The main topic of the conference: “Implantable Cardioverter Defibrillator for Life” Initiative – Fighting against Sudden Cardiac Death in Emerging Economies”. The event was jointly organized by the European Heart Rhythm Association and the Hungarian Society of Cardiology.
The aim of the summit was to demonstrate the benefit and efficacy of the prevention of sudden cardiac death (SCD), as at an annual level SCD is responsible for a significant part of the deceases and it is the leading cause of death in industrial countries. Many arrhythmias could be treated by device therapy and this would also reduce the death rates. The target of the summit was to build bridges between the medical, political and industrial sectors so as to procure greater political and economical care and support for the primary and secondary prevention of sudden cardiac death, heart failure and arrhythmias.
The acceptance and the efficacy of implantable devices in the treatment of heart failure and heart rhythm disturbances, especially that of ICD has increased enormously in recent years and therefore, we apply them in a wide range. In spite of this, many patients with high risk of SCD cannot receive these anti-arrhythmic treatments partly because of the low availability of the devices, and partly because of the lack of properly qualified specialists. Implantation does not simply depend on budget, financing and GDP but it also requires deep professional knowledge. As the conference emphasized both the theoretical background of device therapy – professional recommendations, choice of implantable devices, programming and problem solution- and the practical education of implantation methods are important for the increase of implantation numbers. The paradox of the effort to reduce SCD is that besides the proper risk stratification and the supply of primary illnesses, the implantation numbers of the applied devices in primary and secondary prevention –primarily that of ICD-s – have not reached the case numbers of SCD yet in the economies in transition.
The summit tried to reflect on the regional disparities, their political, economical, financial and last but not least, their educational background through a series of lectures held by the representatives of countries with low, medium and high implantation numbers. However, it also underlined the importance of patient organizations which have a crucial role in the improvement of patients’ quality of life and in the risk reduction and prevention of SCD in the European population. At the end of the four sessions Central-Eastern European cardiologists, health-economists, politicians and journalists discussed the reasons and the possible solutions of the regional differences in the round table discussions. Acknowledging the importance, the timeliness and the message of the topic, Pál Schmitt, President of the Hungarian Republic and Miklós Réthelyi, Minister of the Ministry of National Resources undertook the main patronage and the patronage of the event.
Written invitation had been sent to the presidents of all Cardiologist Societies and Arrhythmia Working Groups in the member states of ESC and also to all the decision-makers of EHRA (Board Members and Committee Members). Finally, 197 registered participants from 31 countries arrived.
The program of the Summit of 2010 was all-important and concise and it was arranged on the basis of the feedbacks of the participants; even a teleconference with the leadership of EHRA was organized to discuss the program. The Faculty was composed of 55 renowned cardiologist-arrhythmologists, health economical and political experts who represented 27 countries (Armenia, Belarus, Belgium, Croatia, Czech Republic, Estonia, F.Y.R.O. Macedonia, Georgia, Germany, Greece, Hungary, Israel, Italy, Latvia, Lebanon, Lithuania, Montenegro, Poland, Romania, Russia, Serbia, Slovakia, Slovenia, Switzerland, Turkey, UK, Ukraine) and acted as invited chairs and speakers in the different sessions.
In the first session the event was opened by such persons of distinction as Prof. Panos Vardas, the president of EHRA and the president-elect of ESC, Prof. Béla Merkely, the president of the Hungarian Society of Cardiology and the Co-chairman of the National Societies Board of EHRA and Mária Sélleiné Márki, the director general of the National Health Insurance Fund of Hungary and then, the lecturers detailed the health care and health economical differences of the European member states. Prof. Péter Józan spoke about the cardiovascular epidemiological differences, Dr. Péter Gaál explained the health economical difficulties of the treatment of sudden cardiac death, Prof. Stefan Kääb held a lecture on the epidemiology of SCD and then Prof. Miran Kenda summarized in his lecture the relation of diabetes and SCD. The session closing speech was held by Prof. Christian Wolpert. He talked about the concept, the birth and the development of the EHRA White Book which is the annual publication of the association representing electrophysiological data of the member states.
