Professor John Cleland (University of Glasgow - Glasgow, UK) has made a huge contribution to developments in the field of heart failure. His roles in education, research and implementation have not only improved diagnosis and care for patients but have also helped develop a lively professional culture encouraging international collaboration and celebration of ‘success in failure’.
“I consider my main achievements in heart failure to be at two levels. Firstly, in the education and research infrastructure that I've helped to create, both locally and internationally. In the 1990s, I was involved in setting up the ESC’s first Task Force on Heart Failure, which later evolved into the Heart Failure Association (HFA). I was honoured to become its second chairman and helped to establish a time-limited service for board members that would help to create space at the top for new blood and ensure that the association evolved and remained dynamic. I also founded the HFA’s official journal, the European Journal of Heart Failure, and spent some time as its Editor-in-Chief. In 1999, I helped to found the British Society for Heart Failure, which is complementary to its European counterpart, with a focus on cooperative practical training. Another highly rewarding project was the first EuroHeart Failure survey [1], which, by detailing the characteristics, diagnosis and treatment of more than 11,000 patients enrolled over 6 weeks in 115 hospitals across Europe, greatly improved our understanding of the scope of the disease.
The second level relates to my involvement in heart failure management. I had a central role in the development of ACE inhibitors and beta-blockers as foundational therapies. I also led the CARE-HF trial [2], which helped to establish the benefits of cardiac resynchronisation therapy in patients with NYHA class III or IV heart failure and reduced LVEF, demonstrating an amazing 36% reduction in mortality on top of medical therapy (in addition to making patients feel better). For many years I have been a passionate advocate of telemonitoring, providing additional (potentially daily) support to patients integrated with conventional care. This field languished in the shadows for a long time until its true potential was realised somewhat dramatically by the COVID-19 pandemic.
One of the great frustrations of my career is that we have not yet established good diagnostic criteria for heart failure, which are essential for effective management. The very first ESC guideline, which I led in 1995, was on heart failure diagnosis. It made a good start, but there has been little progress in the subsequent 30 years. Two-thirds of people who probably have heart failure never get to see a cardiologist; most will either die before a diagnosis or be diagnosed late when management options are limited. Current clinical practice should not be perpetuated without question. New concepts create new technologies and new technologies create new ideas; they feed off each other. I look forward to a revolution in thinking, which will enable earlier diagnosis and improved management. We have the tools. We must now find the will and the way.”
“Do not be afraid to challenge received wisdom and accepted practice – question, question, question.”
