CARDIOVASCULAR DISEASE IN THE XXI CENTURY
Cardiovascular disease (CVD) is still and will continue to be a major health care problem in spite the introduction of new medical technologies. An increased demand of resources and manpower is foreseen.
New preventive strategies should be introduced but will essentially delay the onset rather that eliminate CVD. As a result, cardiovascular disease may become a central part of the complex pattern of disorders of the elderly.
This pattern will increase the demand of a cost-efficient use of resources. Expenditure will remain a major determinant of access to proper CV management, and will also be a potential source to inequity across Europe . Improved knowledge on cost-effective modalities is highly demanded, and may be improved by better implementation of available management guidelines. Further research in this field is demanded.
Access to health quality data and improved knowledge in CVD by healthcare users might improve the quality of care and facilitate the implementation of guidelines. Access to reliable sources of information for the public via Internet would support a beneficial development in this perspective. Efforts to assess the values of preferences of the population regarding health and health care should be encouraged.
The epidemiology of cardiac diseases has made us to understand that cardiac disease is a manifestation of various conditions, such as metabolic and inflammatory perturbations. Cardiologists must have a broad understanding of what causes diseases of the CV system. They should also bear in mind that CV disease is increasingly associated with significant comorbidities requiring multiple therapies. Endeavours to provide guidance for the unified management of patients with several chronic conditions should be undertaken.
EVOLVING APPROACHES TO CARDIOVASCULAR DISEASE
The rapidly evolving diagnostic and therapeutic technologies (e.g. imaging, invasive techniques, regenerative therapy, etc) demand a balanced investment in equipment and knowledge.
The risk of a primary focus on technology rather than the patient must be acknowledged and counteracted. This might be applied through dedicated training curricula and specific guidelines.
Evolving technology may also, in the context of a restrictive economy, induce inequities in the access to novel medical modalities, whether diagnostic or therapeutic. Cardiologists and their organisations have to take increased responsibility in these issues, as well as in priority settings.
HUMAN RESOURCES IN CARDIOLOGY
The availability of trained cardiologists does vary considerably across Europe . To a certain extent, this seems to depend on a true shortage, but other reasons may be different type of organisations with physicians from other specialties and nurses being in charge of certain segments of cardiovascular medicine.
There is a high demand on improved knowledge in this field which may clarify the situation. This would also bring information on functioning systems to those who not yet has tried novel modalities of patient care (e.g. nurse-based clinics).
Cardiology is shifting towards Cardiovascular Medicine in a general perspective. This will require a higher demand of general knowledge, and changes in the organisational model of healthcare towards process-oriented and holistic patient management. One solution to achieve this might be the introduction of multidisciplinary teams in which the cardiologist will act as a process leader in the different presentation of CVD.
Training schemes should focus on the evolving epidemiological and organisational changes in traditional cardiology. These training programmes should make sure that the holistic patient approach is not lost, but at the same time protecting needed specific skills. It seems reasonable that the overall patient management should be overseen by physicians trained in general cardiovascular medicine. They may also have some specific skills but their main professional obligation is to protect the general management of patients. Training programmes have to be overseen and the possibility to introduce novel educational tools and perhaps focused training programmes must be considered. Likewise it will be a higher demand on examination and accreditation.
EVOLVING MODELS OF RESEARCH.
The number of clinician-scientists is rapidly decreasing, and the conditions for a career in clinical research are fading or at least considered unsafe by young cardiologists. Since clinical research is highly cost effective this is a development that must be turned around.
Training programmes should include research training in a formalised way. Adequate tutorship to support individuals with an interest and capabilities in research should be implemented.
Health contributes to productivity of the Society, and should be considered a positive economic factor. Therefore, adequate funding of healthcare should be considered an investment.
Networking of institutions across Europe may improve significantly the quality of research, with the advantage of a major independence and improved use of the cooperation from the industry. While such cooperation is essential, strong European research institutions free from financial bias should be considered as fundamental.
There is an urgent need to improve implementation of clinical practice guidelines at national levels in Europe . Adequate means to create awareness of guidelines among physicians, politicians and patients is required. The performance of observational studies for assessing a wide range of long term outcomes of guidelines implementation should be encouraged.