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CardioPulse ArticlesTop 10 EHJ Associate Editors in 2012Some centres adopt beneficial ICD programming ahead of guidelinesEuropean Cardiovascular Disease Statistics 2012 SummaryDecreased death but increased suffering from cardiovascular diseases

DOI: http://dx.doi.org/10.1093/eurheartj/eht078 1083-1088 First published online: 14 April 2013

Top 10 EHJ Associate Editors in 2012

The EHJ editorial office is proud to announce its top 10 Editors for 2012

View this table:

The Deputy Editors of EHJ selected last year's Top 10 Associate Editors at their meeting on 16 January 2013. The time period involved was 1 January 2012 – 31 December 2012 and the classification is only for manuscripts handled. Flashlights were not included in the figures

RoleFirst NameLast NameEmailCredentialsInstitutionAreas of InterestPerformance
IAEFrancesco Graphic Credit Sam C. RogersCosentinof_cosentino{at}hotmail.comMD, PhD, FESCAssociate Professor and Senior Cardiologist Consultant, Department of Clinical and Molecular Medicine, ‘Sapienza’ Sant'Andrea Hospital, University of Rome, Italy
  • Poly-vascular disease

  • Diabetes mellitus and cardiovascular disease

  • Cardiovascular prevention

  • Basic Science: endothelial dysfunction, oxidative stress and vascular inflammation in dysglycemia/diabetes, dyslipidaemia and ageing.

  • Clinical Research: link between vascular dysfunction and redox changes in patients with diabetes. In particular, translational studies to investigate novel genes involved in the progression of diabetic vascular complications despite intensive glycemic control.

Total ms handled: 73 Time to assign reviewers initially: 1.5 Time to enter decision when reviews received: 4.3
IAEFilippo GraphicCreafilippo.crea{at}rm.unicatt.itMDProfessor of Cardiology, Director Department of Cardiovascular Sciences, Director Specialty School in Cardiology and PhD Program in Cellular and Molecular Cardiology, Catholic University of the Sacred Heart – Policlinico ‘Agostino Gemelli’ Rome, Italy
  • Mechanisms and clinical implications of coronary microvascular dysfunction

  • Pathogenesis of acute coronary syndromes

  • Pathophysiology and therapeutic applications of stem cells in heart failure

Total ms handled: 79 Time to assign reviewers initially: 1.8 Time to enter decision when reviews received:5.3
LAEVolkmar Graphic Credit Sam C. RogersFalkvolkmar.falk{at}usz.chMDCardiac Surgeon, member of / and diverse functions in AATS, DGK, DGTHG, EACTS, ESC,ISMICS, SGK, SGHC, STS and others, Division of Cardiovascular Surgery, University of Zürich, SwitzerlandCardiac surgeon with main interest in minimally invasive cardiac surgery and reconstructive valve surgeryTotal ms handled: 151 Time to assign reviewers initially: 0.5 Time to enter decision when reviews received: 5.3
LAEChristian Graphic Credit Sam C. RogersMatterchristian.matter{at}usz.chMDCardiologist and Internist, Department of Cardiology, University Hospital Zurich, Switzerland
  • Atherogenesis

  • Macrophage function

  • Crosstalk between metabolic and cardiovascular disease

  • Biomarkers

  • ACS

Total ms handled: 59 Time to assign reviewers initially: 4.4 Time to enter decision when reviews received: 6.7
IAEBrahmajee Graphic Credit Sam C. RogersNallamothubnallamo{at}med.umich.eduMD, MPHUniversity of Michigan, USA
  • Interventional cardiology

  • Health policy and outcomes research

Total ms handled: 89 Time to assign reviewers initially: 0.8 Time to enter decision when reviews received: 2.6
LAEChristian Graphic Credit Sam C. RogersSchmiedchristian.schmied{at}gmx.ch;christian.schmied{at}usz.chMDDepartment of Cardiology, University Hospital Zurich, Switzerland
  • Cardiac rehabilitation

  • Exercise trials

  • Sports medicine

Total ms handled: 65 Time to assign reviewers initially: 1.2 Time to enter decision when reviews received: 5.1
IAEHiroaki GraphicShimokawashimo{at}cardio.med.tohoku.ac.jpMD, PhDDepartment of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
  • Ischemic heart disease

