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Cardiology in Europe – the ESC: Mission, Vision, Threats, Opportunities Jeroen J Bax President
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What is the ESC?
• A volunteer led, not-for-profit medical society
• Our members are health care professionals
• ESC volunteers are world renowned experts
• A source of high quality, evidence-based science
• Ensures objectivity, transparency and integrity
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Who is the ESC?
• A global society that identifies CV trends
• addresses inequalities and shares best practice
• to improve standards of care for patients
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WHAT COMES NEXT? Changing from EU to global? Increasing input of Affiliates
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The ESC is governed by an elected Board The ESC’s activities are overseen by 26 committees Over 2 000 cardiology experts volunteer their time and energy 5 000 cardiology experts contribute to ESC activities
>7 000 volunteers The ESC employs 180 staff, managed by a Chief Executive Officer
How the ESC works
European Heart House, Sophia Antipolis, France ESC Headquarters
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Sustainability?
-fewer doctors -increasing bureaucracy -increasing workload -resulting in more burnouts
Volunteers (doctors) limited by:
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Full spectrum of cardiology
The ESC covers the full
spectrum of cardiology
through its 27 cardiovascular
subspecialty communities.
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Why the ESC exists
Cardiovascular disease remains the world’s, biggest killer
• 17.5 million deaths globally (31% of all deaths)
• 3.9 million deaths per year in Europe (45% of all deaths)
• CVD costs the EU economy an estimated 210 billion Euros per year
80% of premature heart disease and stroke is preventable
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Age pyramid for Europe in 2004
Age
Men Women
0 1 1 2 2 3 3 4 4
Numbers per million ESC Report Cardiovascular Diseases in Europe 2006. WHO data; June 2006.
Chart1
11
11
22
22
33
33
44
44
55
55
66
77
77
88
88
99
99
1010
1010
1111
1111
1212
1313
1313
1414
1414
1515
1515
1616
1616
1717
1717
1818
1818
1919
2020
2020
2121
2121
2222
2222
2323
2323
2424
2424
2525
2626
2626
2727
2727
2828
2828
2929
2929
3030
3030
3131
3232
3232
3333
3333
3434
3434
3535
3535
3636
3636
3737
3838
3838
3939
3939
4040
4040
4141
4141
4242
4242
4343
4343
4444
4545
4545
4646
4646
4747
4747
4848
4848
4949
4949
5050
5151
5151
5252
5252
5353
5353
5454
5454
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5656
5757
5757
5858
5858
5959
5959
6060
6060
6161
6161
6262
6363
6363
6464
6464
6565
6565
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6767
6767
6868
6868
6969
7070
7070
7171
7171
7272
7272
7373
7373
7474
7474
7575
7676
7676
7777
7777
7878
7878
7979
7979
8080
8080
8181
8282
8282
8383
8383
8484
8484
8585
8585
8686
8686
8787
8888
8888
8989
8989
9090
9090
Males
Females
-2446.9
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Sheet1
112233445567788991010111112131314141515161617171818192020212122222323242425262627272828292930303132323333343435353636373838393940404141424243434445454646474748484949505151525253535454555556575758585959606061616263636464656566666767686869707071717272737374747576767777787879798080818282838384848585868687888889899090
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Females2306.32334.42334.42306.32306.32334.42334.42362.52362.52362.52362.52390.62390.62418.8247524752587.52587.52615.62615.627002700270027002728.12700270027002756.32756.32784.42812.52812.52840.62840.62896.92896.92953.12953.13037.53037.53009.43009.43009.43009.43037.53037.53065.63121.93121.93178.13178.13178.13178.13290.63290.633753375337533753431.33431.33431.33431.33487.53543.83543.83543.83543.83571.93571.93543.83543.83459.43459.43459.43459.43403.13403.1337533753290.63290.63290.63290.63234.43206.33206.33178.13178.13093.83093.83093.83093.83037.53037.53093.83037.53037.53037.53037.53037.53009.42868.82868.82446.92446.92559.42559.42503.12503.12418.82418.82446.92446.92531.32531.32531.32531.324752390.62390.62362.52362.52334.42334.42306.32306.32165.62165.62165.62165.62165.62165.62193.82193.82053.1202520251940.61940.61912.51912.51828.11828.11715.61715.61659.41659.4157515751490.61490.61378.11040.61040.6562.5562.5562.5506.25478.13478.13506.25506.25534.38534.38
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Age pyramid for Europe in 2050
159
141822273135404448535761667074798388
Men Women
0 1 2 3 4 1 2 3 4
Numbers per million ESC Report Cardiovascular Diseases in Europe 2006. WHO data; June 2006.
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FINANCIAL AFFORDABILITY? WHO WILL PAY?
