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NOAC treatment during AF ablation

ESC Grants available

ESC toolkit for cardiovascular nurses

2015 Arrigo Recordati Prize for Prevention

Tribute to Guido Tarone MD

Heartfailurematters.org now in Portuguese and Arabic

Hand grip strength predicts MI and CVA

Digoxin in CHF & AF

Europe debate on trans fatty acids added to food

European Heart Failure Awareness Day

ESC President meets Portuguese Minister of Health

COPD and risk of sudden cardiac death

New edition of ESC Textbook

2015 Malaysia LIVE Conference

A New ESC website

Personal Data Protection

First ever European Director at TVT

Live Retrograde CTO Revascularization Summit Meeting

EHJ Supplement – The Heart of the Matter

Uninterrupted NOAC therapy during AF ablation is safe

Uninterrupted treatment with novel oral anticoagulants (NOACs) during catheter ablation of atrial fibrillation (AF) is safe, according to research presented at EHRA EUROPACE – CARDIOSTIM 2015 by Dr Carsten Wunderlich.

The observational study included 549 consecutive patients with drug refractory AF who were scheduled for catheter ablation with pulmonary vein isolation at the Heart Centre Dresden. A total of 233 patients were taking a vitamin K antagonist and 316 patients were taking a NOAC. Patients continued to take their prescribed anticoagulation medication without missing any doses. After the procedure echocardiography was performed to exclude pericardial effusion and patients were followed up for six months.

No patients in either group experienced a stroke or systemic embolism. There was one pericardial effusion in the vitamin K antagonist group and two in the NOAC group. Three NOAC patients had an arteriovenous fistula compared to one on vitamin K antagonists. Pseudoaneurysms were experienced by seven patients on vitamin K antagonists and two on NOACs, while three NOAC patients had groin hematoma compared to four on vitamin K antagonists.

‘Our study suggests that NOACs can be continued during catheter ablation of AF without an increased risk of periprocedural bleeding or thromboembolism,’ said Wunderlich. ‘Importantly, pericardial effusions in the NOAC group did not require specialised treatment.’

He added: ‘The results of our observational study suggest that continuous NOACs are as good as continuous vitamin K antagonists during ablation of atrial fibrillation. Our study was conducted in a high volume centre with heart surgery on site and experienced physicians doing about 1,200 ablations a year. In clinical practice we do not stop NOACs before an ablation and this is a good approach for experienced centres but I would not recommend it for all hospitals. This is a single centre experience and a randomised trial is needed before firm conclusions can be drawn.’

 

ESC Grants available summer 2015

1. Young basic scientist wanting to get connections abroad?

The Council on Basic Cardiovascular Science encourages young scientists within Europe to establish research links by visiting institutions abroad. Apply for the ESC First Contact Initiative Grant by 15 July 2015

2. EACVI Training & Research Grants

The EACVI offers research & training grants to help young candidates in obtaining experience in a high standard academic centre in an ESC member country, other than their own
Don't miss the opportunity to get specialised training or research in a non-invasive cardiovascular imaging technique!

Application deadline: 30 September 2015

 

New ESC toolkit for cardiovascular nurses and allied professionals

The ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP) launched its online toolkit during its Annual Congress EuroHeartCare 2015 weekend in Dubrovnik, on 14-15 June. Composed of videos, webcasts, presentations and educational tools, this toolkit aims to help Nurses in implementation of ESC Guidelines. This new initiative is an educational and motivational aid to nurses and allied professionals working in clinical practice.

The toolkit is part of the CCNAP Guidelines Implementation Programme which also includes a survey to evaluate knowledge of Nurses and Allied Professionals in Guidelines Implementation.

 

Salim Yusuf and John McMurray share renowned Prize

John McMurray and Salim Yusuf

Salim Yusuf MD and John J V McMurray MD shared the 2015 Recordarti Prize of €100,000.00 at an award ceremony during the European Society of Hypertension Annual Meeting 13 June 2015, in Milan, Italy.

The eighth edition of the Arrigo Recordati International Prize for Scientific Research recognized a clinical or basic science investigator who had achieved distinction in the study of secondary prevention and risk reduction strategies for patients with cardiovascular diseases.

In his acceptance speech Salim Yusuf spoke of his early career at Oxford, UK, which brought about the groundbreaking knowledge, that simple aspirin and beta blockers had a profound effect on reducing the mortality of acute myocardial infarction.