  • Heart failure

  • Vascular biology

  • Pulmonary circulation

Total ms handled: 32 Time to assign reviewers initially: 0.8 Time to enter decision when reviews received: 1.6
LAEJan Graphic Credit Sam C. RogersSteffeljan.steffel{at}usz.chMD, FESCCardiac Arrhythmia Unit, University Hospital Zurich, Switzerland
  • Atrial fibrillation

  • Anticoagulation

  • Cardiac devices, with special interest in cardiac resynchronization therapy

  • Continuing medical education

Total ms handled: 25 Time to assign reviewers initially: 1.8 Time to enter decision when reviews received: 4.9
IAEStefano GraphicTaddeistefano.taddei{at}med.unipi.itMDProfessor of Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Italy
  • Hypertension

  • Primary prevention of cardiovascular risk

Total ms handled: 158 Time to assign reviewers initially: 0.8 Time to enter decision when reviews received: 3.3
IAEAlec GraphicVahanianalec.vahanian{at}bch.aphp.frMD, FESC. FRCP (Edin.)Bichat Hospital, Paris (and Paris VII University), France
  • Valvular disease

  • Transcatheter valve intervention

  • Valve surgery

Total ms handled: 42 Time to assign reviewers initially: 1.1 Time to enter decision when reviews received: 5.6
  • IAE, International Associate Editor;

    LAE, Local Associate Editor;

    MS, manuscripts.

  • *“Time to assign reviewers initially” is the amount of time (days) it takes the editor to invite reviewers through the system. The clock starts ticking after the editor has accepted the assignment. The Journal benchmark is 3 days!

  • **“Time to enter decision when reviews received” is time (days) it takes the editor to enter a final decision, once a minimum amount of two reviews have been received in the system. The Journal benchmark is 3 days!

Some centres adopt beneficial ICD programming ahead of guidelines

Findings in the latest MADIT trial, showing reduced mortality in patients fitted with an ICD programmed to deliver fewer inappropriate shocks, are already being heededin clinics, according to US cardiologist Dr Arthur J. Moss

It has been known for almost 20 years that anti-tachycardia therapy in high-risk cardiac patients with a primary-prevention implantable intra-cardiac defibrillator (ICD), or a cardiac resynchronization device with an ICD (CRT-D), is ‘troublesome’ due to inappropriate discharge. It has long been thought that, not only is this distressing for patients, but also it may impact on survival. The problem is that, despite the use of sophisticated algorithms, ICD devices cannot reliably discriminate between supraventricular and ventricular arrhythmias, whilst many tachycardias in the range of 170–200 b.p.m. self-terminate and therefore need no treatment at all.

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Dr Arthur J. Moss

This is the scenario laid out by Dr Arthur J. Moss, Professor of Medicine and Founding Director of the Heart Research Follow-up Program at the University of Rochester School of Medicine and Dentistry, Rochester, NY, principal investigator of the MADIT-RIT (Reduce Inappropriate Therapy). He said: Prior studies had shown that with conventional anti-tachycardia pacing (ATP) there is a lot of inappropriate therapy in the range 170–200 b.p.m., though we believed that most arrhythmias of less than 200 b.p.m. were not truly dangerous. We therefore set up this study to compare conventional ATP with two other programs aimed at increasing the threshold at which therapy is delivered. In planning the study we felt confident we could reduce inappropriate therapy but we were not sure what effect it would have on mortality. Hence, we had a very stringent data safety monitoring panel in place, so that if there was a trend, not necessarily significant, towards increased mortality the trial would be stopped. That did not prove necessary. Instead, there was actually a significant reduction in mortality.

The randomized, non-blinded study, which enrolled 1500 patients from 98 centres in the USA, Europe, and elsewhere, with an average follow-up of 1.4 years, had three arms. One arm had ‘conventional programming’, with a 2.5 s delay for arrhythmias of 170–199 b.p.m., and 1.0 s at higher rates, another arm—termed the ‘high-rate’ arm—delivered therapy at 200 b.p.m. and above, with a 2.5 s delay, whilst the third arm—‘delayed therapy’—had a 60 s delay for 170–199 b.p.m., 12 s at 200–249 b.p.m. and 2.5 s at higher rates. By comparison with conventional programming, the first occurrence of inappropriate therapy was reduced in the other two arms by 76–79% (P < 0.001) and risk of all-cause death by 44–55% (P = 0.01, for high-rate therapy and P = 0.06 for delayed therapy).

