SATURDAY 30 AUGUST B A R C E L O N A 2 0 1 4

Download the ‘Strongest scientific ‘ESC 2014’ Mobile App programme yet’ for TOTAL ATTENDANCE ESC Congress 2014 AMSTERDAM 2013 29 982 2014 28 923 ESC CONGRESS 2014 is set to deliver its strongest scientific programme yet with a record-breaking number of original Don’t Miss research presentations. These include: • 09:00 - 15:00 Brussels - Central Village General Cardiology for Physicians and General • 27 clinical Hot Line studies Practitioners • 12 basic science Hot Lines • 10:30 - 15:30 Helsinki (The Hub) - Central Village • 15 Clinical Trial Updates General Cardiology for Nurses and Allied Professionals • 11:00 Valetta (The Hub) - Central Village • 19 registry studies Registry Hot Line: Interventions, devices and outcomese • 4597 abstracts • 11:00 The Hub - Central Village Visit “The Hub” in Central village for Rapid Fire Abstract The ESC Congress has become the dominant scientific and Sessions & Clinical Cases Session educational forum in cardiology, according to Professor • 11:00 Poster Area - Central Village Keith Fox, chair of the Congress Programme Committee. Poster Session ‘It’s the place where the most innovative clinical and basic • 12:30 Moderated Poster Corner - Central Village science studies get presented,’ he says. ‘That our meeting Moderated ePoster Sessions & Discussant viewing is now the number one international event in cardiology is tour of the posters on display underlined by higher-than-ever numbers of submissions • 17:00 Barcelona - Central Village from non-European countries. We have more submissions Inaugural Session than ever before and we’ve also introduced higher cut-off grades for abstracts. It’s clear that the quality of the work EURObservational we’re attracting gets better and better.’ The new studies are supported by more than 400 Research Programme prearranged sessions of debates, symposia, clinical 11 registries in progress and 4 registries seminars and ‘how to’ and ‘meet the experts’ sessions. to be launched by the ESC in 2014: Taking greater prominence this year is the ‘hub’ concept www.escardio.org/EORP

of open-planned venues, with one central ‘Global Focus’ ©Arduino Vannucchi hub, and four smaller hubs. ‘The theme of the hub is Chair of the Congress Programme Committee Professor Keith Fox: ‘It’s clear Come & see us on the ESC stand! engagement,’ says Fox. ‘We’ve found that the circular that the quality of work we’re attracting gets better and better.’ format really helps promote accessibility.’ The Global Focus sessions of this year’s to nine separate villages, each of which is settings differ we face similar challenges congress make maximum use of both clearly colour coded. This year, however, and can learn much from each other.’ the central hub and interaction through basic scientists will come together in their Building on the popular ‘Cardiologists smart phone technology. The interactive own village, and not be embedded in of Tomorrow’ track for cardiologists in Visit the stand at the sessions, which have been designed different villages. training is a new ‘Scientist of Tomorrow’ registration area - C100 to appeal to a broad audience, include The Congress’s international scope track, which will be held in Basic Science EHC fundraising lottery TAVI, cardiac transplantation, complex is reflected in joint sessions with 32 Village 2 and includes sessions on grant €15/ticket - Draw on Monday 1st September PCI, exercise, and treatment of resistant associations and cardiology societies, applications, manuscript submission and hypertension. Other interactive sessions six journals and with the European career planning. ESC eLearning platform likely to benefit from the hub structure Commission and Organisation for A ‘Highlight’ session on Wednesday Lifelong learning in Cardiology include the presentation of Rapid Fire Economic Co-operation and Development will review the Congress, while from abstracts, in which presenters field (OECD). ‘We are a multinational congress Thursday 4 September delegates can log New! Courses in questions from the audience. wishing to engage all countries in the on to the ‘Best of ESC Congress 2014’ Once again the Congress is built upon fight against cardiovascular disease,’ says (broadcast 20:00 CET) in which experts General Cardiology a village system, with themes allocated Fox. ‘The reality is that although clinical will air their views of the last few days. Ask for a demo on ESC stand! learn.escardio.org The spotlight of ESC Congress 2014 is ‘Innovation and the Heart’, a theme which reflects progress in scientific discovery, clinical practice and technology

‘It’s a theme which cuts right across the board - from blue cardiovascular disease. sky science to innovations in clinical trials and guidelines,’ This year 31 sessions in the prearranged programme and says Keith Fox. ‘But it’s not just about discovery, we’re also 479 abstracts have been submitted under the spotlight theme. completing the circle to include innovations in delivery of care One is a special session in the Cardiologist of Tomorrow track and implementation.’ - ‘The Master Prophecies’ - in which experts including Kenneth The spotlight recognises that cardiology is evolving rapidly and Dickstein, David Wood, Patrick Serruys and Luigi Badano offer encourages clinicians to keep up-to-date in their own specialties their personal predictions of the innovations likely to change the and with what is happening across the whole spectrum of future of cardiology.

www.escardio.org #ESCcongress 2

By Professor Lina Badimon, Cardiovascular Research Center, Hospital de la Santa Creu, Barcelona

