 7.7 9,629
EHRA White Book
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Substantial investment in sophisticated
devices / procedures.
Lack of implementation of simple
prevention measures.
EUROPEAN CARDIOLOGY
The Context (II)
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Finland
Czech Republic
France
Germany
HungaryItaly
Netherlands
Slovenia
EUROASPIRE I, II and III
K Kotseva, et al Lancet 2009; 373; 929-940
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Prevalence of smoking, obesity* and central obesity**
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Survey 1 20.3% 25.0% 42.2%
Survey 2 21.2% 32.6% 53.0%
Survey 3 18.2% 38.0% 54.9%
Smoking Obesity Central obesity
*Body mass index ≥ 30 kg/m²
**Waist circumference ≥ 88 cm for women and ≥ 102 cm for men
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Prevalence of raised blood pressure*, elevated TC**
and LDL-C***, and self-reported diabetes mellitus
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Survey 1 58.1% 94.5% 96.4% 17.4%
Survey 2 58.3% 76.7% 78.1% 20.1%
Survey 3 60.9% 46.2% 47.5% 28.0%
Raised BP Elevated TC Elevated LDL-C Diabetes
*SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg diabetics
** TC ≥4.5 mmol/l; *** LDL-C ≥4.5 mmol/l
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Cardiovascular Protective Drug Therapies
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Survey 1 80.8% 56.0% 31.0% 18.1%
Survey 2 83.6% 69.0% 49.2% 57.3%
Survey 3 93.2% 85.5% 74.5% 87.0%
Antiplatelets Beta-blockers ACE/ARB's Statins
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Finland
Czech Republic
France
Germany
Hungary
Italy
Netherlands
Slovenia
Spain
8966 coronary patients
EUROASPIRE III Hospital
Belgium
Ireland
UK
Greece
Poland
Latvia
Lithuania
Romania
Russia
Croatia Bulgaria
Cyprus
Turkey
K Kotseva, et al Lancet 2009; 373; 929-940
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0%0%2%
3%
14%23%
29%33%35%
35%37%
42%46%47%49%
52%52%
57%65%
76%86%
4%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
GreeceSpain
CyprusTurkey
Russian FederationRomaniaBulgariaFranceFinland
United KingdomLatvia
CroatiaCzech Republic
ItalyThe Netherlands
PolandGermanyHungary
SloveniaBelgiumIreland
Lithuania
All patients: 36%
Men 37% Women 34%
Attendance to a CPR programme among all patients* by country
* Attending at least one session CPR attendance rate if advised to follow = 81%
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EUROASPIRE III Coronary patients
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ALL 51.9% 35.3% 78.0%
MEN 51.9% 32.1% 74.6%
WOMEN 51.9% 44.7% 88.3%
Smoking BMI > 30 kg/m2 Abdo obesity*
* WC > 94 cm (men); > 84 cm (women)
K Kotseva, et al EJCP&R 2009; 16:121-37
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EUROASPIRE III Coronary patients
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ALL 56.0% 51.1% 55% 35% 35%
MEN 54.4% 47.5% 52% 34% 39%
WOMEN 60.6% 61.5% 61% 38% 26%
BP>140/90mmHg** TC>4.5 mmol/l LDL-C>2.5 mmol/l Diabetes*** HbA1c<6.5% ****
**SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg for diabetes
****Self-reported and/or glucose ≥ 7.0 mmol/l; **** in patients with self reported diabetes
K Kotseva, et al EJCP&R 2009; 16:121-37
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FinlandGermany
Italy
Slovenia
Spain
EUROASPIRE III PRIMARY CARE4366 high risk individuals
Belgium
UK
Poland
Latvia
Romania
Croatia
Bulgaria
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Advise to follow programme for lifestyle & risk factor management*
* Over the last 3 years
0.4%
1.0%
1.7%
2.2%
3.1%
6.7%
8.9%
9.2%
11.4%
21.7%
99.5%
2.7%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Spain
Finland
Romania
Bulgaria
Belgium
Croatia
Slovenia
Germany
Poland
UK
Latvia
Italy
All patients: 17.1%
Men 20.1% , Women 15.9%
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EUROASPIRE III PRIMARY CARE
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ALL 88.6% 43.5% 61.6%
MEN 88.3% 39.2% 46.9%
WOMEN 89.2% 46.7% 72.4%
Smoking BMI > 30 kg/m2 Abdo obesity*
* WC > 94 cm (men); > 84 cm (women)
K Kotseva, et al EJCP&R 2010
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EUROASPIRE III PRIMARY CARE
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ALL 70.8% 78.9% 81% 43% 53%
MEN 72.6% 72.5% 77% 39% 61%
WOMEN 69.5% 83.6% 83% 39% 46%
BP>140/90mmHg** TC>4.5 mmol/l LDL-C>2.5 mmol/l Diabetes*** HbA1c<6.5% ****
**SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg for diabetes
****Self-reported and/or glucose ≥ 7.0 mmol/l; **** in patients with self reported diabetes
K Kotseva, et al EJCP&R 2010
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WHY IS IT SO ?
Different stakeholders with different perspectives :
Hospitals (fee for service) vs social security systems.
Private vs Public systems.
Lack of awareness / interest for health economics.