The results of the MADIT-RIT results were presented at the AHA Annual Meeting in Los Angeles, November 2012, with simultaneous publication.1 Since the findings became known, some cardiologists have declared them a ‘game changer’ and Dr Moss has received numerous communications from physicians all over the world. Some of them have already acted on the outcome and reprogrammed ICDs in their patients, including one centre in Europe which has for the last 18 months set the ‘danger limit’ at 220 vs. the 200 b.p.m. limit of the study, with satisfactory outcomes, according to Dr Nicolas Clementy (Department of Cardiology, François Rabelais University, Tours, France).

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Dr Nicolas Clementy

In a recent paper, he and his group concluded: ‘High-rate cut-off (220 b.p.m.) shock-only ICD programming, in primary prevention patients with reduced left-ventricular ejection fraction, appeared to be safe during a long-term follow-up. It also resulted in a very low rate of discharges, which are known to be deleterious in this population’.2

Commenting on the implications of the new study, funded by ICD manufacturer, Boston Scientific, Dr Moss said: The results are relevant to all ICDs used throughout the world – they all use pretty much the same algorithms. It has been a great advance going from complex programming – which only electrophysiologists could truly understand! – to relatively simple programming, with therapy at 200 b.p.m. and above. The American College of Cardiology guidelines were only updated in September/October, 2012, so it may be a while before they can consider our data, for a new guidance update, possibly within the next 6 months. The only real question that remains is a mechanism for the effects we have seen. We're not sure if it's due to reduced inappropriate therapy itself or whether, when ATP is utilized inappropriately with supraventricular tachycardia, it leads to ventricular tachycardia or fibrillation – we just don't know, though there were many more incidents of excess ATP in the conventional arm (group A) than in the high-rate (group B) arm, namely, 896 vs. 50.

Several other MADIT studies, which were originally spurred by the landmark Cardiac Arrhythmia Suppression Trial published in 1991, are planned, according to Dr Moss. These include one on new treatments for the electrophysiological sequelae of non-ischaemic cardiomyopathy, which is common in many parts of Asia, a second on cardiac resynchronization therapy for heart failure following radiation/chemotherapy damage in women with breast cancer and lymphoma, and a third on cardiomyopathy associated with Chagas Disease.

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References

European Cardiovascular Disease Statistics 2012 Summary

The latest figures compiled by the British Heart Foundation Health Promotion Research Group from Oxford University, UK and published jointly with the European Heart Network and European Society of Cardiology are startling:

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  • Each year cardiovascular disease (CVD) causes over 4 million deaths in Europe and over 1.9 million deaths in the European Union (EU).

  • CVD causes 47% of all deaths in Europe and 40% in the EU.

  • CVD is the main cause of death in women in all countries of Europe and is the main cause of death in men in all but six countries.

  • Death rates from CHD are generally higher in Central and Eastern Europe than in Northern, Southern, and Western Europe.

  • Death rates from stroke are many times higher in Central and Eastern Europe than in Northern, Southern, and Western Europe.

  • CVD mortality is now falling in most European countries, including Central and Eastern European countries which saw large increases until the beginning of the 21st century.

  • Smoking remains a major public health issue in Europe. Although smoking has declined in many European countries, the rate of decline is now slow and rates remain stable or are increasing in some countries, particularly among women.

  • Women are now smoking nearly as much as men in many European countries and girls often smoke more than boys.

  • Fruit and vegetable consumption has increased overall across Europe in recent decades, while overall fat consumption has remained stable.

  • Few adults in European countries participate in adequate levels of physical activity, with inactivity more common among women than men.

  • Levels of obesity are high across Europe in both adults and children, although rates vary substantially between countries.

  • The prevalence of diabetes in Europe is high and has increased rapidly over the last 10 years, increasing by more than 50% in many countries.

  • Overall CVD is estimated to cost the EU economy almost €196 billion a year.

  • Of the total cost of CVD in the EU, around 54% is due to healthcare costs, 24% due to productivity losses, and 22% due to the informal care of people with CVD.

Further information at:

European Heart Network, www.ehnheart.org.

