History of the ESC. Part 1. The beginning of the adventure: 1950-1992

The birth of the European Society of Cardiology

The idea of establishing a European cardiology society was launched in 1948 during the Third Inter-American Congress of Cardiology in Chicago. Inspired by the American cardiologist Paul Dudley White, two of the European delegates to the congress, Charles Laubry from France and Sir John Parkinson from the United Kingdom, decided to act: they invited representatives from 14 countries (Belgium, Denmark, Finland, France, Greece, Italy, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, the United Kingdom and Yugoslavia) to a constituent meeting in Brussels on 29 January 1949. A draft of the first statutes was created and a board was appointed, with Gustav Nylin from Sweden as President, Charles Laubry as Honorary President, and Roger van Dooren from Belgium as Secretary.

At that time, Europe was divided in the aftermath of the Second World War. A strongly emphasised objective by the early leaders of the European Society of Cardiology (ESC) was to gather the European National Cardiac Societies under an umbrella organisation promoting the exchange of ideas between countries. Looking back from our vantage point here in the 21st century at these humble beginnings, we can all affirm that this dream has indeed come true: the ESC has undoubtedly facilitated the development of cardiovascular medicine throughout Europe.

The ESC was formally consolidated during a first General Assembly during the World Congress of Cardiology in Paris in 1950. The Presidents who served between 1950 and 1991 are listed in Table 1. The statutes approved by the Congress underlined the society’s mission “to contribute to the development of cardiac care”. This was expressed in the statutes as follows: “to foster the development of Cardiology, to further scientific exchanges, to encourage personal contacts and to establish standards for training for cardiologists and those who work in the field of cardiovascular medicine”. As a tool, it was decided that European cardiology congresses should be held every four years with a national cardiac society hosting the event.

Table 1. Presidents of the European Society of Cardiology 1950-1991.

The very first European Congress of Cardiology was led by Sir John Parkinson in London in September 1950. The subsequent, locally organised congresses are presented in Table 2.

Table 2. Congress venues and number of participants, 1952-1991.

The second congress was organised in Stockholm from 10 to14 September 1956. The scientific programme, a list of all participants (n=686) and exhibitors was contained in an 80-page programme, which, compared with the present, much heavier congress documents, seems quite compact. An interesting feature of this programme is its back cover, which lists a key to the languages accepted at the Congress (Figure 1).

Figure 1. The front and back covers of the programme booklet for the second European Congress of Cardiology at Stockholm, 1956.

The last in this series of congresses was held in Düsseldorf in 1984. On that occasion, several new structural meeting concepts were tested, forming the basis for the organisation of the present annual congresses.

Towards annual congresses

The European congresses became increasingly popular over time, and, considering the period, were well attended (Table 2). The concern arose, however, that young cardiologists did not always consider it easy to attend these meetings and to make their voices heard at them. This was recognised by the ESC leadership, and a forum for physicians with scientific interests was created – this was the embryo of what would later become the ESC Working Groups (WG). As a start, small meetings and seminars were organised in between the congresses with the aim to attract young, scientifically active clinical researchers with shared interests in different areas of cardiovascular medicine.

The chairman (Professor Bertil Olsson from Gothenburg, Sweden) who was asked to develop a WG for arrhythmia reported that the work was initiated under simple conditions, remembering that “[w]e invited the most scientifically committed colleagues from different European countries and started an activity with meetings and information exchange. There was no funding from the ESC, so we had to arrange it ourselves. We had the very first meeting in Gothenburg and then dinner in my home. The first year there were lectures by specially selected people from different countries, who were then allowed to spread information in their home countries and invite people to free lectures or posters. The meetings rotated between different countries and from the beginning they were open only for members of the arrhythmia group. The development since then has been as explosive as the arrhythmia industry itself!”

It was not until 1976 that the structure of the WG was formalised and given the following tasks: to promote and organise research, to gather and exchange information, to contribute to the ESC Annual Congress and other scientific meetings and symposia, and to establish appropriate recommendations for the ESC and other similar organisations. The number of WG increased rapidly thereafter, exceeding twenty within a few years.