The Arrigo Recordati International Prize for Scientific Research was established in 2000 and is a legacy in memory of the Italian pharmaceutical entrepreneur Arrigo Recordati. It is awarded every two years to a scientist who has demonstrated dedication to the advancement of scientific knowledge in cardiology. 

 

Guido Tarone MD tribute


Guido Tarone
(1951-2015)

Guido Tarone, the current chair of the WG Myocardial Function, passed away on May 17 2015 at age 63. A bicycle accident took him away too soon from his beloved family, his students and his colleagues.

Guido was an integral member of the small European community of true basic scientists that entered the field of translational science in cardiology. He was associated with EU networks and together with his group in Turin, Italy, was one of the key partners to enthusiastically promote interactions and cooperation between the European groups.

Guido contributed substantially to ESC and HFA activities. He initiated and contributed to position papers, summer schools, workshops. He was as Chair of the WG on Myocardial Function appointed to the office at the ESC meeting in 2014. Guido organized the 2015 annual meeting of the WG on myocardial function together with HFA and the WG on Cell biology in Varenna, Italy, early in May. It was a great meeting, with a new format giving a lot of room to young scientists. It is a great tragedy that now we have to announce his unexpected demise which was an incredible shock.

His inspiring attitude towards science assures that his thoughts will be pursued. During his career he inspired, formed and influenced countless researchers. His personality left a strong imprint as well: Guido was not only a talented scientist, he was also a person with exquisite gentle manners and great humanity. He will be remembered for his warmth and for his kind, open mood. He showed how science requires inspiration and excitement but also independence of thought.

With his scientific work he pioneered our understanding how the heart sensitizes mechanical strain. His work focused on how interaction of cardiac muscle cells with the extracellular matrix could become novel therapeutic targets.
We will never forget Guido, he lives on in our hearts.

Johann Bauersachs, FESC, FHFA, Past Chair WG Myocardial Function
Stephane Heymans, Vice Chair WG Myocardial Function

 

Heartfailurematters.org now in Portuguese and Arabic

Heartfailurematters.org is a website created by the Heart Failure Association of the ESC and designed to provide easily understood and practical information about living with heart failure for patients, their families and carers. The site was developed by heart failure specialists, nurses and primary care physicians with input from patients and caregivers from across Europe. It is presented in 6 sections:

  • Understanding Heart Failure,
  • What can your doctor do?
  • What can you do?
  • Living with Heart Failure,
  • For caregivers,
  • Warning Signs

And also provides useful downloadable tools.  Tailored information is delivered not only in the text, but also by real-life videos of patients discussing the common issues faced by these patients. In addition, the site includes a number of original and captivating animations of the heart showing how the heart works, what goes wrong in heart failure and how treatments can improve symptoms and quality of life.

The site, based on a platform at the IT dept. at the European Heart House, receives over 140 000 visits per month. It is accessed from all over the world, due to the fact that the entire site is translated into 9 languages: English, Spanish, German, French, Dutch, Greek, Russian, Portuguese/Brazilian and Arabic. The site is also currently being translated into Swedish.
An animated guide helps visitors navigate through the site in all languages. Feedback from patients and healthcare professionals on the comprehensive but patient-friendly information is extremely positive and the site is regularly updated and reviewed by an active core group with representatives from each language.

Emphasis is placed on helping patients understand their condition and on providing practical advice for living with heart failure. The value of the site as an educational tool is currently being evaluated by a large randomised trial in the Netherlands. This attractive, web-based tool is an indispensable information resource as part of a treatment programme.

It is also employed by cardiologists, nurses and primary care physicians to provide information and educate patients living with heart failure.

Visit Heartfailurematters.org

Hand grip strength predicts MI and stroke

Weak hand grip strength is linked with shorter survival and a greater risk of myocardial infarction or stroke, according to the PURE study.

Reduced muscular strength, which can be measured by grip strength, has been consistently linked with early death, disability, and illness. But until now, information on the prognostic value of grip strength was limited, and mainly obtained from select high income countries.

The Prospective Urban-Rural Epidemiology (PURE) study included nearly 140,000 adults and was conducted in 17 countries of varying incomes and sociocultural settings. Grip strength was assessed using a handgrip dynamometer and subjects were followed for a median of four years.

The researchers found that every 5kg decline in grip strength was associated with a 16% increased risk of death from any cause, a 17% greater risk of cardiovascular death, a 17% higher risk of non-cardiovascular mortality, a 7% increased risk of heart attack and a 9% higher risk of stroke.

