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EuroPRevent 2014
ACC 2014 Abstract submission opens
Cardiology Update 2015
Editor-in-Chief required
Heart Failure Congress 2014
Depression increases heart failure risk by 40%
40yr PTA Anniversary Symposium
Stent performance
Leadless pacemaker
ESC webinars coming soon
Decreasing CVD mortality slows down
Detecting AF after stroke
AHA valve disease guidelines

EUROPREVENT 2014, AMSTERDAM 8-10 MAY 2014

europrevent

EuroPRevent will bring together the finest international health experts to present their research and translate it into usable knowledge for practitioners, health care workers, researchers, and policy makers.

Three full days of scientific interaction on 'Global Cardiovascular Health' with some of the finest speakers in the field.

One session of EuroPRevent 2014 will review targets for the prevention of non-communicable diseases and the WHO's action plan for 2013-2020. Hosted by the Global Forum on CVD Prevention in clinical practice (a common platform for multiple organisations facilitated by the EACPR, a registered branch of the ESC), a session on 9 May (11.00-12.30) will offer an update report from Shanthi Mendis of the WHO, assess those prevention strategies which work for the rich and the poor, and focus on obesity as an emerging global challenge, particularly in children.

Another session will be presented by Dr Greg Thomas on the Horus study, which analysed by CT scanning 137 mummified bodies of ancient history. Contrary to what one might expect in people who died so young, atherosclerosis was apparent in these subjects. The implication, says Thomas, is that the basic diets of ancient history were not necessarily protective against CVD - and that we as humans are all susceptible. This session on 'Lessons from the Past' is a first for the congress, as normally no one associates mummies and prevention!

Prof Johan De Sutter, Congress Programme Chairperson, explains that other scientific sessions will highlight emerging themes in sports medicine, hypertension and exercise, and provide new evidence on established themes. Download the final programme here!

There is still time to register online.

ACC 2014 ABSTRACT SUBMISSIONS NOW OPEN

acc
The Acute Cardiovascular Care 2014 Congress will take place 18-20 October, Geneva Switzerland and is now accepting abstracts.

The 2014 theme is The Highly Vulnerable Patient focusing on:

• Education on a population and patient basis in order to ensure rapid emergency calls
• Well-organised and appropriately staffed pre-hospital care
• Modern communication tools e.g. transmission of the 12-lead ECG
• Early and accurate diagnosis pre-hospital and in the emergency department
• Clear patient pathways based on objective triage, diagnosis and risk assessment and continuous patient monitoring
• Rapid initiation of evidence-based treatment
• Objective criteria for treatment monitoring including transfer in-hospital and discharge.
• Networking with other health care professionals in order to secure the safe and secured transition to a chronic disease management programme

There will be more than 40 high quality scientific sessions, including a new Hotline Session and Workshops with the International Federation of Red Cross and Red Crescent Societies. Find out more here.

The congress will take place in Geneva, home to the European Headquarters of the United Nations, the World Health Organization, the International Federation of Red Cross and the Red Crescent Societies. Discover more about the host city such as their free Transportation Card.

Online submission is now open.

CARDIOLOGY UPDATE 2015 ANNOUNCED

CU

Cardiology Update belongs to the major cardiology meetings in Europe. Following a long tradition this will be the 21st Cardiology Update Course which is held every 2nd year in Davos, Switzerland. The course is a joint educational programme by the Foundation of Cardiovascular Research and the European Society of Cardiology. A distinguished international teaching faculty contributes to an outstanding programme on latest developments in clinical research as well as on new intervention and treatment strategies in cardiology.

The aim is to provide high quality continuing education on the latest scientific and therapeutic developments and a forum for an open dialogue with international opinion leaders in cardiology.

Programme directors are Prof. Thomas F. Lüscher, Zurich and Prof. Bertram Pitt, Ann Arbor, MI, USA.

Online Registration is now open!

Take advantage of the early registration fees.

For further information, online registration and programme visit: www.cardiologyupdate.ch

ESC SEEKS EDITOR-IN-CHIEF FOR NEW JOURNAL

Editor-in-Chief for the European Heart Journal: Clinical Outcomes & Quality of Care

The Board of the European Society of Cardiology seeks applications for the position of: European Heart Journal: Clinical Outcomes & Quality of Care (EHJ: COQC) Editor–in-Chief Official Start: 1 January 2015

The journal will be the newest member of the ESC family of journals.