Along with the National Cardiac Societies, the WG comprised one of the two fundamental constituent bodies of the ESC with voting rights in the General Assembly as determined by membership size. The first “official” joint WG meeting was held in Brighton in 1978, followed by meetings in Pavia (1978), Spa (1983), Brighton (1985), and finally Santiago de Compostela (1987). The number of submitted scientific abstracts (700-800), was relatively stable between 1981 and 1985, increasing to 1,227 in 1987.

During this development, the leaders of the ESC started to recognise the necessity of overcoming language barriers. As already outlined, several languages had initially been accepted at the congress sessions: the language of the hosting country together with English, French, and German. One of the driving forces behind this process was Franz Loogen (President from 1980 to 1984), who rightly argued that it would be impossible to create a successful European professional and scientific society without a common language. He referred to the European Union, which had failed to establish such a linguistic unity and had to bear substantial translation costs, something that would have been unaffordable for the ESC. Despite some protests, an agreement was reached to focus on English and French, with English as the common scientific language, a language that by that time had become the sole official language of the ESC.

When the Dutch cardiologist Paul Hugenholtz assumed the Presidency in 1984, the conditions were in place for a radical restructuring of the ESC. At that time, the two major annual cardiovascular congresses were organised by the American College of Cardiology and the American Heart Association, respectively, and Hugenholz recognised the potential of ESC-organised annual cardiology congresses. The implication was that National Societies should no longer be responsible for the scientific and educational programme, which instead should be undertaken by a scientific committee acting on behalf of the ESC Board. Further, it became clear that the practical handling of annual congresses would require a permanent staff and office facilities. The underlying financial calculations included plans for an industrial exhibition linked to the annual congress, as well as a regulated collaboration based on mutual trust with the pharmaceutical and medical technology industries within the cardiovascular sector. Some national cardiology societies considered such a transition to be financially risky while others were inspired by this vision of the future. After an intense debate during the General Assembly of 1985, an overwhelming majority of the voting delegates (only two votes against and one abstention) approved the new statutes and by-laws and affirmed that the ESC, from 1988 onward, should organise annual cardiology congresses.

To manage this, the ESC was registered with the Registre de Commerce de Lausanne in Switzerland and a Foundation named ECCO (the European Cardiology Congress Organisation) was created in April 1986. Several pharmaceutical companies supported ECCO as “Founding Fathers” or “Major Sponsors”. An office of 300 m2 was rented in Nyon, Switzerland in 1987, and Mr Wil Neijman, with a background in the congress industry, was employed as the organisation’s first Executive Director. That same year, the position of Executive Secretary of the Board was created, with Mrs Wilma Thieme as the first holder of the office. Later that year, the ESC logo and flag were created (Figure 2).

Figure 2. The logotype of the European Society of Cardiology.

The first executive scientific committee was appointed by the Board in 1987 with nine members chaired by Professor Günter Breithardt. The planning and hosting of the 1987 WG meeting in Santiago de Compostela became the first demonstration of the capability of the newly instituted organisation, ECCO. The annual ESC congresses became an immediate and extraordinary success. The first was held in Vienna in 1988, and the number of participants increased rapidly from then onwards. Within a relatively short time period the ESC congress was established as the most respected and globally leading congress of its kind.

The success of the congress generated strong financial stability for the ESC. Part of the revenue was reserved for future investments, while other portions were used to establish fellowships for the clinical and scientific training of young cardiologists at international centres, as well as prizes for young researchers presenting outstanding contributions to the congress.

The European Heart House

The success of the congresses created a need for larger premises, and in 1990 the first plans for a European Heart House were presented by the Board led by Atilio Reale, who had been inspired by a visit to the American College of Cardiology and their American Heart House in Bethesda, MD, USA. For various reasons, among them taxation concerns and limitations around hiring staff members without Swiss citizenship, the ESC could not remain in Switzerland.