The associations persisted even after adjusting for age, education level, employment status, physical activity level, and tobacco and alcohol use.

Grip strength was a stronger predictor of all cause and cardiovascular mortality than systolic blood pressure.

Read the paper in The Lancet

Digoxin increases mortality risk in CHF or AF

There is conflicting evidence about whether digoxin, might contribute to an increase in deaths in patients with atrial fibrillation (AF) or congestive heart failure (CHF). Now, the largest review of all the evidence to date shows that it is associated with an increased risk of death in these patients, particularly in those being treated for AF.

In a study published in the European Heart Journal [1], researchers from the J.W. Goethe University in Frankfurt, Germany, conducted a systematic review and meta-analysis of all studies published in peer-reviewed journals between 1993-2014 that looked at the effects of digoxin on death from any cause in AF and CHF patients.

They identified 19 relevant studies that included a total of 326,426 patients (235,047 AF and 91,379 CHF patients). They found that digoxin was associated with a 29% increased mortality risk in patients with AF and a 14% increased risk of death in CHF from any cause, when compared to patients not receiving the drug.

Stefan Hohnloser, Professor of Cardiology at Frankfurt University who led the study, said: “Definite evidence can only come from results of randomised controlled trials. However, next to these, carefully performed meta-analyses provide the best clinical guidance and serve to generate hypotheses that need to be tested prospectively. Our analysis, together with evidence from other studies, all point in the same direction: there is harm associated with the use of digoxin.”

Prof Hohnloser said that there has only been one prospective randomised controlled trial of digoxin, which was carried out in 6,800 CHF patients, and none in AF patients. “We need randomised controlled trials to examine the use of digoxin for both conditions and that test the drug versus a placebo or another, active treatment”.

Ref:
[1] “Digoxin-associated mortality: a systematic review and meta-analysis of the literature”, by Mate Vamos, Julia Erath, and Stefan H. Hohnloser et al. European Heart Journal. doi:10.1093/eurheartj/ehv143

 

Europe and trans fatty acids added to food

Standfirst: Europe’s policy makers call for action on industrially produced trans fatty acids in foods in the European Union

The impact of industrially produced trans fatty acids (TFAs) on the health of citizens in the European Union (EU) was debated in Brussels on 14 April 2015, by Members of the European Parliament (MEPs), representatives of the European Commission and WHO Europe.

These fats are produced by adding hydrogen to vegetable oil and are used as ingredients in some processed foods, including biscuits and ready meals.

The panel debate in the European Parliament, Brussels, is an initiative of the Members of the European Parliament (MEP) Heart Group, with the support of the European Society of Cardiology (ESC) and of the European Heart Network (EHN).

To date, only three EU Member States - Austria, Denmark and Hungary - have adopted legislation to restrict industrially produced TFAs in the food chain. It is estimated that thousands of lives and billions of Euros could be saved if these measures were introduced more widely.

In 2008, the European Parliament published a study recommending that a ban on industrially produced TFAs should be considered at EU level. In 2009, the World Health Organization (WHO) concluded that the information available was sufficient to recommend reducing significantly or virtually eliminating industrially produced TFAs from the food supply. In December 2014 the European Commission was expected to present a report on the presence of trans fats in foods and in overall diet in the EU population.

Experiences from Denmark and New York show that TFAs can be replaced with healthier substitutes without increasing the cost or reducing the quality of foods. (1,2)

Refs:

1. Stender S, Dyerberg J, Bysted A, Leth T, Astrup A. A trans world journey. Atheroscler Suppl 2006;7:47–52. doi:10.1016/j.atherosclerosissup.2006.04.011 PMID:16713385

2. Angell SY, Silver LD, Goldstein GP, Johnson CM, Deitcher DR, Frieden TR et al. Cholesterol control beyond the clinic: New York City’s trans fat restriction. Ann Intern Med 2009;151:129–34. PMID:19620165

 

European Heart Failure Awareness Day 2015
 
Heart Failure Awareness Day (8-9-10 May, 2015 depending on country) is designed to raise awareness about the importance of recognising heart failure, getting an accurate diagnosis and receiving optimal treatment.
 
National heart failure societies all over Europe, and amongst affiliated societies, are preparing open house clinics, town square booths, city-wide posters and TV and radio campaigns to bring heart failure to the attention of their fellow citizens.