The Editor-in-Chief should have a combination of biomedicine, biostatistics and epidemiology and/or health economics in their background. He or she should be a senior scientist or physician and preferably with extensive experience in publishing.

An Editor-in-Chief must have a strategic vision for the future of the journal and be comfortable working with an electronic-only manuscript handling system. They also must be open to the idea of administrative staff working remotely from a Virtual Editorial Office. The successful candidate should consider that peers undertaking editorial and review work do not have to be in the same institution, as collaborative solutions exist that allow teamwork on a worldwide scale.

The successful candidate can maintain their editorial functions from anywhere in the world thanks to the technology at their disposition. The role of Editor-in-Chief warrants applications from dynamic, energetic and highly motivated persons in the field of cardiology.

Deadline for receipt of applications: 18 May 2014.

A detailed brief explaining what the selection committee desires to see is available from the ESC Publications Department in electronic format.

Further details from Michael Alexander: malexander@escardio.org

HEART FAILURE CONGRESS 2014

HF

The latest scientific advances and emerging therapies will be showcased under the main theme of Fighting Heart Failure: from prevention to devices. New this year - the first World Congress on Acute Heart Failure will be taking place at the same time. A unique place where all healthcare professionals caring for patients suffering from acute heart failure can meet, exchange and learn about the latest advances and research.

Same destination, same venue, same registration fee! Don't wait, register now! Discounted rates are still available until 21 April.
Registration

What can one expect in Athens?
• hear about new techniques, drugs and devices currently in development that could dramatically change the outlook of patients with heart failure
• get updated on the late breaking trials - New this year: An extra late breaking trial session will be devoted exclusively to acute heart failure
• consult more than 1500 submitted abstracts
• attend the World Congress on Acute Heart Failure
• get a preview of emerging therapies and diagnostic techniques during the special session ‘What's news in Industry’
• discover the newly launched Heart Failure White Paper, endorsed by all National Cardiac Societies and providing contemporary data on the prevalence, survival rates and economic costs of heart failure across the globe and recommendations for improving outcomes.

View the full scientific programme

Over 70 countries will be represented at the event, which is set to attract more than 4 000 delegates including cardiologists, emergency room physicians, intensivists, internists, general physicians, basic scientists, epidemiologists and cardiac nurses.

To be part of the congress register Here.

SCIENTIFIC HIGHLIGHTS FROM EUROHEARTCARE 2014

Held 4-5 April in Stavanger, Norway.

Depression increases heart failure risk by 40%

Moderate to severe depression increases the risk of heart failure by 40%, a study of nearly 63,000 Norwegians has shown. The authors found a dose response relationship between depressive symptoms and the risk of developing heart failure.

This was one of the first large, prospective studies to investigate whether depression increases the risk of developing heart failure. Data were collected during the second wave of the Nord-Trøndelag Health Study (HUNT study) in Norway. Nearly 63,000 of the 97,000 citizens in Nord-Trøndelag county participated.

When the second wave of the HUNT study began in 1995, information was collected including body mass index, physical activity, smoking habits and blood pressure. Depression was assessed and ranked for severity using the Hospital Anxiety and Depression Scale. Every Norwegian citizen receives a unique 11 digit number at birth which is used at hospitals and the National Cause of Death Registry. The researchers used this number to track which patients were hospitalised with heart failure or died from heart failure during the 11 year study.

During the study period nearly 1,500 people developed heart failure. Compared to residents with no symptoms of depression, people with mild symptoms had a 5% increased risk of developing heart failure and those with moderate to severe symptoms had a 40% increased risk.

Gustad
First author Lise Tuset Gustad said: ‘Depression trigger stress hormones [that] induce inflammation and atherosclerosis, which may accelerate heart diseases. Another mechanism could also be because depressed people find it more difficult to follow advice about how to take medications and improve their lifestyle.’




Poor sleep doubles hospitalisations in heart failure patients

Poor sleep doubles hospitalisations in heart failure patients, according to research from Sweden. The Co-ordinating study evaluating Outcomes of Advising and Counselling in Heart failure (COACH) study included 499 patients hospitalised for heart failure. During the initial hospitalisation, information was collected on physical functioning, mental health and sleep. Sleep problems were assessed using the question “Was your sleep restless?” from the Centre for Epidemiologic Studies Depression Scale (CES-D). After 12 months the researchers recorded the number and cause of unplanned hospitalisations during the follow up period and assessed sleep again.