WELCOME TO OUR EFFERVESCENT and beautiful a hub for international business, biomedical and medical renowned concert houses such as the Auditori, Palau de city in which we are meeting once again. sciences, and biotechnology. la Musica and Opera Theater with programmed The city has a privileged location and many performances throughout the year. I don’t have to introduce Barcelona to many of you who civilisations have set foot in Barcelona. Indeed, the useful But first things first. So please attend the scientific know the city as well as I do, but for those who have been Barcelona Turisme website (http://barcelonaturisme. sessions. However, with such a pleasant climate you can here just few times or are coming for the first time, let com) asks visitors: How many Barcelonas do you want enjoy the city both by day and by night. And walking, me tell you that this is your perfect opportunity to mix to find? They propose a Roman Barcelona, a medieval you will find, is the best way to get to know the city itself science with a visit to this remarkable city. Barcelona, modernist Barcelona, contemporary and its history. Barcelona is an open and dynamic Mediterranean Barcelona, Gaudi’s Barcelona, Picasso’s Barcelona, Now, the diversity and quality of the Catalan cuisine. city with a unique climate and a friendly thriving Miró’s Barcelona, the parks of Barcelona, and Barcelona From high scale restaurants to tapas bars you will find environment. Barcelona is also the only city in the world design. You can take the Bus Turistic for a quick glimpse exceptionally good food. A total of 27 Michelin stars to have nine sites designated as UNESCO World Heritage of what this wonderful city has to offer. have been awarded to Barcelona restaurants, but a (and you should visit some of them): Sagrada Familia, I would also add to the list the Barcelona of museums, healthy Mediterranean diet can be found on almost every Casa Batlló, La Pedrera, Palau de la Música Catalana, with the National Art Museum of (MNAC, street corner. International food can be found on the other Hospital de la Santa Creu i Sant Pau, Park Guell, Palau with its unique collection of Romanesque art), the corner! Shopping in Barcelona is also a delight, with Guell, Casa Vicens and Cripta Colonia Guell. Barcelona Museum of Contemporary Art, CaixaForum, good shops and high quality goods all at a reasonable Barcelona, a city of grand design, large promenades and Picasso Museum, Joan Miro Foundation and Antoni price. Just visit the Paseo de Gracia! blue sea, has been a melting pot of cultures throughout its Tapies Foundation. • Today at 15:30 the Tour de Coeur arrives at the 2000-year history, and witness to many transformations And the Barcelona of music. All types can be enjoyed, congress centre in Barcelona with a group of Swiss and revolutions. And in recent years the city has become from classical to contemporary, from jazz in pubs to cardiologists arriving by bike from Geneva.

Public awareness of SCD a priority for local society AS PRESIDENT of the Spanish arrests per year and fewer than 15.4 and Germany 8.5. Less than to everyone. There will be tents, Society of Cardiology it is a 5% survive. Treatment in the 10% of the Spanish population is crowds and activities - with great pleasure and honour to host the first minutes after an arrest trained in CPR. This is much too media visibility - in one of the 2014 ESC Congress in makes the difference between low for our country. most popular plazas of the city. and be part of such an incredible life and death. Immediate CPR During the Congress the ESC There will be information on scientific exchange. or the use of an AED can restore and Spanish Society of Cardiology all these activities during the Barcelona will be the centre a regular heartbeat and save will join forces in an ambitious congress - at the ESC plaza stand of attention during these five lives. In Europe and especially awareness and educational C230. We encourage you to join intense days and our task as in Spain we must increase the programme on CPR called these events and help us make the local scientific society is to number of AEDs and educate our ‘Barcelona Cardioprotected City’. Barcelona a ‘Cardioprotected draw attention to sudden cardiac populations in immediate CPR The network of pharmacies in City’. death. In Spain alone there are treatment. Spain has 1.7 AEDs Barcelona will be acting together José Ramón González Juanatey more than 40,000 sudden cardiac per 10,000 inhabitants, France to give information and training Spanish Society of Cardiology