Each country can participate in an award for the best programme. 5 winning national heart failure societies receive 5000 Euros from the HFA and certificates at the HFA Summit in October.
Winning programmes (all programmes are judged together in one country) show outstanding commitment to the event and illustrate the best preparation and organisation in the following categories:

  • Public Event
  • Open clinic
  • TV & radio coverage
  • Newspaper & website coverage
  • Printed material for patients
  • Involvement of patient groups

Prevention a priority in Portugal

On Sunday 19 April, the Portuguese Minister of Health, Pablo Macedo, opened the XXXVI Annual Congress of the Portuguese Society of Cardiology, together with ESC President Prof Fausto Pinto, Dr Miguel Mendes and Prof José Silva Cardoso, respectively President Elect and President of the Portuguese Society of Cardiology.

Together they agreed to make prevention a priority, in order to reduce the mortality due to cardiovascular diseases in Portugal. In only two weeks, 14-16 May EuroPRevent, the annual leading international event in preventive cardiology organised by the ESC, will take place in Lisbon, Portugal.

The theme of this year's congress is: “Addressing Inequalities in Cardiovascular Health”. The educational programme is accredited by the European Board for Accreditation in Cardiology (EBAC) for 15 hours of External CME credits.

After the Congress the 5 Km RUN 4 HEALTH race will start at 15:30 hr at the Jamor National Sport Centre. Organised by the European Society of Cardiology and SURVIVORS RUN, all profits from the 10 Euro fee will be donated to the European Heart for Children.

Chronic obstructive pulmonary disease increases the risk of sudden cardiac death

People suffering COPD have an increased risk of sudden cardiac death (SCD), according to new research published online in the European Heart Journal [1].
 
When compared with people of the same age and sex without the disease, COPD patients have an overall 34% increased risk of SCD, but their risk almost doubles more than five years after first being diagnosed with COPD. In COPD patients who have frequent exacerbation of symptoms, the risk of SCD increases more than three-fold after five years.
 
The Rotterdam study is the first to show that COPD is associated with an increased risk of SCD in the general population and that this remains the case even when taking into account that COPD is known to increase the risk of death from any cause.

The ongoing study, which started in 1990 in The Netherlands, has been following 14,926 people living in the community aged 45 and older, for up to 24 years. The participants have regular medical examinations and are continuously monitored, so that deaths and medical conditions are recorded

The researchers say that their findings should help doctors to assess their patients’ risk of SCD more accurately, as well as suggesting directions for further research into how to target preventive action more effectively. Preventive treatments could include beta-blockers, implantable cardioverter defibrillators (ICD), or the withdrawal of drugs that prolong the QT interval, such as adrenaline, various cold remedies, some antibiotics and anti-depressants.
 
The authors, Dr Lies Lahousse, Prof Guy Bruselle and Prof Bruno Stricker write in their EHJ paper, “Sudden cardiac death (SCD) is a major health problem; however, risk stratification remains difficult and probably not all risk indicators have been identified.”

 “COPD has been associated with an increased risk of cardiovascular disease and with SCD in specific high-risk patient populations. This study shows that COPD is a risk indicator for SCD in the general population and that the risk increases with COPD severity. This provides directions for further measures to prevent SCD. People with COPD who died due to SCD were more likely to die during the night”.

Ref:
[1] “Chronic obstructive pulmonary disease and sudden cardiac death: the Rotterdam study”, by Lies Lahousse et al. European Heart Journal. doi:10.1093/eurheartj/ehv121
 

ESC Textbook of Intensive and Acute Cardiovascular Care SECOND EDITION now available

An updated and expanded edition, to keep physicians at the heart of Intensive and Acute Cardiovascular Care excellence.

Encompassing pre-and post-hospital care, procedures, diagnostics, techniques, management, settings, structure, function and more.

The new IACC Textbook is a key reference for education, serving the needs of all professionals involved in the management of patients with acute cardiovascular care diseases. The second edition includes 5 new topics:

  • The heart team in acute cardiac care
  • Patient safety and clinical governance
  • Ultrasound-guided vascular access
  • Donor management
  • Palliative care in the ICCU

A comprehensive book with the best scientific information contained in 78 Chapters and 11 Sections.

As part of the new 2015 Acute Cardiovascular Care Association offer, ACCA members will benefit from a preferred price.

Order Here

2015 Malaysia LIVE Conference

The  MyLIVE 2015 Conference will be held from 11–13 June 2015 in Kuala Lumpur at the Hilton Kuala Lumpur and Le Meridien Kuala Lumpur Conference centres. This is the Interventional Cardiovascular Society of Malaysia’s (ICSM) annual conference with live transmission offering a unique opportunity to meet, discuss and form networks with colleagues from around this region.