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MAIN ISSUES OF HEALTH CARE
• Patients access to new pharma & medical devices
• Health care systems affordability • Health care systems sustainability
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Mission Statement
To reduce the burden of cardiovascular disease
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Cardiology in and outside of Europe: one common goal
Core Strategic Objectives: • Advocate for quality of care • Application standards and guidelines • Disseminate high quality scientific knowledge • Build community of cardiovascular specialists
• Serve interests of our patients
Working together to make a difference
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Core activities of the ESC Constituent bodies:
National Cardiac Societies Associations, Working groups and Councils
International Affairs: Affiliated Cardiac Societies (outside ESC) Education: Congress, ESCel, Guidelines, Journals External relations: Advocacy and policy making
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National Cardiac Societies
Backbone of the society Leadership meetings – rotating schedule every 2 years Joint sessions at NCS meetings Booth at NCS meetings NCS have input at every level of ESC (congress, education, guidelines etc)
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Our roots are European Our reach is global
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EU REGIONAL DISPARITIES; INEQUALITIES? FINANCIAL AFFORDABILITY?
The NW vs SE axis
Also: global disparities EU / USA versus
South Africa, South America, (partial) Asia
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ESC Associations Strong partners, fulfill the need of subspecialisations, with specialised congresses and Journals
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ESC Working Groups and Councils
Working Groups: small, specific structures, high level of expertise
Councils: cardiologists meeting non-cardiologists e.g. basic scientists, GPs
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FRAGMENTATION?
But also: Changes in industry support -
sustainability?
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ESC, Industry & CME – reasons for concern
MedTech Europe Code -- Implementation of Code 1 January 2018 - Bans direct support of healthcare professionals for third party educational events
-Why? -1. reduces spending -2. organize promotional courses -3. avoid conflict of interest
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ESC response: Position Paper in EHJ
“The Future of Continuing Medical Education:
the Roles of Medical Professional Societies
and the Healthcare Industry”
The ESC Board; EHJ 2018 – thanks – Peter Kearney
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Driving Reaction & Action Together
Comprehensive Communication Plan with Biomed Alliance (= the medical community)
Call for action:
Industry partners to work with European medical societies for a collaborative, independent approach to CME
(stop solo « industry education »)
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We need you:
Share the EHJ publication with your members Share with local regulators Share your contributions with us Together we are stronger
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Focus for now and the future Membership Education Advocacy, representation of the community
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Membership
• Intensify the collaboration with National Cardiac Societies • Connect with the Associations, WGs, Councils • Develop the concept of “personalised” membership: tailor the needs of individual members to the ESC products
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EU INEQUALITIES? AFFORDABILITY? Industry support?
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Personalised membership
Expand investment in affiliate societies Invest in the young generation
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You are a young cardiologist? Discover your ESC Young community
Cardiovascular Imaging
Interventional Cardiology
Basic & Translational
Science
Acute Cardiovascular
Care
Thrombosis Researchers
Heart Failure Specialists of
Tomorrow
Electrophysiology
General Cardiology
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GENERATION GAP?
FEMINISATION of MEDICINE
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Needs-Driven Education
Robust, unbiased, education built on a strong, evidence-based foundation
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Education: ESC Congress
World leading cardiology congress FAST FACTS Size: 33,000 Largest cardiology conference Involvement NCS, Assoc and WGs International – global character 150 countries
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EU and GLOBAL INEQUALITIES?
Industry support model?
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How to continue? Develop distance learning
General cardiology and subspecialties Interactive, MCQs
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GENERATION GAP? EU INEQUALITIES?
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How to continue?
Fundament for 1 EU education Opportunity for close collaboration with NCS Tailor the education towards local needs Development of EU accreditation / certification Potential for expanding to affiliates (non-ESC countries)
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Education: Guidelines
EU (and beyond) recognised authority and standard for cardiology practice 40 + countries endorsing ESC guidelines Broad clinical topics Well accepted by National Cardiac Societies and beyond
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Very high and accelerating downloads levels
1.2 2 3.5
2014 2015 2016
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RCT vs REAL WORLD?
Future of the RCT with new
regulations
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EURObservational Research Programme - Represent real world data
ESC National Cardiac Society Affiliated Cardiac Society Other participating country
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Advocacy, policy making, lobbying
Celebrating the FIVE year anniversary of the European Heart Agency this year!
Brussels Office
Advocacy
European Heart
Academy European
Heart Health Institute
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ESC Atlas of Cardiology – serves as common database YOU made it, YOU have access to all the data – READ AND EXPLORE!
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Mission for 2016-2018
To stabilize To protect To further develop – continuity in line of action
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Mission for 2016-2018: subtle adjustments
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Challenges of ESC
Maintain healthy financial situation Maintain worldwide recognition Avoid fragmentation Avoid loss of focus
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ESC Strategic plan 2016-2020
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The 3 threats for medical doctors
Increasing bureaucracy No more interaction with industry
Education? Innovation?
Interference of E-health
Google
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Projected Future of Imaging
THOUSANDS, TEN THOUSANDS, HUNDREDS OF THOUSANDS OF DATA SETS
Supercomputer ARTIFICIAL INTELLIGENCE MACHINE LEARNING DEEP LEARNING “BIG DATA“
CLINICAL OUTCOME
PREDICTION RULES DIAGNOSES TREATMENT RECOMMENDATIONS
Algorithms rather than medical knowledge Obermeier & Emanuel, NEJM 2016
1. Relationships and no causality 2. Will improve diagnostic accuracy 3. Will improve prognosis 4. Will replace much of the work currently done by radiologists and pathologists
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This lecture has shown you the potential challenges we all face Together we can turn these threats into opportunities And together we will shape the future of cardiology
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