www.escardio.org #ESCcongress 3 ESC introduces five new practice guidelines, with a range of tools for everyday application By Pepe Zamorano, provide the most comprehensive recommendations ever for Head of Cardiology, University the diagnosis and treatment of PE. Clinicians can confidently Discover and download Hospital Ramon y Cajal, Madrid stratify risk in their patients with suspected PE and provide the ‘ESC Pocket Guidelines’ App appropriate treatment. Available in the Apple and Android stores THIS YEAR’S ESC CONGRESS will see the launch of five new ESC ● The 2001 version of the guidelines on Aortic Diseases guidelines: Non-Cardiac Surgery, were restricted to the diagnosis and management of aortic Acute Pulmonary Embolism, dissection. Now, the 2014 guidelines also cover aneurysms, Hypertrophic Cardiomyopathy, Aortic Diseases and calcifications, congenital diseases leading to aneurysms, Myocardial Revascularization. The first was developed aortic inflammation (aortitis) and aortic tumours. The 2001 jointly with the European Society of Anaesthesiology and document focused on diseases in the thoracic aorta, but the the last with the European Society of Thoracic Surgery. latest version also includes diseases in the abdominal aorta. The guidelines were developed by expert Task Forces The Task Force developed a flow chart for acute aortic under the governance of the ESC’s Committee for Practice syndrome, which will lead to earlier diagnosis and rapid Guidelines. All in all, more than 100 experts are involved in treatment with improved patient outcomes. the development of each one. ● Our joint ESC/EACTS Guidelines on Myocardial As ever, these latest guidelines summarise all the available ● This year’s ESC/ESA Guidelines on Non-Cardiac Revascularization have based their 2014 recommendations information and will provide an invaluable resource. Their Surgery, chaired by Steen Dalby Kristensen and Juhani on a systematic review of 100 trials in 93,553 patients. derivative products, such as the free ESC Pocket Guidelines Knuuti, cover surgical risk assessment, preoperative The key findings were that, among patients with stable application, also provide a range of interactive tools to help evaluation and optimal perioperative management and CAD, coronary artery bypass grafting reduces the risk of apply the guidelines in daily practice. The Essential Messages also address cardiological and anaesthesiological issues death, myocardial infarction and repeat revascularization and Summary Cards summarise the main points and make in patients with specific cardiac diseases and common co- when compared with medical treatment. Notably, all them available to students, teachers and non-cardiologists. morbidities. The use of perioperative beta-blocker treatment stent-based coronary revascularization technologies You can find out more in the Guidelines area on the ESC is complex and has received much attention. were found to reduce the risk of repeat revascularization, stand, where, if you have not yet downloaded the ESC Pocket whereas new generation drug-eluting stents - but no other Guidelines app, you can be shown how to do so. Here you ● The Hypertrophic Cardiomyopathies Task Force led percutaneous revascularization technology - improved can also pick-up this year’s newly printed Pocket Guidelines by Perry Elliot will spark considerable interest with advice survival when compared with medical treatment. - free for ESC members while stocks last. Other derivative based on real estimates of risk rather than relative risks products (Summary Cards and Essential Messages) will also as in all previous guidelines. One of the most important be distributed free to all those visiting and we will answer innovations in the guideline is a new risk calculator which any questions you may have on our world renowned ESC uses simple clinical measures to estimate the five-year risk Clinical Practice Guidelines. of sudden cardiac death in such patients. ● Stavros Konstantinides and Adam Torbicki’s team 31 August, 11:00-12:30, Central Village have written the first recommendations on new oral 2014 ESC Guidelines overview anticoagulants in Pulmonary Embolism. These guidelines

Invitation Satellite Symposium Cardioversion in Europe – New Trends and Treatments Aug 30, 2014 • 15:30 – 16:30 hrs Astana – Village 7, Fira Gran Via, Barcelona

Chairmen: Lluis Mont, Barcelona, Spain Jean-Yves LeHeuzey, Paris, France

15:35 RHYTHM-AF – What is current practise of cardioversion in Europe? Harry Crijns, Maastricht, Netherlands

15:50 What changed in the latest ESC Guidelines for AF, and why? Hein Heidbuchel, Leuven, Belgium