European Society of Cardiology, www.escardio.org.

Andros Tofield

Decreased death but increased suffering from cardiovascular diseases

Cardiovascular disease looks set to be the top global burden for years to come

The Global Burden of Disease Study 2010 (GBD 2010) shows that many countries saw significant decreases in the number of deaths from cardiovascular diseases between 1990 and 2010, but did not reduce the number or suffering of patients.

The proportion of disability-adjusted life years (DALYs) from cardiovascular disease decreased between 1990 and 2010 in developed regions. In Western Europe, North America, Australasia, and high-income countries in Asia Pacific, other chronic ailments such as musculoskeletal disorders (e.g. low back pain) caused the highest burden in 2010.

But, for many developing countries, e.g. Latin America/Andean, Asia, and North Africa/Middle East, the proportion of DALYs from cardiovascular disease increased due to achievements in controlling other diseases (infectious diseases) and expanding cardiovascular epidemics.

The South of sub-Saharan Africa experienced a 23% decrease in the proportion burden (DALY) that was attributable to cardiovascular disease. However, in the East and West regions of sub-Saharan Africa, the fraction of DALY due to cardiovascular diseases has increased. Dr Mohammad Forouzanfar, the engine behind the cardiovascular disease work in GBD 2010, speculates that this could be because of the South's current epidemic of fatal infectious diseases including HIV.

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Mohammad H. Forouzanfar

But the number of years lived with disability (YLD) per capita (standardized for age) showed a minimal change globally, with small and non-significant change by regions. Forouzanfar says: ‘While we were successful in reducing the death we were not as successful in the prevention of cardiovascular diseases and the total number of patients increased’.

Many of the achievements in cardiovascular disease over the past two decades were in emergency care and better survival from acute cardiovascular conditions, including ischaemic heart disease and stroke. Long-term survival of chronic sequelae, e.g. stable angina and heart failure, has improved and has increased the number of patients.

The age at death has increased in almost all regions in the world. Today's cardiovascular patients are older and have more comorbidities, making them more complex to treat. Forouzanfar adds: ‘We have a shifting to more chronic sequelae in several cardiovascular diseases’.

To illustrate his point, since 1990 YLDs have increased by 48% for ischaemic heart disease, 87% for total stroke, and 69% for atrial fibrillation.

The GBD 2010 project highlights priorities for research and action. First is to fill gaps in the data. For many developing countries in South Asia, South East Asia and especially sub-Saharan Africa the project relied on surveys, from which estimates were calculated.

Second is the need for good-quality surveillance systems with enough accuracy and sensitivity to monitor and track short-term changes and local differences. Interventions can then be revised and re-evaluated.

Third is using the GBD results for future research and local health planning. The study shows which risk factors are most important locally and how much they contribute to cardiovascular disease. Studies are needed to discover why current public health interventions have not been as successful as expected and how they can be redesigned to achieve better results.

What does the future hold for cardiovascular disease? It is very difficult to predict. The Russian experience in the 1990s showed that one political change teamed with social changes had a huge effect on death and epidemiology of cardiovascular and many other diseases.

Conflicts were significant risk factors for increasing ischaemic heart disease and cerebrovascular diseases.

Taking a look at risk factors, smoking looks set to decrease globally. Prevalence is still high in Asia but has begun to drop, and successes have been achieved in Western Europe and some countries in Australasia.

The story looks less bright for Basal Metabolic Index, which has not decreased as a risk factor anywhere. Mean systolic blood pressure will continue to be important. It has been decreasing in Western countries and Latin America but increasing in sub-Saharan Africa and Asia. Alcohol consumption is likely to continue rising in central, East, and South Asia, and Eastern Europe where there was a brief decline in 2000–2005.

Forouzanfar says: ‘It means that even with current rates of cardiovascular disease in developing countries, combined with an aging population, we think that ischemic heart disease, cerebrovascular disease and several cardiovascular diseases will be a priority and a challenge there for the coming decades’.

Developed countries have passed the peak of the epidemic. But because of the ageing population, cardiovascular disease will continue to be the principal health burden in these countries.

Forouzanfar concludes: ‘We think that cardiovascular disease will be on top of the list and we should keep our eyes open, even in developed countries. It will definitely continue to be a priority for global health’.

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