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Celine Colas

European Society of Cardiology (ESC)

ESC Press Office

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Summit highlights low device use in Europe

A two-day “summit meeting” has highlighted discrepancies among European countries in the use of implantable cardiac devices.

Even though the use of implantable devices for the treatment of cardiac failure and rhythm disturbances has increased enormously in Europe in recent years, there still remain large differences between countries. Indeed, a report last year in the European Journal of Heart Failure found that there is an underuse of devices in many of the European countries surveyed.(1) This is especially so in the emerging economies of Eastern Europe.

Thus, while the use of device therapy – in particular the implantable cardioverter defibrillator (ICD) – has gained increasing acceptance and is now being used on a large scale as an adjunct to traditional drug treatment, there are still many patients at high risk of sudden death who are denied these anti-arrhythmic treatments because of limited availability and trained specialists.

devices02These discrepancies among European countries – and building bridges to overcome them – were the subject of the European Heart Rhythm Association’s (EHRA) two-day “summit meeting” in November at which representatives from countries with low, medium and high ICD use explained the regional differences within their clinical, political and economic background.

The meeting, titled Implantable Cardioverter Defibrillator (ICD) for Life Initiative – Fighting against Sudden Cardiac Death in Emerging Economies, took place in Budapest on 26-27 November at the Hotel Zara.

A press conference preceding the opening of the meeting explained the problems and proposed solutions. Participants included:

  • Professor Panos Vardas, President of EHRA and President Elect of the European Society of Cardiology
  • Professor Béla Merkely, President of the Hungarian Society of Cardiology
  • speakers Angelo Auricchio, Frans van der Werf, Goran Milasinovich, and Christian Wolpert
  • Cardiologist Dr Christian Wolpert, from the University Hospital Mannheim, Germany, who (along with Drs Auricchio and Vardas) has researched the current status of cardiac electrophysiology in member countries of the European Society of Cardiology (ESC).

“Overall in the emerging economies of ESC member countries,” said Dr Wolpert, “we have found great disparity in access to anti-arrhythmic therapy, for a variety of reasons. The implant rates and number of treating centres and physicians certainly correlate with the economic status of their countries and budget restrictions. However, even in countries with a higher GDP and where device therapy could be implemented, we have found low awareness, a lack of information and few treating specialist, all of which leads to severe under-treatment. A higher uptake of device therapy could save many sudden cardiac deaths.”

An analysis of ICD use in ESC member countries published by the EHRA in their 2010 White Book(2) shows a great difference in the number of implantations between the countries, said Dr Bela Merkely, President of the Hungarian Society of Cardiology. He added: “It is likely that many patients who would potentially benefit from device therapy do not receive it. However, uptake does not just depend on budget, reimbursement and GDP. Implantation is a technically demanding task. Education in device therapy – concerning indications, device selection, programming and troubleshooting – and the implantation procedure must all be emphasised to increase the number of implantations.”

Dr Merkely said the meeting aimed to build bridges between the medical, political and industrial sectors “so as to procure greater political and economic care for the prevention and treatment of sudden cardiac death, heart failure and arrhythmias”.

“We are inviting representatives from countries with low, medium and high procedure numbers to highlight these regional differences and reflect their political and economical background – which is why we have the participation of Central and Eastern European cardiologists, health economists, politicians and journalists.”

Because of this broad scope, the EHRA Summit was also supported by its main patron, Dr Pál Schmitt, President of the Hungarian Republic, and by Dr Miklós Réthelyi, the Minister of National Resources.

Dr Panos Vardas, President of the EHRA, said: “This summit meeting in Budapest is not about the technical details of electrophysiology but more about its everyday benefits in the prevention of sudden cardiac death. Sudden cardiac death is responsible for for a great number of deaths each year – and indeed in industrialised countries is the leading cause of death. Device therapy can correct many rhythm disturbances and reduce mortality rates. ICDs are expensive, but their cost-effectiveness is comparable to – even more favourable than – other more commonly used treatments.”

References

  1. Van Veldhuisen DJ, Maass AH, Priori SG, et al. Implementation of device therapy (cardiac resynchronization therapy and implantable cardioverter defibrillator) for patients with heart failure in Europe: changes from 2004 to 2008. Eur J Heart Fail 2009; doi:10.1093/eurjhf/hfp149.
  2. More information on the White Book here

Published on: December 9, 2010

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