The researchers found that 215 patients (43%) had sleep problems at discharge from the initial hospitalisation and nearly one-third (30%) had continued sleep problems at 12 months. Patients with continued sleep problems were two times more likely to be hospitalised during the follow up period than those without any sleep problems. Risk was double for all-cause hospitalisations and for cardiovascular hospitalisations.

Of the 284 patients without sleep problems at initial discharge, 14% developed a sleep problem during the follow up period. There was a trend for these patients to have more cardiovascular hospitalisations than patients without sleep problems but the finding was not significant.

Poor sleep can increase inflammatory activity and levels of stress hormones, both of which accelerate heart failure progression. It is also related to psychological distress. Lead author Peter Johansson said: ‘All heart failure patients should be asked about sleep so that if there is a problem we can find out what it is and provide treatment.’

40 YEAR BALLOON ANGIOPLASTY ANNIVERSARY SYMPOSIUM

Gruntzig
It was in 1974 that Dr Andreas Grüntzig performed the first arterial balloon dilatation of a femoral artery at the University Hospital in Zurich. He had spent much time testing materials with his assistant Maria Schlumpf and the engineer Walter Schlumpf, until finding the appropriate material for the balloon. This was followed in 1977 by the first coronary artery dilatation performed intraoperatively.

During this Anniversary Symposium co-workers of Andreas Grüntzig will report on the exciting development of the method and its use in the first patients.

The short symposium takes place on Thursday 8 May 14.15 – 18.00 hrs. in the large auditorium at the University Hospital Zurich. The programme topics include:

-“How it all began”… Alfred Bollinger and Maria Schlumpf
-What does the surgeon say to balloons? Marko Turina
-Balloon angioplasty for renal arteries. Felix Mahler
-Interventional cardiology: What is on the horizon? Thomas F Lüscher
-Vascular surgery: away from the knife to the balloon. Mario Lachat

The day ends with a reception in the Dick and Davy foyer

1-YEAR SUPERIORITY OF STENT LOST AFTER 5 YEARS

Stent

Left: Cypher Select 3 stent courtesy Johnson & Johnson Medical NV/SA
Right: Zotarolimus-eluting Endeavour Sprint stent courtesy Medtronic





The superiority of sirolimus-eluting stents over zotarolimus-eluting stents at 1 year was lost after 5 years, according to a Danish study. The result was caused by a reduced risk of adverse events in the zotarolimus group between 1-5 years.

SORT OUT III was an open-label, registry based, randomised superiority trial at five percutaneous coronary intervention centres in Denmark. The researchers allocated 2,332 patients to the zotarolimus-eluting Endeavour Sprint stent from Medtronic or the sirolimus-eluting Cypher Select Plus stent from Cordis, Johnson & Johnson.

Higher rates of adverse clinical outcomes were found in the zotarolimus group at 1 year and in the sirolimus group between 1-5 years. For example, the zotarolimus group had higher rates of major adverse cardiac events than the sirolimus group at 1 year (odds ratio [OR] = 2.13) but lower rates during 1-5 years (OR=0.78). These opposite results were found for definite stent thrombosis, target vessel revascularisation and target lesion revascularisation.

At the 5-year follow up, clinical outcomes did not differ significantly between the 2 groups. Head to head comparisons of drug-eluting stents have traditionally assessed the primary endpoint after 9-12 months. The researchers concluded that this may be insufficient to capture long-term outcomes with drug eluting stents.

The study is published in The Lancet.

LEADLESS PACEMAKER SAFE AND EFFECTIVE IN FIRST HUMAN STUDY

The first study of a permanent, completely self-contained, leadless cardiac pacemaker in humans has shown feasibility and safety. The Nanostim device was successfully implanted in 97% of patients and the complication free rate was 94%.

LEADLESS was a prospective, nonrandomised, single-arm study in 33 patients who were followed up for 90 days. The study took place at two hospitals in Prague and one in Amsterdam.

The most common indication for cardiac pacing was permanent atrial fibrillation with atrioventricular block (67% of patients). Currently the pacemaker can only be used in patients with an indication for single-chamber ventricular pacing.

The new device is a self-modulating pacer guided into place using a catheter inserted in the femoral vein and is affixed to the heart in the right ventricle, the same place a standard lead would be located. At 6mm in diameter and about 42mm long, the device is smaller than a triple-A battery. During the study the procedure took an average of 28+17 minutes (range 11-74 minutes).

Leadless pacemaker
Nanostim Leadless Pacemaker

The authors concluded that the absence of a transvenous lead and subcutaneous pulse generator – which can lead to complications in conventional cardiac pacemakers - could represent a paradigm shift in cardiac pacing. The study was published in Circulation.

