Cardiology in Europe – the ESC: Mission, Vision, Threats, Opportunities Jeroen J Bax President

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

Who is the ESC?

• A global society that identifies CV trends

• addresses inequalities and shares best practice

• to improve standards of care for patients

WHAT COMES NEXT? Changing from EU to global? Increasing input of Affiliates

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

Sustainability?

-fewer doctors -increasing bureaucracy -increasing workload -resulting in more burnouts

Volunteers (doctors) limited by:

Full spectrum of cardiology

The ESC covers the full

spectrum of cardiology

through its 27 cardiovascular

subspecialty communities.

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

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

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3838

3838

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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

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5454

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5656

5757

5757

5858

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5959

5959

6060

6060

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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

2306.3

-2475

2334.4

-2475

2334.4

-2475

2306.3

-2475

2306.3

-2475

2334.4

-2503.1

2334.4

-2503.1

2362.5

-2531.3

2362.5

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2362.5

-2559.4

2362.5

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2390.6

-2587.5

2390.6

-2587.5

2418.8

-2643.8

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-2728.1

2587.5

-2728.1

2587.5

-2812.5

2615.6

-2896.9

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-2840.6

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-2925

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-2925

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-3009.4

2840.6

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2840.6

-3065.6

2896.9

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2896.9

-3065.6

2953.1

-3150

2953.1

-3150

3037.5

-3150

3037.5

-3121.9

3009.4

-3121.9

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3009.4

-3150

3009.4

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3037.5

-3178.1

3037.5

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3065.6

-3234.4

3121.9

-3234.4

3121.9

-3290.6

3178.1

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3375

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-3487.5

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-3515.6

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3431.3

-3543.8

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3487.5

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-3403.1

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-3206.3

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-3150

3178.1

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-3065.6

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-3009.4

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-2390.6

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-2137.5

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Sheet1

112233445567788991010111112131314141515161617171818192020212122222323242425262627272828292930303132323333343435353636373838393940404141424243434445454646474748484949505151525253535454555556575758585959606061616263636464656566666767686869707071717272737374747576767777787879798080818282838384848585868687888889899090

Males-2446.9-2475-2475-2475-2475-2475-2503.1-2503.1-2531.3-2531.3-2559.4-2559.4-2587.5-2587.5-2643.8-2643.8-2728.1-2728.1-2812.5-2896.9-2896.9-2840.6-2840.6-2840.6-2896.9-2896.9-2896.9-2925-2925-2953.1-2953.1-2981.3-2981.3-3009.4-3009.4-3065.6-3065.6-3065.6-3150-3150-3150-3121.9-3121.9-3121.9-3150-3150-3178.1-3178.1-3234.4-3234.4-3290.6-3290.6-3318.8-3403.1-3403.1-3403.1-3459.4-3459.4-3487.5-3515.6-3515.6-3543.8-3543.8-3571.9-3571.9-3628.1-3628.1-3628.1-3628.1-3684.4-3684.4-3600-3600-3515.6-3515.6-3487.5-3459.4-3459.4-3403.1-3403.1-3346.9-3346.9-3318.8-3318.8-3262.5-3262.5-3206.3-3206.3-3150-3150-3065.6-3065.6-3065.6-3009.4-3009.4-3065.6-3065.6-3009.4-3009.4-3009.4-3009.4-2953.1-2953.1-2784.4-2784.4-2362.5-2362.5-2446.9-2390.6-2390.6-2306.3-2306.3-2306.3-2306.3-2362.5-2362.5-2334.4-2334.4-2250-2250-2137.5-2137.5-2109.4-2109.4-2025-1968.8-1968.8-1968.8-1828.1-1828.1-1800-1743.8-1743.8-1715.6-1715.6-1575-1575-1490.6-1490.6-1378.1-1378.1-1265.6-1181.3-1181.3-1068.8-1068.8-1068.8-984.38-900-900-815.63-815.63-731.25-731.25-562.5-562.5-309.38-309.38-253.13-253.13-253.13-253.13-225-225-253.130

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

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.

FINANCIAL AFFORDABILITY? WHO WILL PAY?

MAIN ISSUES OF HEALTH CARE

• Patients access to new pharma & medical devices

• Health care systems affordability • Health care systems sustainability

Mission Statement

To reduce the burden of cardiovascular disease

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

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

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)

Our roots are European Our reach is global

EU REGIONAL DISPARITIES; INEQUALITIES? FINANCIAL AFFORDABILITY?

The NW vs SE axis

Also: global disparities EU / USA versus

South Africa, South America, (partial) Asia

ESC Associations Strong partners, fulfill the need of subspecialisations, with specialised congresses and Journals

ESC Working Groups and Councils

Working Groups: small, specific structures, high level of expertise

Councils: cardiologists meeting non-cardiologists e.g. basic scientists, GPs

FRAGMENTATION?

But also: Changes in industry support -

sustainability?

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

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

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 »)

We need you:

Share the EHJ publication with your members Share with local regulators Share your contributions with us Together we are stronger

Focus for now and the future Membership Education Advocacy, representation of the community

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

EU INEQUALITIES? AFFORDABILITY? Industry support?

Personalised membership

Expand investment in affiliate societies Invest in the young generation

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

GENERATION GAP?

FEMINISATION of MEDICINE

Needs-Driven Education

Robust, unbiased, education built on a strong, evidence-based foundation

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

EU and GLOBAL INEQUALITIES?

Industry support model?

How to continue? Develop distance learning

General cardiology and subspecialties Interactive, MCQs

GENERATION GAP? EU INEQUALITIES?

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)

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

Very high and accelerating downloads levels

1.2 2 3.5

2014 2015 2016

RCT vs REAL WORLD?

Future of the RCT with new

regulations

EURObservational Research Programme - Represent real world data

ESC National Cardiac Society Affiliated Cardiac Society Other participating country

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

ESC Atlas of Cardiology – serves as common database YOU made it, YOU have access to all the data – READ AND EXPLORE!

Mission for 2016-2018

To stabilize To protect To further develop – continuity in line of action

Mission for 2016-2018: subtle adjustments

Challenges of ESC

Maintain healthy financial situation Maintain worldwide recognition Avoid fragmentation Avoid loss of focus

ESC Strategic plan 2016-2020

The 3 threats for medical doctors

Increasing bureaucracy No more interaction with industry

Education? Innovation?

Interference of E-health

Google

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

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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