16:05 Real-life experience with vernakalant Juha Hartikainen, Kuopio, Finland

Satellite Symposium Supported by a Grant from Cardiome International AG

www.escardio.org #ESCcongress 4 The paradox of successful CVD treatment Veronique Roger to deliver tomorrow’s Geoffrey Rose lecture THERE IS SOMETHING paradoxal in the title of with a wider range of symptoms.’ tomorrow’s Geoffrey Rose Lecture on Population Sciences. The other ‘challenge’ which this changing pattern of heart For the theme recognises the ‘clinical success’ of treatment, disease is likely to raise is the everyday relevance of practice but recognises too that this success is not without its guidelines. ‘Guidelines are disease-specific,’ explains problems and challenges. Roger, ‘but we’re now seeing patients with a complexity of ‘We have been successfully treating and preventing concomitant diseases, which makes it difficult to implement cardiovascular disease for the past 25 years,’ says Veronique the guidelines. What’s good for a single organ may not be Roger, this year’s lecturer, ‘and that means we care for good for the whole person.’ different patients today. We are now dealing with survivors The approach, she proposes, is to manage the heart who are living with cardiovascular disease - and having Veronique Roger: ‘I patient more holistically and to recognise that the success to treat them in an increasingly prominent context of co- know that I’m not of treatment might not simply be in ‘fixing the heart’. ‘We morbidity and ageing.’ seeing the kind of really need to look at the whole patient,’ says Roger. But it The perspective for Roger’s lecture is the trends over heart patients I was 25 takes the long-term view of epidemiology - the pattern of time observed in populations, an angle of epidemiology years ago.’ trends over time - to confirm what anecdotally is seen in the close to that of Geoffrey Rose himself, who too believed changing face of cardiovascular disease - tobacco control, clinic. ‘I know that I’m not seeing the kind of heart patients I that the determinants of disease lie not with the treatment better diets, a greater uptake of exercise. was 25 years ago,’ says Roger. of acute conditions but with the wider environments which And one of the ‘challenges’ of this success, says Roger, The long-term surveillance of epidemiology provides the encourage their development. is simply to recognise that CVD has a different complexion confirmation of what the eye sees individually, and shows And just as those environments change over time, so from that of 25 years ago. ‘Our patients are older,’ she beyond all doubt that the face of cardiovascular disease is too has the typical coronary patient also evolved. Hence explains, ‘and it’s not possible to treat them effectively indeed changing. Surveillance highlights the success (better the challenge which comes with success in cardiovascular without some recognition of their co-morbidities and treatments, better survival) and the clinical changes (fewer disease. ‘Twenty-five years ago in Rochester my typical psychosocial demands - even end-of-life considerations STEMIs, greater preserved ejection fractions), but that too heart attack patient was a 50-year-old man who smoked,’ when appropriate.’ brings its challenges, which everyday practice is also obliged says Roger, recalling her near 30-year illustrious career Roger singles out heart failure as the ‘really interesting’ to recognise. at the Mayo Clinic in Minnesota. ‘Now,’ she reflects, ‘my example of this, a disease now considered the most prevalent • Veronique Roger is Professor of Internal Medicine typical patient is a 76-year-old woman who’s had a smaller cardiovascular disease. But the ‘epidemic’ of heart failure, and Professor of Epidemiology at the Mayo Clinic. She MI and is also presenting with osteoarthritis, chronic kidney she argues, is not of the disease per se but of hospitalisations is a cardiologist and epidemiologist with interests in the disease and diabetes.’ because of it. Thus, the ‘epidemic’ of heart failure is not occurrence and outcomes of cardiovascular diseases. Her The change, Roger admits, is not just a matter of social - driven by any rise in incidence (that remains ‘stable’, she research has been continuously funded by the National or lifestyle - change, but a result too of better treatment, not says) but by an improvement in survival from heart failure Institutes of Health since 1996. least the timely application of primary PCI and a whole range and other cardiovascular diseases. ‘In fact,’ she adds, ‘the of effective medical therapies, notably the statins. But there incidence of true heart failure might even be going down, 31 August, 11:50-12:30, Skopje (The Hub) - Central Village also have been population trends which equally explain this and what we’re seeing today is a more complex case-mix, ESC Geoffrey Rose Lecture on Population Sciences European Heart Journal makes further impact factor progress, as top three titles pull ahead

RELEASE OF THIS YEAR’S Journal wealth of news, opinion, invited review, Citation Reports was delayed by more than a guidelines and correspondence. month but, for the European Heart Journal, Participants in Barcelona will also have the delay was well worth the patience. For yet the opportunity to share in the EHJ’s best again, the EHJ increased its impact factor in cardiology with two Special Sessions - to a new record of 14.723, from 8.9 in 2008, on the year in ‘prevention to intervention’, keeping its profile in the Cardiology category introduced by Lüscher and summarised by at an all-time high. his US deputy editor Bernard Gersh, and on There is still much debate in academic the year in heart failure and valvular disease, circles on the value of impact factors in introduced and summarised by deputy the sole assessment of quality in scientific editor Frank Ruschitzka. And just for good journals, but few would disagree that the measure Lüscher himself will co-chair a EHJ’s leap last year was, in the words Special Session on Tuesday on ‘the editor’s of its editor-in-chief Thomas F Lüscher, EHJ editorial meeting, with editor-in-chief Thomas F Lüscher pictured far left criteria for good scientific papers’. and deputy editor Frank Ruschitzka third from right. ‘spectacular’. Having broken through into the exalted realm of double-digit impact factors With more than 3700 original manuscripts especially important in citations for the 31 August, 10:10-10:50 in 2011, last year’s score, based on article submitted each year and a rejection rate of new impact factor. This year will also see Brussels - Central Village citations for 2012, shot ahead to 14.097, a around 90%, Lüscher is confident that the several simultaneous publications of Hot The European Heart Journal’s Year move of almost five points on the previous EHJ’s editorial policy of transferring well Line studies from this year’s congress. But in Cardiology: from prevention to year. regarded papers to these more specialist above all, of course, lies the intrinsic quality intervention Such a move was unprecedented, says sister journals is helping raise their quality of the original manuscripts accepted for Lüscher, but he is once again happy to see the and profile - and protecting the ESC family publication. ‘A higher impact factor attracts 1 September, 10:10-10:50 EHJ making yet further progress in impact of journals from other titles. the better papers,’ says Lüscher, ‘and now Brussels - Central Village factor, although this time of a more modest Lüscher attributes the huge success of we’re able to take only the best.’ Papers on The European Heart Journal’s Year in scale. the EHJ to several factors but especially to TAVI, valvular heart disease and preventive Cardiology: heart failure and valvular ‘The top three journals in cardiology are the journal’s ever broadening international cardiology have all been well cited. heart disease now all very close to each other in terms of scope. ‘We’re now a truly global journal,’ With weekly publication introduced at the impact factor,’ Lüscher told ESC Congress he says, ‘with a fully international structure start of last year, the EHJ has now joined a Impact factors in Cardiology 2013 News, ‘and we’re beginning to pull clear of of deputy and associate editors and editorial select list of high-ranking journals, which the rest. There’s a pattern now forming.’ board. This has made a big difference to our includes JACC and Circulation, but this, Journal title Impact factor Nor was the EHJ the only impact factor appeal.’ admits Lüscher, has surprisingly had no J Am Coll Cardiol 15.343 move for the ESC journals - EHJ Supplements He also notes editorial innovations in the detrimental effect on impact factor. The Circulation 14.948 jumped from 5.065 to 5.640, the European commissioning of more commentaries and increased frequency prompted a slight Eur Heart J 14.723 Heart Journal Cardiovascular Imaging from opinions, and the introduction of fast track reduction in the size of each issue, which Circ Res 11.089 2.394 to 3.669, and Europace from 2.765 to publication (with a time to first decision has now settled into a weekly rhythm of four 3.050. of one week), which, he says, have been original papers per issue and an additional Nat Rev Cardiol 10.154