THE NEXT ESC WEBINARS

gillesudo
Leaders in their fields bring cardiologists the latest research - take part in online webinars wherever you are.

• 26 March: ESC webinar on Challenges in Stroke Prevention in Atrial Fibrillation with Felicita Andreotti and Joao Morais - Free registration

• 7 April: EHRA webinar on Sleep apnea and cardiovascular co-morbidities with John Camm, Anil Sinha and Pascal Defaye - Free registration

• 08 April: EACVI webinar on Deformation Imaging - Current Application in the Clinic and Future Developments with Jens Uwe Voigt and Iana Simova, organised by the EACVI Club 35

• 16 April: ESC Webinar on Challenges in antiplatelet therapy after ACS: the best alternatives for short and long term management? With Kurt Huber and Anthony Gershlick - Free registration

• 26 May: HFA webinar on Iron deficiency in heart failure - From evidence to practice with Stefan Anker and Piotr Ponikowski - Free registration

EU-FUNDED PROJECT SHEDS LIGHT ON CARDIOVASCULAR DISEASES

gillesudo
The EU-funded EuroHeart (European Heart Health Strategy) II Project came to an end last month after three years of research into current cardiovascular disease (CVD) trends and analysis of EU-wide CVD prevention policies.

The project in which the ESC was a partner reveals that:

• Europe is facing a levelling-out of previously decreasing mortality rates in certain population groups in several EU countries

• Combined with increases in other key CVD factors, this confirms the imperative for policymakers to act now in order to avoid that the decline in CVD mortality observed over many years is reversed.

• There is tremendous scope for reducing CVD at population level (key factors include dietary salt, saturated fat and tobacco).

• Adoption, implementation and evaluation of effective policies to impact change at population level remain patchy and variable.

DETECTING AF AFTER STROKE

Subcutaneous cardiac monitor detects AF after unexplained stroke

An insertable cardiac monitor worn for six months has been found to be up to seven times more likely to detect atrial fibrillation (AF) after unexplained stroke than briefer monitoring with traditional techniques.

The findings from the CRYSTAL-AF (CRYptogenic STroke And UnderLying Atrial Fibrillation) trial were presented as a late-breaking science report at the American Stroke Association’s International Stroke Conference 2014.

The study included 441 patients in 55 centres in the US, Canada and Europe who had an unexplained stroke. All had at least 24 hours of standard cardiac monitoring within 90 days of the stroke, and half were tracked with an insertable monitor (the Reveal® XT by Medtronic) which can provide data continuously for up to three years. The device is slipped under the skin of the chest via a small incision.

After six months, one year and three years, AF was found in 8.9%, 12.4% and 30% of patients with the monitor compared to 1.4%, 2% and 3% who had standard testing.

Study author Dr Richard A. Bernstein said: “Finding AF after a stroke changes therapy from the aspirin class of drugs, which are not very effective in AF, to anticoagulants.”

Since the conclusion of the study, a later and smaller device the Reveal LINQ™ has been released in the US and Europe.

device

LOWER INTERVENTION THRESHOLD FOR VALVULAR HEART DISEASE

The intervention threshold has been lowered in the new valvular heart disease (VHD) guidelines published by the American College of Cardiology (ACC) and the American Heart Association (AHA).

Since the AHA/ACC focused update in 2008, there is better knowledge about the natural history of untreated patients with severe VHD and outcomes from surgery have improved. The 2014 guidelines say that select patients with severe asymptomatic aortic stenosis and severe asymptomatic mitral regurgitation can be considered for intervention depending on certain factors such as the ability to achieve a durable valve repair in mitral regurgitation.

The guidelines provide a new classification of VHD and describe four progressive stages from ‘at risk’ to ‘symptomatic severe’. The definitions consider the degree of valve narrowing or leakage, the presence of symptoms, the response of the left and/or right ventricle to the valve lesion, and any change in heart rhythm. The system is intended to help clinicians determine the optimal timing of intervention.

The guidelines propose a more complex evaluation of interventional risk which combines procedure-specific impediments, major organ system compromise, comorbidities, patient frailty, and the Society of Thoracic Surgeons predicted risk of mortality model. Doctors should discuss the risk scores, risks and benefits with the patient to choose the best therapy.

For the first time the guidelines include recommendations on the timing and choice of new catheter based therapies including transcatheter aortic valve replacement (TAVR).

The 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease is available here.