CARDIOLOGY 10 YEARS PAST 10 YEARS FUTURE

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1 CARDIOLOGY 10 YEARS PAST 10 YEARS FUTURE Maarten L Simoons Thoraxcenter Erasmus MC Rotterdam President ESC

2 Cardiology, the next 10 years (?) Break through of genetics cardiomyopathy, ion channel disorders future: common diseases CAD, AF,. personalized medicine, pharmaco-genetics Continuing development of new drugs: anti-thrombotic (will replace coumadin) heart failure lipid management rhythm management future: some of you know better than I do

3 Cardiology Continuing development of better imaging modalities CT coronary angiography to detect / exclude CAD to select subjects who benefit from preventive R, replaces current risk stratification MRI coronary angiography Continuing development of new devices: stents, drug eluting stents, bio-degradable stents percutaneous valve implantation and valve repair pacemakers, CRT and ICD Heart failure monitoring devices home monitoring, e-monitoring, e-care

4 Cardiology practice Further sub-specialisation general cardiology, preventive cardiology, vascular medicine imaging specialists, Intensive cardiac care, (adult) congenital heart disease clinical electrophysiology, pacing, interventional cardiology (sub-sub: structural heart disease, congenital) Concentration of interventions and surgery Minimal requirements for volumes of procedures Quality Assurance

5 Cardiology practice Further sub-specialisation general cardiology, preventive cardiology, vascular medicine imaging specialists, Intensive cardiac care, (adult) congenital heart disease clinical electrophysiology, pacing, interventional cardiology (sub-sub: structural heart disease, congenital) Concentration of interventions and surgery Minimal requirements for volumes of procedures QA: ESC opportunity to develop the standards!

6 Cardiology practice Sub-specialisation, Concentration of procedures More nurse practicioners for specific patients / tasks More patients when more people get older and treatment gets better!!

7 Cardiology practice Sub-specialisation, Concentration of procedures More nurse practicioners for specific patients / tasks More patients when more people get older and treatment gets better!! Yet, pressure from governments to reduce costs Payors or hospital management may restrict the use of specific drugs or devices

8 1949 European Society of Cardiology created 1952 ESC congresses, every 4 years organized by National Societies 1976 Working Groups, WG meetings First annual congress 1993 European Heart House Sophia Antipolis 2001 Cardiovascular Round Table 2004 Associations Largest annual Cardio-Vascular congress in the world Well attended subspecialty (Association) congresses European Heart Journal, Cardiovascular Research 5 sub-specialty journals

9 ESC strong financial position (annual report 2010) Operating income 36,377,000 Surplus 4,985,000 Results by division Congress and meetings 9,532,000 Journals 2,350,000 Membership services 504,000 Management, finance, HR - 2,469,000 Technology, business service - 2,338,000 Board and committees - 1,089,000 Guidelines - 562,000

10 Strengths Structure NS, WG, Assoc Volunteers with vision Staff Congresses, meetings Journals Education products Relation with industry

11 Strengths Structure NS, WG, Assoc Volunteers with vision Staff Congresses, meetings Journals Education products Relation with industry Weaknesses Depending on industry congress particip. 60%

12 Strengths Structure NS, WG, Assoc Volunteers with vision Staff Congresses, meetings Journals Education products Relation with industry Threats Changes industry policy Less individual journal subscriptions Other societies (ACC) Weaknesses Depending on industry bringing participants 60%

13 Strengths Structure NS, WG, Assoc Volunteers with vision Staff Congresses, meetings Journals Education products Relation with industry Weaknesses Depending on industry bringing participants 60% Threaths Changes industry policy Less individual journal subscriptions Other societies (ACC) Opportunities CME requirements CME provider Practice info (surveys) E- publishing E- learning

14 Changes of industry policy - Prices for drugs / devices - government and insurance pressure - patents run out, generics - Development costs - regulators and self imposed rules - Compliance - Government and self-imposed rules - Public perception is not positive, in spite the fact that much improvement in healthcare has been driven by industrial developments - Other issues??

15 ESC congress Participants (currently 25,000) will decrease - Less industry support for physicians - internet access to main clinical results (Hot lines) More emphasis on sub-specialty congresses Need for medium size education meetings ESC UPDATE programmes Overview of new developments, practice oriented Davos, Rotterdam, Dubrovnic, Rome, other to come

16 However, CME programmes still too many lectures, Future: more interactive case discussions, e-learning less (or no) live case presentations CARDIOLOGY 10 yr past & future CARDIOLOGY AND VASCULAR MEDICINE ESC UPDATE programme, Rotterdam, may 310 participants from 28 countries: The Netherlands 163 Turkey 37, China 21, Egypt 17, South Korea 14 Lectures with long discussion periods European experts Interactive case presentations

17 LEVELS OF CME EXPERTISE COSTS SUPPORT Local hospital + local Regional + local National +++ national International international New models needed to finance ESC UPDATE s Limited number of participants, high quality, Guideline based (core-curriculum), interactive

18 CME Currently required 17 countries, not yet 13 countries To do: promote CME requirements in other countries promote standardization of CME requirements Core-curriculum & Guidelines are basis for CME To do: continuous updates, rapid web-updates avoid conflicts of interest of authors

19 Education: Set the European standards!! Continue development of European standards to qualify as a cardiologist, or CV nurse / technician Develop European examinations in Cardiology as well as sub-specialty examinations Echocardiography, Pacing and electrophysiology Other imaging: MRI, CT, nuclear cardiology Interventional cardiology, Intensive cardiac care Adult Congenital Heart disease General cardiology

20 Education: Develop new financial models 60% of CME paid by industry (UK 30%, F 60%) Individual CME budget for physicians The Netherlands academics 5000 per year Unrestricted (Industry) grants to Universities and professional organizations, or rather commercial CME companies? Insurance company or government financial support unlikely, due to budget constraints How will industry spend their CME funds??

21 EurObservational Research programme Continue and further develop data collection about clinical practice in Europe. USA data not relevant! Research Guidelines EurObs Education

22 EurObservational Research programme Continue and further develop data collection about clinical practice in Europe PATIENTS WITH CAD, Guidelines ACS/MI, ARRHYTHMIA S HEART FAILURE, CARDIOMYOPATHY CONGENITAL / VALVE DISEASE, PROCEDURES EurObs Research EUROPEAN DATA NEEDED Education

23 Cardiology industry relations Common interest in quality of patient care Common interest in improved diagnostics and therapy Common interest in education and training (CME) Greater emphasis on perceived conflicts of interest of clinical investigators, teachers, program organizers Transparency, no single sponsor CME programmes Need to develop new models for financing CME

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