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Professor Ioannis Goudevenos (University Hospital of Ioannina, Greece), President of the Hellenic Society of Cardiology (HSC), talks about heart failure in Greece and about increasing collaborations between the HSC and the HFA.
According to Prof. Goudevenos, today’s clinician cardiologist managing patients with heart failure must not only be familiar with the pharmaceutical therapy required to treat the syndrome but also have expertise in arrhythmias, intensive cardiology, imaging, devices and immunology. He thinks that these ‘new pathways’, together with the education in heart failure provided by the HFA, have made specialising in heart failure very attractive to physicians.
Recent years have seen a rise in the numbers of patients hospitalised with heart failure in Greece. While he is not aware of any official heart failure statistics, Prof. Goudevenos suggests that around one-third of hospitalisations are due to heart failure and that even in internal medicine wards there are growing numbers of patients with heart failure with preserved ejection fraction and other comorbidities. In addition to the greater volume of patients, the age of heart failure patients in the advanced stages of the disease is increasing and while the rate of -blocker and mineralocorticoid prescription remains high, at more than 80% and 60%, respectively, conditions such as renal insufficiency, hypotension and hyperkalaemia mean that many patients are unable to tolerate angiotensin converting-enzyme inhibitors and angiotensin receptor blockers. “It is estimated that only 30% of patients hospitalised with heart failure are able to receive optimal doses of neurohormonal inhibitors,” says Prof. Goudevenos. In Greece, all patients are assigned to a therapeutic protocol and medicines are prescribed electronically. Secondary prevention of arrhythmogenic death using implantable cardioverter defibrillators or cardiac resynchronisation therapy is offered to all patients meeting European guideline eligibility criteria, although electrophysiology studies are obligatory in most cases. The creation of outpatient heart failure clinics has led to a considerable improvement in the management of patients over the last ten years. A major challenge facing heart failure treatment in Greece is the sparsity of data on the prevalence and management of the disease in the country.
One of the goals of the Hellenic Society of Cardiology is the development of a national registry on the prevalence and treatment of heart failure throughout Greece.
Discussing some of the HSC initiatives that have been put in place to try to improve the outcome of patients with heart failure, Prof. Goudevenos cites the creation of electronic platforms to inform and educate Greek patients about the disease in their own language, and the regular involvement of the HSC in a range of heart failure-related public activities. On the annual Heart Failure Awareness Days, the HSC organises several events, including press conferences, TV programmes, hospital open days and public discussions. The HSC Working Group of Heart Failure organises courses to support continuous education on heart failure for cardiologists and related physicians. It has also created a proposal for the patient discharge letter that will help to optimise the prescription and uptitration of medication, thereby minimising adverse drug effects and facilitating the connection between in-hospital and post-discharge management.
The HSC values its relationship with the HFA. For Heart Failure 2019, the President of the local Working Group of Heart Failure and various members of the HSC Board were involved in providing ideas for sessions featured in the Local Track and also helped to organise a number of public events, including a walking tour of the historical centre and this year’s HoT walk. “We also promoted attendance at this important congress to all our members,” says Prof. Goudevenos. The HSC is looking to build on its links with the HFA and to achieve even greater collaboration. Currently, the President of the Working Group of Heart Failure participates in the annual meeting of HFA working groups. The HSC would also like to work more closely with the HFA on practical issues, such as national registries and surveys, and even to have a greater contribution to political issues, for example suggesting ideas at a national level for consideration in white papers on heart failure.
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