Cardiology in Europe Richard Horton, MD Editor in Chief of The Lancet London, UK

The ESC is the most significant cardiology meeting to take place in Europe. One test for international leadership would be to determine how the ESC addresses 2 fundamental issues: (1) the global burden of heart disease, not just within the confines of Europe (2) the inclusion of patients’ views and comments in shaping research agenda European Society of Cardiology Cardiology in Europe

The inclusion of patients in a specialty meeting establishes a collaborative meeting of minds where patients can understand, comment on and shape research agenda. Physicians and researchers are then also able to shape the research and policy agenda with patients’ needs in mind. One example of a specialty meeting successfully incorporating patients is the annual HIV/AIDS meeting (held this year in Durban, South Africa). The patient as participant Cardiology in Europe

(1) The research agenda would evolve to better reflect patients’ concerns. (2) Public awareness, such as information concerning risk factors, exercise, and diet, would increase with patient involvement. Currently, many patient associations disseminate information in newsletters, journals and websites. They could easily be invited to participate in the ESC meetings. Benefits of patient participation Cardiology in Europe

“… there the issue is, we choose to exclude them. And I would ask, how can we honestly choose to exclude patients from our dialogue? And there's no answer to that question.” Richard Horton, MD Editor in Chief of The Lancet …on the exclusion of patients from the ESC Cardiology in Europe

Investigators, in choosing the questions they choose to study, are driven by the forces around them - this includes industry sponsored trials as sources of revenue. The research agenda would benefit from a balance between the needs of industry, doctors, and patients. These 3 groups need to come together to debate. The research agenda Hidden bias

There is a pervasive bias against women in cardiology - an absence of women in leadership and senior editorial positions across Europe. Women are a large proportion of cardiologists, yet are not succeeding to the highest ranks. There has also been no significant increase in the number of women recruited to clinical trials in the past 20 years. Women in cardiology Hidden bias

“So what we’ve created is a knowledge base for men, and we have systematically excluded women from that knowledge base, which politically, it seems to me, should be one of the highest priorities of any international organization that claims to represent cardiologists.” Richard Horton, MD Editor in Chief of The Lancet …on the role of women in cardiology Cardiology in Europe

One advantage of internet publishing, such as BioMed Central, is that there is a bias to publish. More quality controlled, peer-reviewed work will move faster into the public domain. One disadvantage is that as the threshold for publication falls, the quality of the work will diminish. The role of the internet Bias in publishing

Everyone is biased to their own region for submission of material. Ultimately, it does not matter where the material is published. What matters is that good work is published, and that the information is successfully disseminated to patients. Regional and national bias Bias in publishing

Results of a 15-country, 48-center survey of lifestyle, risk factor and therapeutic management of 5269 patients with coronary disease were compared to the first survey, performed 5 years ago. There has been little change in the prevalence of smoking, obesity, blood pressure control and cholesterol levels, while prophylactic drug use increased modestly. About 30% of patients with diabetes went undetected by their cardiologist or physician. EUROASPIRE trial results Cardiology in Europe