www.escardio.org #ESCcongress 5 Update on peripartum cardiomyopathy Call for nomination of PPCM subjects for entry to ESC registry PERIPARTUM cardiomyopathy (PPCM), PIGF and low relaxin levels) in women more information about bromocriptine a potentially life-threatening condition with PPCM but not in healthy controls, from the ESC’s EURObservational affecting previously healthy women which, she says, might lead to a bedside Research Programme registry on PPCM. in the last months of pregnancy and test similar to BNP in heart failure. In addition to data on therapeutic postpartum, represents a major challenge It is now thought that multiple factors management, the registry, launched in for cardiologists and is the subject of a induce PPCM when they merge in common May 2012, is collecting information on Clinical Seminar this morning. downstream mechanisms to enhance disease presentation, co-morbidities, and ‘There are still many unanswered oxidative stress and cause cleavage of diagnostic management of patients and questions in PPCM including what triggers the pregnancy hormone prolactin into a their offspring. the pathological process, best treatments prolactin fragment causing endothelial ‘We’ve now enrolled 220 patients and even how many women are affected damage and myocardial dysfunction. from 93 participating centres across 42 in different countries,’ says Karen Sliwa, Such observations around prolactin countries, but our ultimate goal is to enrol the session’s first speaker. ‘We’re hoping led to suggestions that bromocriptine 1000 women,’ says Sliwa. ‘We’d like to to raise awareness of this devastating (an inhibitor of prolactin) might offer an invite clinicians with PPCM patients and condition and encourage colleagues to sign effective treatment. Indeed, when Sliwa access to echocardiography to enter them patients up to our registry.’ randomised 20 women with PPCM in a into the registry. By joining us they really Sliwa, from the University of Cape single-centre proof-of-concept study to can contribute to our understanding of Town, has done much to champion the bromocriptine plus usual care or usual care PPCM, and have opportunities for studies cause of PPCM. In 2009, after becoming Karen Sliwa: ‘We’re hoping to raise awareness of this alone she found the bromocriptine subjects in their part of the world.’ aware of large numbers of PPCM patients devastating condition and encourage colleagues to showed significantly higher rates of LV sign patients up to our registry.’ in her clinic but finding little published recovery. 30 August, 11:00-12:30 data, she wrote to the Heart Failure Now, in the absence of a large Beirut - Village 6 Update in peripartum cardiomyopathy Association of the ESC suggesting they As the working group explored further, randomised trial, Sliwa hopes to gather set up a systematic working group. The it was clear that the incidence of PPCM result was the Study Group on Peripartum varies throughout the world, with one in Cardiomyopathy, one of whose first 2200-3000 women affected in the US, Registry on activities was a paper summarising the one in 1000 in South Africa and one in current state of knowledge and revising the 300 in Haiti. But no data are available for Peripartum Cardiomyopathy definition. Europe, a reflection of our current lack of ‘For diagnosis the previous cut-off was knowledge. • To raise awareness of this uncommon but devastating problem strictly five months post-delivery, but we One difficulty is that presentation ranges • To better understand the condition found some women were being missed from acute heart failure to more subtle • To improve management strategies because they presented later,’ says Sliwa. symptoms. ‘It’s all too easy to miss it,’ ‘We now say in the months following says Sliwa, ‘because normal pregnancies delivery.’ are associated with non-specific fatigue, Although patients with PPCM have dyspnoea, peripheral oedema and higher rates of spontaneous LV function abdominal discomfort.’ recovery than those with other forms Echocardiograms can be valuable for of non-ischaemic cardiomyopathy, diagnosis, revealing enlargement of all normalisation of LV function at six months chambers with marked reduction in left occurs only in one-third of patients. ‘The ventricular systolic function. ‘But not all Join a worldwide network harsh reality is that, in addition to 15% of women, especially those in Africa, have Contact: [email protected] women with PPCM dying from acute heart access to such technology,’ says Sliwa. At failure, two-thirds of these young mothers this year’s Heart Failure Congress in May EURObservational Research Programme are left with damaged hearts that reduce she identified a characteristic fingerprint life expectancy,’ says Sliwa. (ratio of the placental growth factors sFlt/ ESC ‘nearer the heart of European politics’ with new Brussels bureau THE ESC OPENED its Brussels bureau of the ESC constituency, monitoring and The European Heart medicine for those aspiring to academic in February 2013 to be nearer the heart of exchanging information, and developing Health Institute degrees. The courses aim to fill current European politics. Known as the European positions on EU legislation which affect The European Hearth Health Institute gaps in the further development of care for Heart Agency, the bureau now houses cardiovascular health. covers clinical trials, personalised cardiovascular patients in Europe. The first European Affairs, the European Heart The Committee’s four main areas of work medicine, novel technologies, quality postgraduate course in heart failure began Health Institute and the European Heart are prevention, research, regulatory affairs assessment, health economics and health in January this year in collaboration with Academy. ‘Experience shows that science and registries. The European Heart Agency care management, and is compiling an Zürich University. is not enough’, said ESC President Panos also provides the secretariat for the MEP ESC Atlas of Cardiology, which will form The European Heart Academy can now Vardas at the time. ‘All the evidence shows Heart Group and is a founding member of a unique database on healthcare systems, also announce the first Master of Science that we need to exercise more, eat less, two pan-European alliances, the Alliance provision and services in cardiovascular in Health Economics, Outcomes and reduce alcohol consumption, and stop for Biomedical Research in Europe (BioMed medicine. The Heart Policy Unit of the Management in Cardiovascular Sciences smoking. Unfortunately, this knowledge has Alliance) and the European Chronic Institute is collecting the data from a few in collaboration with the London School had little impact on the rates of CVD-related Diseases Alliance (ECDA). The ESC is pilot national societies, which will then be of Economics. The course will prepare morbidity and mortality.’ Policies, he urged, also the project leader of CardioScape, an expanded to all 56 of the ESC’s National students in advisory, management need to focus on primary prevention. ‘Fifty EU-funded project which outlines current Cardiac Societies. This up-to-date and leadership roles in cardiovascular per cent of CVD deaths could be prevented cardiovascular disease research and reference will provide a unique collection medicine. The first students will start in with proper policies,’ he said. innovation landscape across Europe. of data on comparative best practices and October 2015, with applications open from trends in cardiovascular medicine. The October 2014. European Affairs Institute also supports the health economic Other new courses are expected to be The ESC European Affairs Committee activities of ESC affairs, registries, clinical introduced soon. works with EU and national policymakers, trials and technologies. European advocacy groups and medical The stand of the European Heart Agency associations to encourage a policy The European Heart Academy is located at ESC Plaza C108, where environment favourable to cardiovascular Cooperating closely with selected additional information can be found. health. Its specific actions include access universities in Europe, the Academy offers to policy making, coordinating the actions specialised courses in cardiovascular