The second session was about the possible device therapy for the primary and secondary prevention of SCD. The speeches of Dr. Zoltán Csanádi, Prof. Robert Hatala and Prof. Andrzej Lubinski also covered the guidelines for the possibilities of ICD treatments for conventional pacemaker, primary and secondary prevention. Prof. Milos Taborsky presented the results of the previous EHRA- Eastern Initiative Meeting held in Pilzen. His lecture was followed by a round table discussion.
In the third session about cardiac resynchronization therapy Prof. Béla Merkely summarized the latest evidences of efficacy of CRT treatment. On behalf of the National Health Insurance Fund of Hungary, Dr. József Gajdácsi explained the health economical background and the financial model of this special, expensive, but cost-effective treatment. He presented the algorithms for decision making in Hungary and pointed out the possibilities of the system.
In the fourth session Prof. Frans Van de Werf explained the process of establishment and the implementation of international guidelines, mentioning the difficulties of the implementation as well. Then the lectures of Prof. John Camm and Prof. Michael Glikson followed. They talked about the costs of ICD treatment which proved to be the most cost-effective method of prevention and treatment of SCD and explained how the expenditure of the treatment influences the number of patients actually receiving it. As proper education also belongs to the cost-effective treatment, in his speech Prof. Josef Kautzner focused on the education and training systems and described the policy of EHRA regarding the Central-Eastern European education in arrhythmology.
In the next session Prof. Davor Milicic and Prof. George Andrei Dan occupied with such complex questions of the treatment of SCD as the screening of patients with high risk factors, the establishment of proper predictive factors and the application of this in practice. Prof. Alessandro Proclemer introduced in a separate lecture the Italian Pacemaker / ICD registry, worthy of copying in case of the follow-up of patients already wearing devices. As we learned from Prof. Amiran Revishvili’s lecture ventricular tachycardia ablation had become a widely accepted method of treatment in case of patients with ICD, having recurrent and frequent ventricular arrhythmias.
The lectures of the last session dealt with the management of patients already having device protection. Dr. Roland Dieckmann, Ms. Pavla Kristofova and Ms. Trudie Lobban presented the system and the achievements of the German, the Czech and the British model. The story, the importance, the goal and the planned future of the Eastern Initiative was summarized by Prof. Goran Milasinovic. Prof. Karl-Heinz Kuck projected the future perspectives of the treatment of SCD.
At the end of the second, the third, the fourth and the fifth sections in the frame of thirty minutes long round table discussions the participants had the possibility to introduce the practice and the data of their own countries, and to reflect on the political-economical background of these in a few minutes. Following this, the participants discussed the opening possibilities and pointed out the lack of homogeneity; all the invited speakers agreed that it is a problem to be solved in any case. All the round table discussions were followed by the presentation of a vision of the future and the policy of the given treatment, previously discussed in the section.
In its entirety EHRA Summit reached its goal; beside the professional talks there had been place for the presentation of the political and economical effects as well and the conclusion was also favourably received by the national and international media. Hungary had been chosen by the European Society of Cardiology as the site of the latest EHRA Summit for the reason that Hungary belongs to those countries where the number of the implanted cardiac rhythm management devices equals the healthcare demands. Hungary is part of the “green region” which means that the number of the implanted devices grows at an adequate rate and the development can be maintained. By receiving the opportunity of organizing the summit, the Hungarian Society of Cardiology could introduce its decennial work, exemplary in the region.
The fundamental message of EHRA Summit was that for the prevention of sudden cardiac death the professional collaboration does not suffice to remain within the country borders. The collaboration has to cross borders so as to develop a common international professional, health economical and health political strategy and union. Besides the financial background and political acceptance, both short-term and long-term theoretical and practical education is needed, in centres of high case numbers, so-called high volume centres. The two forms of training would be either a so called „proctorship” programme of 8-12 weeks or a one year EHRA fellowship programme. The development of an international educational network, the accreditation of the training centres and the training plans, and the trainees distribution according to centres and training programmes are all the competence of EHRA. Furthermore, it is the task of the industrial sector to provide financial support for these programmes. For making the public acquainted with arrhythmias, the importance of publicity has to be emphasized. This can be realized for example by the permanent presence of national and international arrhythmia organizations (such as the EHRA) in the media. In addition to this, it is crucial to establish properly organized and advertised, active national and international patient organizations, similar to Arrhythmia Alliance.
Endre Zima MD
