Dr Marco Tubaro (San Filippo Neri Hospital, Rome), Chairman of the ESC Working Group on Acute Cardiac Care, has described acute coronary care as "the most challenging field of cardiology".
The Working Group aims to establish the status of the Intensive Cardiac Care Unit (ICCU) as the correct place to treat all patients who need acute cardiac care, to develop guidelines for the ICCUs in Europe, and to establish acute cardiac care as a self-contained medical sub-specialty.
The clinical challenges facing the ICCUs and the specialty of acute care will be addressed at the Acute Cardiac Care 2008 congress, which takes place in Versailles, France, from 25-28 October. Details of story and interview opportunities for journalists can be found at the end of this press announcement.
According to Professor Nicolas Danchin (Hôpital Européen Georges Pompidou, Paris), Vice-Chairman of the ESC Working Group on Acute Cardiac Care, foremost among the challenges addressed at the congress will be continuing high rates of mortality among acute infarction subjects, the time delay between onset of symptoms and first medical contact, and treatments for acute heart failure.
- Continuing high rates of mortality
Around 30 per cent of patients who have a myocardial infarction begin with a cardiac arrest. While there has been progress in improving overall mortality rates following acute myocardial infarction (AMI), survival rates when the arrest takes place outside hospital are no better than 5 per cent in most European countries. Survival rates are slightly better in the USA, mainly because of better public health campaigns and more defibrillators in public places. Survival rates for those undergoing acute cardiac care following chest pain are better than 95 per cent. So, much depends on immediate intervention. "Resuscitation should begin within three or four minutes of the cardiac arrest," says Dr Danchin. "That's why it's so important to teach the basics of resuscitation to the whole population. And that should begin in schools."
- The importance of timing
There has been little improvement in the time delay between the onset of symptoms and the first medical contact. "This is vital," says Dr Danchin. "We need to reopen the occluded arteries and that must be done very quickly. If you can do this within the first 60 minutes - the 'golden hour' - there is virtually no myocardial damage done." However, research data to be presented at the congress show that the median time between onset of symptoms and first medical contact is more usually 4-6 hours than one hour.
How can the time delay be shortened? A more efficient paramedical service will help, but is not sufficient. Dr Danchin believes complete public education is necessary: "If someone has prolonged chest pain of ten or 15 minutes, they really have to call someone right away."
- The treatment of acute heart failure
The treatment of acute heart failure still lacks efficient medication. There have been improvements, but there is still a high rate of acute and sub-acute mortality in patients with acute heart failure. "We need new ways to manage these patients," says Dr Danchin.
Acute Cardiac Care 2008 will present new data on the way acute cardiac patients are managed, particularly in accordance (or not) with the latest guidelines. New analysis from the Euro Heart Survey's Acute Coronary Syndromes Registry will compare acute treatment in 2006/7 with clinical practice in 2000 and 2004. "Hopefully, there will have been improvements," says Dr Danchin.
The congress will also review the latest ESC guidelines on the treatment of AMI and emphasise that early emergency PCI (percutaneous coronary interventions via balloon angioplasty and stent) should be the "default strategy". "If it's not feasible to implement quick PCI," adds Dr Danchin, "our advice is that intravenous thrombolysis is the best alternative."
- Acute Cardiac Care 2008 will take place from 25-28 October at the Palais des Congrès de Versailles, Place du Château, 10 Rue de la Chancellerie, 78 000 Versailles, France
- The full scientific programme is available on the website of the ESC here
- The ESC's latest guidelines on Acute Pulmonary Embolism (2008), Acute and Chronic Heart Failure (2008), and Acute Coronary Syndromes (2007) are available on the ESC website here
- The ESC does not provide press services at the congress, but will arrange interviews and provide support for stories via its press office at firstname.lastname@example.org. ESC spokespeople will be available for independent comment on studies presented at the congress.
- Journalists wishing to attend the congress will be welcome (free on-site registration upon presentation of relevant credentials). Appointments for interviews on site can be made at the ESC stand at the congress.
The European Society of Cardiology (ESC):
The ESC represents nearly 53,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
The ESC achieves this through a variety of scientific and educational activities including the coordination of: clinical practice guidelines, education courses and initiatives, pan-European surveys on specific disease areas and the ESC Annual Congress, the largest medical meeting in Europe. The ESC also works closely with the European Commission and WHO to improve health policy in the EU.
The ESC comprises 3 Councils, 5 Associations, 19 Working Groups, 50 National Cardiac Societies and an ESC Fellowship Community (Fellow, FESC; Nurse Fellow, NFESC). For more information on ESC Initiatives, Congresses and Constituent Bodies see www.escardio.org.
European Society of Cardiology, The European Heart House 2035 Route des Colles, B.P. 179 - Les Templiers, Sophia Antipolis F-06903 France
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