www.escardio.org #ESCcongress 6 Debate: Are beta-blockers ‘first choice in the routine treatment of hypertension’? Still a ‘hot topic’, according to Debate Session tomorrow

says Bryan Williams No, Chair of Medicine, University College, London

THERE ARE FEW things more emotive they are better than nothing at all and are ‘We now have better drugs to cardiologists than questioning the use still preferred in people with hypertension of beta-blockers, which have been their complicated by symptomatic angina or than beta-blockers.’ ‘comfort blanket’ for many years. They chronic heart failure or post-MI, but in were one of the first effective medicines these settings they are prescribed for in cardiology and have generated much other reasons, not as a preferred primary and I doubt we will ever get it, the vast loyalty. However, the simple fact is, that treatment for hypertension. majority of patients with hypertension when it comes to treating hypertension, we There will of course be the usual chorus should not receive a beta-blocker as their now have better drugs than beta-blockers. that all of the data is with atenolol and preferred initial therapy. Simply, because When, as one of the clinical advisors to this is not the best beta-blocker because we now have better drugs to prevent stroke the NICE (UK) guidelines in the UK in it is shorter acting . . . et cetera. The and death in people with hypertension, 2006, we recommended that beta-blockers problem is that there is no outcome data whilst at the same time these drugs are should no longer be used as a preferred of any note with any other beta-blocker at least as effective at preventing heart initial therapy for the routine treatment for the treatment of hypertension. If the disease and less likely to cause diabetes. of hypertension, there was predictable other beta-blockers are better than atenolol It is not about beliefs, it is all about the uproar - because cardiologists ‘knew’ and as good as, or better than, the other evidence and the evidence condemns beta- that beta-blockers protected the heart and drugs we have for treating hypertension, blockers to another age for the treatment of cardiologists ‘believed’ that beta-blockers then we need that proof. Until we have it, hypertension – medicine has moved on. were a good choice for hypertension. Alas, ‘beliefs’ are a religious experience, but good medicine is founded on solid science. There is no doubt beta-blockers are a says Henry Krum highly effective treatment at reducing YES, Monash University, Melbourne, Australia mortality in heart failure and symptoms in angina, but the available evidence does not support their preferred use for THIS IS AN interesting question, but and relatively lower pulse pressure hypertension. perhaps framed in the wrong way. than older hypertensives. Much of Numerous large-scale analyses have The real question is: do beta-blockers this is disproportionately driven by consistently found that beta-blockers when still have a key role in the treatment of sympathetic activation in the young. So it used for the treatment of hypertension patients with systemic hypertension? not surprising that meta-analysis of beta- were less effective at preventing stroke, A cottage industry has sprung up in blockers according to age demonstrate less effective at preventing death and no the last few years criticising this class of beneficial trends favouring beta-blockers more effective at preventing the onset drugs in the uncomplicated hypertension against other classes in younger patients, of angina or heart failure than other setting. This is a little unfair. When used which is not evident in studies of older drugs such as diuretics, calcium channel appropriately - that is, given at the correct patients. blockers or RAS blockers. Thus, there dose and dosing interval to appropriate As alluded to, newer beta-blockers is absolutely no evidence that they are patients - these agents demonstrably overcome many of the deficiencies of the more cardioprotective than other classes provide substantial clinical benefit. older types. So-called ‘third generation’ of commonly used antihypertensives - It is clear that the benefits of anti- agents such as nebivolol and carvedilol and they are about 50% less effective at hypertensive therapy relate far more ‘They provide substantial lower (rather than raise) central aortic preventing stroke than these other drugs. to the magnitude of blood pressure pressures, are true once-daily drugs, Furthermore, beta-blockers are more reduction achieved rather than the drug clinical benefit.’ and exert beneficial (rather than adverse) likely to promote weight gain and worsen class which achieves it. This has been metabolic effects. glucose tolerance and increase the risk shown in numerous meta-analyses on a 2.7/1.9 mmHg difference between the Finally, there is a group of patients with of developing diabetes, especially when stroke, coronary heart disease and major beta-blocker-based and the amlodipine- hypertension plus additional disorders in combined with diuretics. CV events. In this regard, old-fashioned based regimen, and unsurprisingly more which beta-blockers are clearly of benefit Finally, because of their less effective blood pressure-lowering agents such as events with beta-blockers. In contrast, - conditions such as tachyarrhythmia, stroke prevention, beta-blockers were atenolol, given once daily, are not terribly when non-atenolol beta-blockers are coronary artery disease, chronic heart the least cost-effective treatment for effective anti-hypertensives. So it’s no meta-analysed, they perform as well as if failure and perhaps other disorders of hypertension when formally analysed by surprise that large-scale stand-alone not better than comparator drug classes. sympathetic overactivity yet to be fully NICE in both 2006 and 2011. Put simply, studies and meta-analyses involving The next question is the age of the delineated. antihypertensive therapy has moved on and once daily atenolol versus comparators patient receiving therapy. Younger Thus, based on these arguments, we left beta-blockers behind as yesterday’s have produced sub-optimal results. For hypertensives manifest greater cardiac should not yet be throwing the baby out therapy. example, in the ASCOT study there was output, a more hyperdynamic circulation with the bathwater! Of course, if there is nothing else, then

31 August 16:30-18:00 - Dublin, Village 3 - Treatment of Hypertension - Debate session

• Barcelona Princess • Majestic Thank you • Diagonal Zero • NH Constanza • Expo Barcelona • Porta Fira to our hotel • HC Barcelona Plaza • Princesa Sofia partners • Hesperia Tower • Pullman Barcelona Skipper

www.escardio.org #ESCcongress 7

Today’s special session for GPs will NEW review recent research highlights THIS YEAR’S ESC Congress has three special sessions for nurses (and allied professionals) and general practitioners, all taking place today: a Special Session on heart failure; a Clinical Seminar on atrial fibrillation, and a Clinical Seminar on the implementation of guidelines. In addition, one of the best attended sessions of ESC Congresses is the Take Home Messages for Practitioners, which today takes place at 13:30. In Amsterdam last year more than 2000 filled the congress hall for that session. The co-chairman of this year’s session, Gonzalo Baron Esquivias from Seville, previews the likely highlights.

This year’s five highlights will begin stopped early because of a statistically intraventricular conduction defects, left with updates on hypertension and significant improvement in primary ventricular hypertrophy and permanent peripheral artery diseases, with Denis composite endpoint. Full results will be ventricular pacing were independent Clement from Ghent, Belgium, asking presented in a Hot Line session tomorrow. predictors of one-year mortality. if ‘the dream’ of renal denervation is The TOPCAT study found that the New data on the use of new oral over, are we achieving targets in arterial addition of spironolactone to existing anticoagulants in non-valvular atrial hypertension, and is venous disease still treatments did not significantly reduce fibrillation have been published: the underestimated and still untreated. the composite primary outcome in ENGAGE AF-TIMI study showed that Victoria Delgado, from Leiden, patients with HF and preserved ejection edoxaban was non-inferior to warfarin, Netherlands, will review developments fraction. However, a post-hoc analysis while new data from the ARISTOTLE in cardiovascular imaging, with updates of the study has later revealed marked (apixaban) and ROCKET (rivaroxaban) on the early detection of LV dysfunction, regional variations, with spironolactone trials are expected. advances in risk stratification, the benefitting patients from the Americas Two studies compared the results of selection of candidates for device but not in other regions. These results ablation versus antiarrhythmic drugs in The latest therapies, and the future of imaging illustrate the relevance of an adequate different clinical scenarios of AF: the techniques with pocket-size devices and patient selection in HFpEF trials, SARA study and Zhang et al found that member of the novel insights. in which shortness of breath can be ablation was superior to drug therapy in Sigmund Silver from Munich will incorrectly labeled as heart failure. maintaining sinus rhythm at follow-up. consider CAD, with updates on adjunctive In the final presentation Angel Moya In the field of pacing Reddy et ESC Journal therapy for STEMI, drug-eluting stents, from Barcelona will summarise studies al analysed the safety and clinical new drugs, and the new ESC guidelines in arrhythmia. Two reports have reviewed performance of a novel completely self- family for myocardial revascularisation. the prognostic role of ECG, with Aro et contained leadless cardiac pacemaker. Dr Ramón Bover from Madrid will al looking at prolonged PR interval in patients for CRT implantation. review the highlights in heart failure, of 10,785 individuals followed for 30 years, which the main news has probably been and finding no impact on survival. Pérez- Discover more: 30 August, 13:30-15:00 that the PARADIGM-HF trial, testing Rodón et al analysed the ECG recordings www.escardio.org/journals LCZ696 (a first-in-class angiotensin of 524 patients with syncope, and found Brussels, Central Village receptor neprilysin inhibitor, ARNI) was that the presence of atrial fibrillation, Take home messages for practitioners

