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Faces in the crowd: What’s your take-home message from London?

ESC Congress News 2015 - London

What’s your take-home message from London?

Shouvik Haldar, Cardiac electrophysiologist from London, England

The message for me is the importance of CPR as early as possible when patients collapse outside hospital. There’s been interesting data on 17,000 patients showing there’s very little point in continuing CPR after 35 minutes. This message impacts on cardiologists at all levels. We’ll get patients who’ve been resuscitated after this point and we feel obliged to carry on when we need to face the clear truth. It reinforces the evidence that speed is of the essence - if we intervene as soon as possible after cardiac arrest ,then they have a chance of survival.


Karin Schenck-Gustafsson, Cardiologist specialising in gender-related medicine from Stockholm, Sweden

The fact we need to take into account the different biologies of women. It’s encouraging of course that there have been presentations at this year’s Congress which have focused on cardiology from a perspective of gender. This includes data on women and mortality risk following MI treatment. Conditions such as coronary artery spasm are more common in women yet the reasons behind this and other cardiac issues have not been fully investigated. We need more studies which take gender into account if we are to improve our knowledge and understanding of the different outcomes depending on the sex of the patient.

Roy Shetty, General cardiologist from California, USA

For me, it’s been about the crucial role of cardiologists in assessing athletes for life-threatening issues such as IHSS. I see young people playing basketball who drop dead because of this. So how do you ensure that young athletes are safe to play top level sports? The consequences of not knowing are severe. The message from this Congress has been about what tests you need to run to minimise risk. EKG for example is a very important part of testing along with examination, and an exercise test if necessary. If there are no signs of heart conditions like heart murmurs or IHSS, then you can be confident.

Ruth Strasser, Academic cardiologist from Dresden, Germany

I have been really impressed by the courage of both the ESC and cardiology journals to present and publish studies that have negative results. This year, for example, there have been really important messages in atrial fibrillation showing that incorporating additional ablation strategies does not deliver any improvement in results. Publicising such data is really important because it helps to overcome people’s prejudice about techniques and avoids the expense of undertaking unnecessary procedures. It also prevents different investigators from having the same idea and repeatedly undertaking the same experiment. It really is important to know when to cut your losses and recognise when procedures do not work.

The role of the nurse practitioner?

Tomasz Baron, Non-invasive cardiologist, from Uppsala, Sweden

In Sweden we use nurse practitioners widely, allowing them to work independently in our outpatient clinics, to look after the rehabilitation of MI patients and those with heart failure, and to check lipid levels. They have great expertise and generally have further degrees. They can offer a different perspective from doctors, because they have more time to understand the impact of disease on people’s everyday lives. They can really focus on patient wellbeing and organise labour-intensive activities.


Sergio Bernal, General cardiologist, from Santiago, Chile

The fact is that cardiologists make mistakes. Some may think they are perfect but it’s impossible for us to know about everything. So nurse practitioners are crucial in alerting us when we do get it wrong. Nurses are around the patient the whole time, so they have an instinct if something is wrong. This can mean the difference between death and survival especially in the first 24 hours of treatment. It used to be just women who trained as nurse practitioners, but now we are finding more men too.


Theodore Spiro, Clinical research scientist from New Jersey, USA

In non-interventional cardiology it has to be direct oral anticoagulants. Patients don’t require routine monitoring of coagulation and that makes everyone’s life easier. But most important of all there are fewer risks for patients. In interventional cardiology the new generation of drug-eluting stents is also a very good innovation, because there is less stent thrombosis. Trials are starting to show that patients don’t need to take anticoagulation treatment for so long. This is good for the patient because there are lower risks of bleeding complications, and they can undergo surgery sooner.

Daniel Jesuorobo, General cardiologist from Bayelsa State, Nigeria

Where I come from there are only around five cardiologists in the entire region. So nurse practitioners are invaluable. Their main role is to educate people about their lifestyles, to reduce their risk of heart problems. This is a crucial job. We can’t afford a lot of the equipment, so instead we focus on changing behaviour. Nurses also have a key role to play in clinic, teaching patients with hypertension about home monitoring, and cardiologists also rely on them in rural areas. If they went on strike it would be impossible to cope.

What recent innovation has been most useful to you?

Fernando Oswaldo Dias Rangel, General cardiologist from Rio de Janeiro, Brazil

TAVI has made a dramatic improvement in my practice because we have very old patients with co-morbidities. We’re talking people with low ejection fraction, with severe calcific aortic stenosis. Before TAVI, they would have had surgery and most would have died because they were so sick. Now we’ve had great success with valve implantation, which we’ve been using for three years. Our centre in Rio has done about 200 procedures and they’ve improved people’s lives immensely - patients can socialise, work and have a good quality of life. This wasn’t possible before.


Hassan Ali, General cardiologist from Saudi Arabia

For my institution it’s been the implantation of ICDs for people with life-threatening arrhythmias - like ventricular arrhythmias - and progressive heart failure. We began implanting these devices three or four years ago when we were lucky enough to have the services of an electrophysiologist to do the testing and fit the devices. Before this our patients had to travel to other cities and even other countries to obtain the service. This was really awkward because ICDs must be followed up regularly with interrogation to check their function. We’d like to be able to explore risk for family members of people with sudden death, but don’t currently have the labs to provide the genetic information.

