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Bringing it all together in cardiovascular care

One of the highlights of the Irish cardiovascular healthcare calendar is due to take place later this week, with the 66th Annual Scientific Meeting and AGM of the Irish Cardiac Society (ICS). The meeting, which runs from 8 to 10 October, is being held in the Malton Hotel in Killarney and will feature an impressive host of leading national and international speakers.

One of the strengths of the meeting, according to President of the ICS Prof Ken McDonald, is the wide participation of cardiology specialists from the north and south of the island, which comes as a result of the Society’s all-Ireland composition. Prof McDonald, who is a Consultant Cardiologist at St Vincent’s University Hospital, Dublin, says this allows delegates to learn about the innovations in cardiology introduced in another jurisdiction and also have conversations about the common challenges they face.

As usual, the meeting will have a strong international component, with four of the main speakers coming from overseas.

Dr Susan Connolly from Imperial College Healthcare NHS Trust in London, who undertook the majority of her cardiology training in Ireland and completed a PhD at University College Dublin in 2004, will deliver a presentation entitled ‘Injectable Lipid-Lowering Therapies — Ready for Prime Time?’ Cardiac care in the digital age will be the focus of discussion in the presentation by Mr Ben Bridgewater from the University Hospital of South Manchester, while Dr James Carr, Knight Professor of Cardiac Imaging, Northwestern University and Feinberg School of Medicine, US, will speak about MRI in heart failure and heart transplantation.

Heart failure

The annual Stokes Lecture will be delivered by Prof John Cleland, Professor of Cardiology at Imperial College London, UK, on ‘Heart Failure — The Final Frontier’. Prof McDonald, as a heart failure specialist himself, says it is a talk he is particularly looking forward to.

“Heart failure remains the major cardiovascular public health problem,” he notes.

“A lot of the conditions we deal with are coming under control but heart failure remains a problem. It would be my area of subspecialty interest and I am personally delighted that we have one of the world’s leading experts in heart failure coming over to give us his views as to what should be done to grapple with this major public health issue. Cardiology tends to focus on the immediate need to deal with cardiovascular emergencies. The chronic disease management aspect of cardiovascular disease has not received the same attention in the same way, for example, as chronic obstructive lung disease would have received the same attention over the years.

For the first time in the meeting’s history, GPs will be invited to discuss with specialists how to develop a coherent structure that strengthens the links between primary care and secondary care in cardiovascular medicine 

“So it is part of the reason we have a problem; because we haven’t focused on it. It is also because it is a complex disease to manage and we haven’t had effective therapies up until maybe the last 15-to-20 years. We now have pretty effective strategies for it. So Prof Cleland will put all this in perspective for us and obviously encourage us all to move forward to improving matters for patients with this condition.”

Closer to home, Prof McDonald points out that Dr Kevin Walsh from the Mater Hospital, Dublin, will speak about the important subject of adult congenital heart disease. The subtitle of Dr Walsh’s presentation is ‘Success Creates Problems’, and the talk promises to be provocative.

Research

Another central part of the programme is the Brian Maurer Young Investigator award, which is supported by Servier. Dr Chris Watson, a researcher in the Conway Institute, University College Dublin, won the award at last year’s meeting for his project entitled ‘Epigenetic Modifying Therapy for the Treatment of Cardiac Fibrosis and Hypertrophy’.

Dr Watson’s study showed that cardiac tissue damage, such as cardiac fibrosis and cardiac hypertrophy, was related to increased levels of an epigenetic process known as DNA methylation.

Prof McDonald says that Dr Watson’s work was just one example of the quality of home-based research in cardiology.

“Certainly, when research comes back from abroad it is of the highest quality,” he says.

“But the quality of the home-grown research is also very good. The difficulty with home-grown research has always been that there are not enough man-hours to do it or to do it as effectively as other people do it. But nonetheless, despite that handicap, people do some very good research in this country and we look forward to listening to some of that at the conference.”