With a focus on interventional cardiovascular procedures, MyLIVE 2015 will feature the latest advances in current therapies and clinical research, interactive “How do I treat” sessions, “My Worst Nightmare”, hands-on training workshops on devices, case reviews and live transmission from the National Heart Institute (IJN) of Malaysia and from Samsung Medical Centre, Seoul, South Korea. This is a two and a half day conference.

Other highlights this year include the joint scientific session with The Society for Cardiac Angiography and Interventions (SCAI) and complicated cases session with the experts.

This conference is for cardiologists, interventional radiologists, physicians who specialize in interventional cardiology, vascular surgeons, allied health, fellows and other medical professionals interested in cardiovascular disease.

Dr. Rosli Mohd Ali FNHAM Organising Chairman of MyLIVE 2015 looks forward to meeting  participants and welcomes them to Kuala Lumpur, Malaysia.

New ESC Website

An exciting new version of www.escardio.org will be launched in April 2015, giving readers easier and quicker access to trusted clinical practice guidelines, education opportunities, sub-specialty expertise and the world's largest cardiovascular event!

The new site will allow:

  • Search by topic
  • Search by individual personal profile
  • Get a clear overview of all content in a single click
  • Access content wherever you are via your smartphone or other mobile devices

http://www.escardio.org/

Personal Data Protection debate in Europe

Dr Frans Van de Werf FESC, Chair, ESC European Affairs Committee writes:

There is currently a fervent debate in Europe regarding Personal Data Protection. Decisions by European Union (EU) policymakers could seriously affect the capability of scientists - including those in the cardiology community - to conduct health and scientific research.

When it comes to data protection, we expect our privacy to be protected. The European Commission is working on reforming the existing EU framework on personal data protection (Directive 95/46/EC) to strengthen people's rights, their ability to control their data and their capacity to exercise their rights more effectively.

However, personal data, such as our health records, provide a vital resource for medical research, key to identifying causes of disease and developing strategies for health promotion and prevention, as well as diagnosis and treatment. Decisions by the policy makers regarding the EU Personal Data Protection Regulation, could penalise the pursuit of health and scientific research in Europe, by making the use, re-use and storage of personal data for medical studies unmanageable.

Committed to creating an environment favourable to cardiovascular prevention, medicine and research, the ESC has already taken action to seek a positive outcome for health and scientific research within the framework of these discussions. I strongly encourage you to read our Position paper on Personal Data Protection and if you are from an EU country, to support your National Cardiac Society in addressing the issue with your National Ministers for Health & Research.

 

European Course Director at Transcatheter Valve Therapeutics meeting

Dr Francesco Maisano, Zurich, Switzerland will be joining the four US founding directors as the first European at the Chicago Transcatheter Valve Therapeutics (TVT) conference in June 2015.

The TVT conference is the leading meeting in interventional cardiology worldwide and it is an honour to be invited as a director.

The four founding course directors Martin B. Leon, Mark Reisman, Gregg W. Stone and John G. Webb will continue, but will add two additional course directors with special perspectives. Dr Francesco Maisano is the first European director, the other is Dr Nicolo Piazza of McGill University Health Centre, Montreal, Canada. In addition, the meeting venue will move from the Northwest USA to Chicago in 2015.

This 3 - day educational event is sponsored by the Cardiovascular Research Foundation and will take place on 4-6 June, 2015 at the Chicago Hilton Hotel, with an opening reception including, “Director’s Choice Taped Cases” on Wednesday, 3 June at 6:00 – 8:30 PM - CST. The directors are excited about this new location for TVT 2015 and expect more than 1000 attendees.

http://www.crf.org/tvt

The 4th European Live Summit on Retrograde CTO Revascularization 8-9 May, Zurich, Switzerland

At least every tenth patient undergoing a percutaneous coronary intervention (PCI) presents with one or more chronically occluded coronary arteries (CTO). Since its introduction in the 1990’s, retrograde revascularization techniques have considerably improved procedural success rates, but require substantial operational skills and a profound knowledge of PCI material, even among experienced operators.

Following on the success of the first three meetings, course directors Alfredo R. Galassi, Thomas F, Lüscher, and George Sianos proudly announce the 4th European Live Summit on Retrograde CTO Revascularization at the University Hospital of Zurich, Switzerland on 8-9 May, 2015.