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www.escardio.org #ESCcongress What are you looking forward to at ESC Congress 2014?

It’s an honour for me to have an abstract selected at As a practising doctor for many years in ESC Congress 2014. cardiology, echocardiography and ECG, I am “ I’m most interested in the field of transcatheter aortic “looking forward to seeing what’s new in diagnostic valve interventions and invasive coronary imaging, and therapeutic developments. I enjoy Professor and expect to improve my knowledge of these fields in Brugada’s lectures on ECG. I have already had the Barcelona.The Congress is a good way to learn from key oppurtunity to hear him speak at previous congresses. opinion leaders in the field. It is exciting to be part of a congress which covers I’m looking forward to discussing our presentations so many interesting topics in cardiology. Everything and meeting colleagues from all over the world, as is here together - science, practice, exhibitions, happens every year. interesting people, and a wonderful city in Barcelona, I’m also sure that I will have a good time in Barcelona with Dali art and Gaudi architecture. I hope I will and enjoy this fascinating city. have a good time in Barcelona, meeting interesting colleagues and learning something new for my Takao Sato ” Biruta Reinsmite patients in Latvia. Department of Cardiology Riga 2 Hospital University of Toyama Latvia ” Japan faces in the crowd I’m really interested in finding out more about new We live in an era of rapid development of medical facestreatment options for patients within terminal heart failure.the crowdtechnologies. So I am very glad that I have the Their first option is a transplant, but there are currently “opportunity to keep abreast of the latest news in “shortages of donor organs. cardiology and talk about the results of my own At the ESC this year I want to find about the third research to colleagues from other countries. generation of left ventricular assist devices. These It is a big responsibility and honour to speak at can be used as a bridge to transplantion and can buy such a high level, and listen to presentations from patients valuable time. The devices use new materials leading experts. which make them less prone to bleeding complications. I hope that my visit to the ESC Congress will They are also smaller, and this makes it possible to provide a stimulus for my further research and implant children and small women. Such devices slow practical work in my university. the progression of disease and preserve other organs, allowing patients to undergo transplant in better ” Emilija Nestorovic condition. Vladimir Evdokimov Heart Failure and Transplant Cardiologist Moscow State University of Belgrade, Serbia ” Medicine and Dentistry, Russia

ESC CONGRESS NEWS Editors-in-Chief: Sub-editor: Printing company: Sponsorship: With the support of the Michel Bertrand, Freek W.A. Verheugt Simon Brown Open Print [email protected] ESC Congress 2014 Press Committee. Barcelona, Spain Medical writers: Graphic Design: Photography: Project Management: Free distribution. 30 August - 3 September 2014 Janet Fricker, Sophie Goodchild Hobby One Multimedia Patrik Engström Romain Verdun, [email protected] Copyright ESC 2014

This programme is accredited by the European Board for Accreditation in Cardiology (EBAC) for Organised by Wroclaw Medical 1 hour of external CME credit(s). Each participant should claim only those hours of credit that University have actually been spent in the educational activity. Course director: Piotr Ponikowski EBAC works according to the quality standards of the European Accreditation Council for Continuing Medical Education (EACCME), which is an institution of the European Union of Medical Specialists (UEMS).

EBAC ACCREDITED EDUCATIONAL PROGRAMME HELD DURING THE ESC CONGRESS 2014

Beirut & Nicosia Rooms Saturday, August 30, 2014 Village 6 (15.30-16.30)

Each step of the heart failure patient’s journey counts

Chairpersons Faculty Jeffrey S. Borer Martin R. Cowie Luigi Tavazzi Piotr Ponikowski Adriaan Voors

Supported by an unrestricted grant from Servier In compliance with EBAC/ EACCME guidelines, all speakers/ chairpersons participating in thisprogramme have disclosed or indicated potential conflicts of interest which might cause a bias inthe presentations. The Organizing Committee/Course Director is responsible for ensuring that allpotential conflicts of interest relevant to the event are declared to the audience prior to the CMEactivities.