Prof McDonald, along with Prof Cleland and the President of the American College of Cardiology Dr Kim Williams, who is also a speaker at the meeting, will judge this year’s three finalists. They are: Dr John McEvoy, whose paper is entitled ‘High-sensitivity Cardiac Troponin T and Risk of Hypertension’; Dr Stephanie James, who will show how a comparison of morbidity, mortality and cost impact of stage B and stage C heart failure underlines the clinical and economic need for national heart failure prevention strategy; and Dr Conor Kerley, who will provide an overview on the novel roles for dietary nitrate in non-ischaemic dilated cardiomyopathy and resistant hypertension.

“The bar is set high to get to the final day to present,” Prof McDonald says.

“For example, there are three finalists this year; there would have been space for more if we felt that there was more work of that quality but these are the three that we believe to be really worthy of being heard and it will be interesting to see which one is worthy of getting the award.”

Clinical care

The presentation of Dr James, who is Cardiology Research Fellow at St Vincent’s University Hospital, will be timely, in light of Prof McDonald’s acknowledgement that the HSE’s National Heart Failure Programme, for which he is the Clinical Lead, has stalled due to a lack of investment.

“The Clinical Care Programme at a national level is not really moving forward at any sort of pace at present. It really is a resource issue,” he states.

“Despite that, within the Programme there are still some very interesting pilot projects being done, which will serve to inform a wider development of important strategies, such as primary care/secondary care interaction. The programme isn’t stagnant but it could be more vigorous if there were more funds made available.”

The interaction between primary care and secondary care in relation to heart failure and other cardiovascular issues will be one of the subjects for discussion at the meeting.

For the first time in the meeting’s history, GPs will be invited to discuss with specialists how to develop a coherent structure that strengthens the links between primary care and secondary care in cardiovascular medicine.

“That is exciting because again, it has got a north/south dimension and a primary/secondary care dimension and it will allow us to improve the care of chronic cardiovascular disease,” according to Prof McDonald.

“This personally is potentially a very exciting development because most of the people with cardiovascular disease never see a specialist, or a lot of them don’t, yet cardiovascular disease management is quite complex and it is very difficult for a GP to be on top of it all, so improving communications between primary and secondary care is one way of dealing with that issue.”

Training

Another first at this year’s meeting will be a training session for cardiology fellows.

“The meeting, in its general structure, is quite formal,” he explains.

“The ‘how-to session’, which we are bringing in the Saturday morning, allows more fluid interaction between people in training and their mentor in certain aspects.

“The aspect we choose will vary year-to-year. This year, the session will be on imaging and cardiovascular medicine.

“It will give an opportunity in a less-structured format for the juniors and the trainees to interact with the people who are specialised in those areas, and get into the practicalities of everyday problems. It is a different format of learning, rather than a simple didactic presentation of information.”

Other highlights of the programme are the Brian McGovern Fellowship (supported by Bayer), which is valued at €40,000 and will be presented at the gala dinner on the Friday night, and the Travel Home Bursaries (supported by MSD), which are valued between €500 and €1,000 each and will also be provided to 10 attendees.

The meeting will also see the launch of the ICS Historical Handbook, which will cover the years 1949 to 1980. The book, which was compiled by Prof John Horgan, past ICS Secretary and President, is an attempt to document the early years of the Society and to give an insight into the development of cardiology as a specialty.

It also gives some insights into professional life as a cardiologist during the period. The book consists of a complete re-production of the meeting minutes for the first year and then a summary of each year’s subsequent activity.

“It should be an exciting meeting,” Prof McDonald concludes.

“There are new developments this year that are particularly important and there are some fantastic international speakers coming out that we are really looking forward to listening to, and Killarney is always a nice place to go to.”

There will be comprehensive coverage of the ICS 2015 Annual Scientific Meeting and AGM in the next issue of MI, out on October 22

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