A number of requirements for the new venue were listed: it should not be located in a capital city, which would be expensive and distract focus; it should not be directly connected to a university; it should be located in an attractive environment with a reasonably large airport and good transportation connections in all directions. Following a period of field studies, the area around Nice was considered the most suitable. Sophia Antipolis, where the European Heart House is now located, was at that time an undeveloped area where an internationally oriented campus focused on science and communication was being planned. The ESC was offered the opportunity to acquire a large lot at a favourable price there, and the Board’s decision to purchase the land and construct a European Heart House was formally approved in May 1991.

Among the proposals submitted by various architects, three were selected for further consideration. The first sought to imitate the form of a heart by erecting a building shaped as half of a heart beside an artificial lake, which, by reflecting it, would complete the shape. The proposal was considered artistically impressive, but it was rejected due to practical considerations regarding the office and other facilities.

The second proposal consisted of a rectangular building with a restrained Scandinavian design. It was regarded as elegant, but not sufficiently inspiring in a conceptual sense – simply not a unique European creation.

The third, winning proposal was characterised by a semicircular building with a sloping roof (Figure 3). According to the architect, this section is intended to symbolise the body, while water flowing along the roof symbolises life-giving blood. This structure was complemented by an adjacent elliptical building in order to provide sufficient office and educational space. Construction began in late November 1992 and proceeded at an impressive pace. The European Heart House was inaugurated nine months later, on August 31, 1993, in conjunction with the cardiology congress in Nice.

Figure 3. The European Heart House.

The decision to build a headquarters for European cardiology proved highly visionary. The European Heart House became a natural meeting place for the ESC Board, its various committees, the WG, associations, and councils. Today, a large staff works there organising not only the annual European cardiology congresses, but also specialised meetings and other work regarding, e.g., memberships, guidelines, surveys, and educational programmes.

Towards a modern organisation

The growing organisation and its increasing commitments combined with improved financial possibilities soon made it clear that the structure of the ESC needed modernisation. Work on this began in the early 1990s. At the same time, it became evident that influence over the Society, until then concentrated in the hands of a relatively small group of board members driven by the ambition to create a strong European cardiology community, had to be broadened. An important issue was how to engage the National Cardiac Societies and their members and ensure that they were given the opportunity to interact with the ESC. One solution was the establishment of committees with participants recruited from member countries, often – though not always – chaired by a board member, which would be tasked with addressing issues of importance for European cardiology. The work carried out within these groups became an important source of renewal and development in numerous areas. Clinical practice guidelines, prevention of cardiovascular disease, education, specialist accreditation requirements, EU lobbying, and awards and scholarships are examples of this work.

The development of the ESC’s now well-known and internationally respected scientific journals was another important line of progress. European Heart Journal published its first issue in 1980, Cardiovascular Research was acquired in 1994, and thereafter one journal followed another, with strong involvement from the WG. A key factor in their success was the idea of linking journal subscriptions to congress registration fees. The first journal included in this model was European Heart Journal, which consequently achieved a rapidly increasing circulation. Combined with dedicated efforts to raise scientific quality and improve editorial processes, this increased both researchers’ interest in publishing in the European journals and publishers’ willingness to invest in them.

Work on a strategic future plan was initiated. Some key points are summarised in Table 3.

Table 3. Issues of strategic importance for the ESC in the early 1990s.

The idea was to develop the original ESC into an association that would be of interest not only to the profession but also be recognised by the general public and politicians, with the capacity to actively contribute to the future development of prevention and treatment of cardiovascular disease at a European and national level. To achieve these goals, the ESC needed to be transformed into a modern organisation whose strategic direction would be guided by European cardiologists, with responsibility for day-to-day operations entrusted to the staff employed at the European Heart House (Figure 3).

Figure 4. European Society of Cardiology 1950-1990 and the vision of a future structure.

More information on how this was accomplished and subsequent developments will follow in upcoming articles on the continuing history of the ESC.

Bibliography

Snellen H A. Birth and Growth of the European Society of Cardiology. Eur Heart J. 1980;1:5-7. 

Programme Second European Congress of Cardiology 1956. Heart. 1957;19:144-146. 

A brief history of the European Society of Cardiology. Eur Heart J. 2009;30(8):871-881.