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In today’s Inaugural Session (17:45 – 19:30; Trianti), two titans from the world of cardiology, Prof. Sir Magdi H Yacoub and Prof. Mariell Jessup, will receive their HFA Lifetime Achievement Awards and will share their thoughts on issues they consider to be of pressing importance in the field of heart failure.
Heart failure: A curable disease?
Founder of the largest heart and lung transplantation programme in the world, Professor Sir Magdi Yacoub (Imperial College London, UK) has developed novel operations for a number of complex congenital heart anomalies and led national and international collaborative research into myocardial regeneration, novel left ventricular assist devices (LVADs) and wireless sensors.
He was knighted for his services to medicine and surgery in the 1992 New Year Honours List and was awarded the Order of Merit by Her Majesty The Queen in the 2014 New Year Honours List.
Asked what he considers to be his greatest career achievement, Prof. Yacoub hesitates, “That’s a hard one for me to specify. It’s like being asked 'Which is your favourite child?'! However, if I did have to choose, I would say that one relates to LVAD bridge to recovery and the reverse remodelling that has had a significant impact on the lives of patients, particularly those with end-stage heart failure.” Just as important to him, however, is his involvement in global cardiology. He is President and Founder of Chain of Hope UK, a charity that is working towards providing high-standard cardiac care to children all over the world and that has established a number of centres globally, including the Aswan Heart Center in Egypt. He is more certain of his response when asked to select the proudest moment of his career. “That’s easier to answer,” he says, “it was being elected to The Royal Society by pure scientist peers.”
On the subject of being a recipient of the HFA Lifetime Achievement Award, Prof. Yacoub—who will be presenting this year’s Eugene Braunwald Lecture—talks about feeling extremely privileged, particularly so because Professor Eugene Braunwaldis one of his idols. And this is reflected in his choice of lecture topic, which was made partly to honour Prof. Braunwald. As he explains, “After some deliberation, I chose to talk about ‘Is heart failure a curable disease?’. Prof. Braunwald made an almost immeasurable contribution to progressing research in this area.” He thinks that while curing heart failure has been one of the most challenging problems in medicine, the evolution of many tools to help uncover the basic molecular and cellular mechanisms of the disease, along with multimodality imaging, has provided unprecedented opportunities for finding solutions to this seemingly impossible task. Prof. Yacoub concludes in characteristically positive fashion, “I feel strongly that we are poised to solve this global problem in the not-toodistant future.”
Clinical Practice guidelines: The alpha and the omega
Professor Mariell Jessup (American Heart Association, Dallas, TX, USA) expresses her profound honour and humility to stand alongside the great names who have received the HFA Lifetime Achievement Award.
Her career in heart failure began when she started working with Karl Weber at the University of Pennsylvania, eventually taking over his clinical trial programme when he left. She then went on to work on the heart transplant programme at Temple University, Philadelphia. Prof. Jessup is especially proud to be delivering this year’s Philip Poole Wilson Lecture because of the work Professor Poole- Wilson did in increasing awareness about the heart failure epidemic that was at that time about to strike throughout the world. “I admired him greatly,” she says, “and it seemed to me a logical step from his raising the alarm about the increase in heart failure to identifying what qualifications would be required by the physicians who would be taking care of these patients.” This is what Prof. Jessup regards as probably her greatest contribution to heart failure. Recognising that the skills required by a heart failure specialist were unique, she and others worked towards developing board certification for heart failure specialists in the US. This also firmly established heart failure as an important secondary subspecialty and led to its recognition as a huge problem worldwide.
“All scientists, all clinicians should recognise that preventing heart failure is bigger than the individual patient in the clinic and that work on a more global level is required.”
Her lecture—‘Clinical Practice Guidelines: What is the alpha and what is the omega?’ reflects the journey of guidelines from basic science and clinical trials (the alpha) to implementation at the level of the patient (the omega). She thinks that too much focus is given to the alpha part of the guideline process and much less attention is given to the omega part. “It’s one thing to produce really good guidelines, but it’s another thing completely to make them an important, and necessary, part of a clinician’s daily practice.” Outcomes data suggest that adherence to clinical practice guidelines is suboptimal. While there is some evidence that mortality rates from heart failure have decreased, they are still very high. In addition, more and more patients throughout Europe and the US are developing the disease as a result of diabetes and obesity. In fact, at least in Western countries, the downward trajectory seen in the incidence of cardiovascular disease over the last 50 years has stalled, and even begun to reverse, as a result of these conditions. Added to this is the rise in heart failure associated with an increase in the ageing population. Finding ways to encourage clinicians to follow guidelines is difficult and requires much more discussion than it currently receives. Consideration needs to be given to determining how guideline knowledge can be applied to enable clinicians to treat each patient in the most appropriate way.
Prof. Jessup’s take-home message is that the omega of guidelines is actually prevention and that more time needs to be spent finding better ways to do this. Echoing the UK local government and National Health Service’s initiative, she wants doctors to make sure that every contact counts. Thus, when treating a patient, a clinician should not focus solely on their area of expertise, but should also stress the elements of a healthy lifestyle, including diet, exercise and blood pressure and lipid control. Doctors also need to become involved in advocacy, campaigning for increased availability of, and access to, places to exercise and healthy, fresh food. She recognises the HFA’s support of prevention and suggests that the association could build on this by working even more closely with local organisations, local governments and individual countries to promote healthy living and smoke-free, easy-to-exercise environments. Prof. Jessup is optimistic about tackling the development of heart failure and, citing the success of international programmes to reduce smoking, she believes that efforts aimed at ameliorating other risk factors for heart failure, such as effective management of hypertension, could be similarly successful.
Our mission: To reduce the burden of cardiovascular disease.
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