Lack of collaboration between professionals: GPs dietiticians, nurses, rehabilitation, cardiologists (… …)
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ESC demonstration project in preventive cardiology
EUROACTION
Wood D A, et al Lancet 2008; 371: 1999-2012
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Proportions of patients achieving the European targets for a
healthy diet
Hospital General Practice
Intervention Usual Care
p = 0.005
p = 0.26
p = 0.13
p = 0.009
p = 0.004
p = 0.91
p = 0.04
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Proportion of patients achieving the European target for blood pressure
P = 0.04
General PracticeHospital
p = 0.03
+ 17% (+ 2% to + 32%)+ 10% (+ 0.6% to + 20%)
Intervention Usual Care
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ARE THERE SOLUTIONS ?
1. Invest in prevention.
2. Create alliances with sister societies for the management of chronic diseases.
3. Create alliances with other professionals :
• GPs
• Nurses
Declining medical demography.
4. Homogenise education in cardiology.
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Obesity in the world
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16,2
32,7
28,3
40,5
North
Americas
53,2
64,1
Europe24,5
44,5
Middle East
46,5
80,3
South East
Asia (India)67
99,4
Asia & Australia
(China)
10,418,7
Africa
2007
2025
Diabetes Mellitus : a pandemic
South and Central
Americas
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ESC ROAD MAP
2010-2012
Priority to education.
Develop research activities.
Improve our visibility.
Adapt to a changing environment.
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Priority to Education
Remote distance courses webcasts /
webinars.
Workshops with National Societies.
Homogenous validation procedures.
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EDUCATION IN CARDIOLOGYNew initiatives
OTTO SMISETH
Education in Cardiology
Education online
Professional Standards
Educational courses
Guidelines Implementatio
n
Tracking platform for CME and Certification
purposes
Content Portal mapped out on
curricula
Emphasis on distance learning
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• New initiatives aimed at bring ESC scientific content closer to ESC Members
– Distance learning developments
– Local events
– Guidelines implementation initiatives
OTTO SMISETH
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SCHEDULE OVERVIEW Sept 2010 - Aug 2013
From Sept. 2010 to Aug. 2011 From Sept. 2011 to Aug. 2012 From Sept. 2012 to Aug. 2013
TF TF TF
September
2010September 2011
September
2012
October 2010 October 2011 October 2012
November
2010November 2011
November
2012
December
2010December 2011 VHD
December
2012 Diabetes
January 2011 Pregnancy January 2012 CVD Prevention January 2013
February 2011 February 2012 February 2013 Arterial Hypertension
March 2011 PAD March 2012 HF March 2013
April 2011 Dyslipidemias April 2012 April 2013 Stable Arterial Disease
May 2011 May 2012 May 2013 Cardiac Pacing
June 2011NSTE-ACS
UNI Definition of MIJune 2012 AMI STEMI June 2013
July 2011 July 2012 July 2013
August 2011 August 2012 August 2013
TOTAL
GUIDELINES 5
TOTAL
GUIDELINES 4
TOTAL
GUIDELINES 4
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Develop Research Activities
ESC Research Foundation.
Euro Observation Research Project.
Research Grants.
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EORP Provisional Programme2009 2010 2011 2012
Heart Failure Heart Failure Heart Failure Heart Failure
Pregnancy in Cardiac Diseases
Pregnancy in Cardiac Diseases
Pregnancy in Cardiac Diseases
-
Atrial Fib. Ablation Atrial Fib. Ablation Atrial Fib. Ablation
Percutaneous Valve Percutaneous ValvePercutaneous
Valve
Angina/IHD Angina/IHD Angina/IHD
ACS? ACS
Cardiomyopathies Cardiomyopathies
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M. KOMAJDA - Stockholm 2010
Improve our visibility
Web site
Press / Media
EU Lobbying
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ESC E-communication
Eva Swahn, ESC Vice-President, Communication
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ESC web site traffic in 2010
• Unique visitors: ~ 100,000 per month (90,000 in 2009)
• Visits: ~150,000 per month
• Page views: ~ 1 million per month
• Total visits: 2,005,691
• Page views: 11,815,673
• ~ 7,000 web pages
Eva Swahn, ESC Vice-President, Communication
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ESC Web Site priorities 2011
Attract and promote
scientific contentImprove user
friendliness and usability
Eva Swahn, ESC Vice-President, Communication
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Projects 2011-2012
• Search Engine and journal content
• News and targeted audiences: cardiologists of tomorrow
• ESC Congress goes « Mobile »
• Support Education activities, « Global scientific Initiatives »
• More visibility for National Societies
• Working Group content and congresses promotion
• Networking tool
• Association projects: EAE 3D Echo Box update, …
Eva Swahn, ESC Vice-President, Communication
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Alliance for Biomedical Research in Europe
with another 20 societies interested in participation
at launch in Brussels Dec. 9th
weblinks to be added…
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M. KOMAJDA - Stockholm 2010
Develop our International Influence
Global Scientific Activities
. China . Brazil
. Saudi Arabia . Mexico
. Asia Pacific (Malaysia)
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M. KOMAJDA - Stockholm 2010
Anticipate a changing environment
Change in industry support.Towards « global packages » of scientifc services and unrestricted grants:a Society of members vs clients.
Relationship between ESC and Industry.
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Guideline Format Preference
0
10
20
30
40
50
60
70
80
% r
esp
on
de
nts
Paper Web Email Colleagues Other
Young Private practice
In what format do you prefer to receive this kind of information or support?
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LOOK TOWARDS THE FUTURE
Attract the young « All Electronic »
generation
Web / distance learning activities.
Create alliances between all
pofessionals
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We are the voice of cardiac
patients in ESC Countries.