The course is endorsed by the EuroCTO Club and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and provides an excellent opportunity for interventional cardiologists at various levels of training to enhance their knowledge and skills in retrograde techniques. The course is based on 8-10 interactive live cases commented on by a panel of international CTO experts, allowing interactive discussion of interventional strategies. Additional lectures and presentation of pre-recorded cases provide insights into clinical data, interventional material, new techniques and management of complications.

An international faculty of more than 50 CTO experts from Europe, South Africa, United States, Canada, Middle East, Russia and Asia Pacific guarantees lively discussions and will be ready to discuss hot topics and uncertain areas with you. In the industry exhibition, the interested course participant has the chance to interact with representatives from different manufacturers and obtain a hands-on experience of dedicated CTO material.

With all its educational content, the 4th European Live Summit on Retrograde CTO Revascularization provides all an interventionist needs to know to establish their own retrograde CTO program at home!

Visit them at: http://www.zhh.ch/4th-european-live-summit-retrograde-cto-revascularization

Thomas F. Lüscher receives CardioCentro Award 2014

CardioCentro Award 2014 (L) to (R) Dr G Pedrazzini (Chief, Cardiac cath lab T F Lüscher, F Rezzonico Director

Prof. Thomas F. Lüscher was honoured with the CardioCentro Award 2014 on 12 December 2014 in Lugano, Switzerland. The award was presented for recognition of Prof Lüscher’s work in establishing the CardioCentro Ticino as an official partner to Zurich University and the Zurich University Hospital.

There already existed a close relationship between the CardioCentro Ticino and the Zurich University Hospital, with exchanges of junior and senior physicians. In addition, successful research takes place for heart valve diseases, myocardial infarction and stem cell therapy at CardioCentro Ticino. There is also close clinical corporation for the management of congenital cardiac defects and heart transplantation.

The University Hospital Zurich, the University of Zurich and CardioCentro Ticino, have signed an important collaboration project in the field of Cardiology and Cardiac Surgery, turning CardioCentro into an "Associated Institute" of the University of Zurich.

More information on CardioCentro Ticino in CardioPulse.

EHJ Supplements – The Heart of the Matter March 2015

Dr Roberto Ferrari Editor-in-Chief reports

Roberto Ferrari

I am delighted to inform you that the 3rd issue of the new European Heart Journal Supplement – the Heart of the Matter has now been published and I would like to encourage all to read the three issues online: http://eurheartjsupp.oxfordjournals.org/

Why should one read European Heart Journal Supplement – the Heart of the Matter?

For the new concept, related to the change in editorial policy.

The ESC Journal family has grown substantially.  In essence, all of the major cardiology topics are covered by a specific journal, which did not leave much room for the Supplement to attract mono-thematic aspects of cardiology.  So, we (the Editors) decided to offer the reader and corresponding authors a unique possibility of reporting the activities of a scientific society, the ESC Affiliated Societies or individual cardiac institutions.

The first issue was published on-line in November 2014 and highlights the research activities from the King Abdulaziz Cardiac Centre NGHA in Riyadh.  This was followed by a report from ANMCO on antiplatelet therapy in acute coronary syndrome.

Future issues include the Chinese Society of Cardiology with Prof Huo Yong exploring a distinct way of cardiovascular disease control and prevention in China and another from the Cardiac Society of India with Dr Harshawardhan Mardikar. 

The current issue is a report from Gruppo Villa Maria (GVM) Network, including approximately twenty clinical institutions in Italy and abroad, and the Health Science

Foundation which is an Italian Institute of Research.  It is a collection of contributions that mainly concern one of the hot topics in current cardiovascular medicine: vascular and structural cardiac disease assessment and interventional (surgical or catheter-based) therapy. They also cover basic research performed within the group in conjunction with external collaborators. Furthermore, two articles deal with the overwhelming issue of governance and management of combined scientific and clinical institutions in a climate of increasing economic restrictions in today’s turbulent world, associated with the problem of harmonising public and private providers of cardiovascular health service in public-oriented systems such as the Italian and other European National Health Systems.

Reading the European Heart Journal Supplement – the Heart of the Matter of the Gruppo Villa Maria Care & Research and ES Health Science Foundation (ES: Ettore Sansavini) is important for any group that has to deal with the complexities of cardiovascular disease and I hope that it might offer guidance on how to implement and harmonise the various branches of cardiology