Asim Shadzard, Interventional and general cardiologist from Germany

In non-interventional cardiology it has to be direct oral anticoagulants. Patients don’t require routine monitoring of coagulation and that makes everyone’s life easier. But most important of all there are fewer risks for patients. In interventional cardiology the new generation of drug-eluting stents is also a very good innovation, because there is less stent thrombosis. Trials are starting to show that patients don’t need to take anticoagulation treatment for so long. This is good for the patient because there are lower risks of bleeding complications, and they can undergo surgery sooner.

Jolien Roos-Hesselink, Interventional cardiologist from Rotterdam, the Netherlands

What’s made a difference for me and my colleagues is the fact patients have become more actively involved in decision-making. There has been a move away from a paternalistic approach in which patients relied on the cardiologist for a decision. Now, with the help of knowledge platforms such as eMedicine, patients can share in decision-making - for example on heart valve replacement. This has had a cost benefit for the health service. If patients are happier and satisfied with their treatment, then they will have fewer complaints. And this means they are less likely to visit outpatients.

What advice would you give to young cardiologists?

Marius Ibe, General cardiologist from Lagos, Nigeria

Be focused and identify what your specialty is, what you have a flair for. Because it’s important that you enjoy what you do. Also remember that it’s not just about treating people. You have to learn to be an educator and communicator and to know what is good for your society. Then you can help patients take responsibility for their health, help them follow healthy lifestyles. Here in London people walk a lot but back home people want to take transport all the time. So my job is to show them how they can change their lifestyle and improve their cardiovascular health.


Gebhard Lings, Internal medicine from Bregenz, Austria

What’s really important is to find a good mentor and role model who can help you navigate the early stage of your career. While this often happens by chance, it will pay to do your research and talk to other people who have gone ahead of you to get a feel for the type of support offered by the department. You would need to take a long hard look at yourself and analyse your own strengths and weaknesses, and ensure that you have good empathy for patients. I also think that it’s really important that people practice internal medicine first and specialise in cardiology afterwards, to ensure they have a good basic grounding.

Ian Jeffrey, General cardiologist from Canberra, Australia

The advice I’d give to a young cardiologist is try and balance your practice. What I mean is that they should attempt to achieve a balance of service provision to their patients with an academic association with a university. To make sure they have that involvement in research. Otherwise work becomes a bit hum-drum after 30 years or so. You will find you need this additional stimulation. It’s pretty easy to have an academic association even if you are not in a university hospital. We’re training so many medical students these days so most hospitals have links to a university.


Kathleen McGarry, General physician/cardiologist from Dublin, Ireland

I’d tell them that cardiology is a very satisfying career that offers infinite variety. There are very few other fields that provide such a range of options. You could specialise in invasive cardiology, echocardiography, preventive cardiology or even, for those who like research, go down the academic route. As you go through the training programme you’re likely to find that one element stands out that interests you above all others. Young people also need to be assertive in lobbying training bodies to make training schemes more family friendly by offering more flexible part-time training and job sharing. This is particularly important bearing in mind that over 50% of the medical work force now are women.

How important is the environment in CVD?

Akvile Smigelskaite, Cardiology Resident from Vilnius, Lithuania

Society needs to promote the infrastructure for better environments to help the entire population incorporate exercise into their everyday lives. One way would be to provide free bikes to encourage people not to use their cars and to introduce safe cycle lanes and walkways in cities that allow people to get from A to B on foot. Such strategies would have the double benefit of reducing pollution and increasing the amount of exercise people take. Local authorities should ensure that parks are secure places where people feel comfortable to exercise.  It is also important to provide peaceful environments that help people to unwind from the stress of modern life, since this is also a major cause of  cardiovascular disease.

Austine Obasohan, Clinical Cardiologist from Benin City, Nigeria

The emphasis isn’t so much on atmospheric pollution. It’s on others areas of the environment which affect health and socio-economic factors. These include poor diet and hygiene as well as infections with an impact on the heart such as rheumatic fever, a problem that leads to valve disease. Poverty leads to poor diet although it is also a disease of affluence. Even in the developed world ischaemic disease is common and there’s a general tendency to copy diet in the western world. I mean such as food high in fat as well as salt which leads to hypertension.


Edward Vogl, Clinical Cardiologist from Sidney, Australia

Although the environment is emerging as an important issue in the development of cardiovascular disease, it still isn’t something that a lot of people know much about. The problem is that you can’t easily set up an interventional study and expect results two years later, making it hard to keep the issue in the limelight. Another difficulty is that the environment isn’t under the control of individual patients, and short of moving to a different area there isn’t much they can do to influence it.  It is a societal issue that needs to be addressed by politicians, multinational companies and big business rather than members of the public, although they can play an important role in lobbying for change.

Mark Westwood, Interventional cardiologist and cardiac imaging director from London

Here in East London we have some of the highest social deprivation in the country. So environment is a significant factor in cardiovascular disease in boroughs such as Newham and Hackney. It’s about the impact of socio-economic factors such as diet and lifestyle. The smoking rates in this part of the city are much higher than in other parts of the UK. I work at Barts Health and we work hard with local communities to educate them about smoking cessation. Our goal is to address the whole picture - prevention and accessing healthcare services in a timely manner.