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  1. 1. European Perspectives Circulation 2006;114;f153-f156 Circulation is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX 72514 Copyright © 2006 American Heart Association. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org Subscriptions: Information about subscribing to Circulation is online at http://circ.ahajournals.org/subscriptions/ Permissions: Permissions & Rights Desk, Lippincott Williams & Wilkins, a division of Wolters Kluwer Health, 351 West Camden Street, Baltimore, MD 21202-2436. Phone: 410-528-4050. Fax: 410-528-8550. E-mail: journalpermissions@lww.com Reprints: Information about reprints can be found online at http://www.lww.com/reprints Downloaded from circ.ahajournals.org by on July 22, 2010
  2. 2. Circulation October 3, 2006 f153 Spotlight: Alberto Zanchetti, MD Journals Focus Circulation: European Perspectives Dr Zanchetti is a leading figure in the world The Scandinavian Cardiovascular Journal is of hypertension and editor-in-chief of the published 6 times a year, and the 5 Nordic Journal of Hypertension. countries are represented on its editorial board. Page f155 Page f156 European Perspectives in Cardiology A View From the In 1991, Dr Widimsky travelled to The Netherlands to take up a research fellowship in Rotterdam and was depressed by the scale of the difference he found between practice there Czech Republic and in his own country. To put it in perspective, Czechoslovakian cardiologists were performing up to only 5% of the volume of procedures (angioplasty or bypass Petr Widimsky, MD, PhD, FESC, surgery) routinely undertaken in Holland. heads the Cardiocentre Vinohrady, Fortunately for Dr Widimsky, his staff, and his patients, which he founded in 1996, of the on his return in 1992 he was informed by the director at the Charles University and University University Hospital Vinohrady that he could take any neces- Hospital in Prague, Czech sary steps to replicate what he had seen in Holland. He Republic. He recalls with remembers it as a “very challenging” period. “When I saw Monika Polak, PhD, how things the high-tech and high-volume clinical work and research at the Thoraxcentre in Rotterdam and in Zwolle, I hoped that have changed since the fall this would also be available for Czech patients one day.” of communism. Following the separation of Czechoslovakia into the he collapse of communist regimes across Eastern Europe Czech Republic and Slovakia on 1 January 1993 (Figure 1), T in 1989 was momentous, says Dr Widimsky. It not only liberated nations from central Soviet control, but also enabled there was a quick recovery by the Czech Republic economy and remarkable progress in its health service. This meant the free flow of information, personnel, and capital from West that the day Dr Widimsky was hoping for came only 7 years to East and vice versa. But despite the significant political later. He attributes this success in catching up with the West change and a general economic upturn postcommunism, Dr to the commitment of both politicians and clinicians. Widimsky recognises clear differences that remain in medical This was achieved after the government introduced free practice between Eastern and Western Europe. health care for patients in 1991. Workers paid 13.5% of income Dr Widimsky, who was appointed professor of medicine by into the healthcare budget, and healthcare providers were fully Czech President Václav Havel, is at the head of the busiest reimbursed for acute, emergency, and outpatient care. “For 6 cardiology centre in the Czech Republic in terms of admissions. years the only limit was the physical capacity of doctors,” says It receives 6000 to 7000 patients per year and is staffed by 65 Dr Widimsky. His own hospital began doubling the annual physicians, including 18 cardiologists and 4 cardiac surgeons. number of angioplasty procedures undertaken and rapidly went The differences that exist between the old Eastern bloc and the from performing 100 to 1000 procedures each year (Figure 2). West are entirely down to funding, according to Dr Widimsky. He says, “There is a clear East-to-West gradient. But the boundary of what is now ‘East’is shifting — 15 years ago it was Czechoslovakia, but today the Czech Republic and a few other countries like Slovenia have already reached Western standards in medicine. Thus the underdeveloped East is shrinking.” In 1989, says Dr Widimsky, the differences in cardiology practices between East and West were “huge.” For example, cheap drugs such as long-acting nitrates were sometimes dif- ficult to come by, and in the late 1980s, streptokinase, a cheap drug manufactured in East Germany, was available for only a few patients with acute myocardial infarction (MI). Only a hand- ful of people (around 25 cases per hospital per year) benefited Figure 1. Czechoslovakia split on January 1, 1993 to become 2 from procedures such as angioplasty or bypass surgery. independent states, Slovakia and the Czech Republic. Downloaded from circ.ahajournals.org by on July 22, 2010
  3. 3. f154 Circulation October 3, 2006 Dr Petr Widimsky Circulation: European Perspectives Figure 2. Acute thrombotic occlusion of the left anterior descending artery in a patient with large anterior ST elevation MI (left) and the result after stent implantation. The number of such procedures in the Czech Republic increased rapidly from 100 to 1000 each year. This scale of progress could not continue on economic Republic in the past 10 years or so, the differences have almost grounds, and in 1997 a limit was imposed on healthcare disappeared.” According to World Health Organisation esti- providers. The annual increase now allowed by the budget is mates, the United Kingdom’s total health expenditure was 8.1% 3% to 6%. Nonetheless, the benefits for patients have been of GDP in 2004, compared with 10.9% in Germany, 10% in clear. Dr Widimsky explains, “The mean life span of the pop- France, and 9.8% in the Netherlands.1 In comparison, the Czech ulation after communism was prolonged substantially, by as Republic spent 7.2% of GDP on health that year, while Slovakia, much as 6 to 7 years. In 1989, mortality from MI was about Poland, and Romania spent 5.8%, 6.4%, and 5.7%, respectively. 30% — now it is around 5% to 10%.” Although some of this The Russian Federation was among the lowest spenders in improvement is due to better standards of living, much is also Eastern Europe, allocating only 5.3% of GDP to health. due to better treatment, he adds. Overall, however, Dr Widimsky remains optimistic, “These days,” Dr Widimsky says, “the Czech Republic is because doctors in all countries know what is best for their on a par with Western Europe, and, in some instances, even patients, and the rapid spread of information achievable ahead of it. More than 60% of patients with acute coronary through publication and international congresses these days is syndromes receive clopidogrel on leaving hospital, and more harmonising practice across Eastern and Western Europe. patients per million of the population undergo interventional “In this respect,” he says, “the European Society of cardiological procedures in the Czech Republic than in the Cardiology is doing a great job in providing funding to United Kingdom.” As an example, he says that at least 90% of enable young cardiologists from less-developed countries to patients suitable for reperfusion (those who present with ST train in the best cardiology centres in Western Europe.” elevations on ECG within 12 hours of symptom onset) undergo Almost €400 000 has been invested into this important primary percutaneous coronary intervention in the Czech activity this year alone. Republic, compared with less than 10% in the United Kingdom. It is not just young doctors who are on the move, Dr However, most other former Eastern Bloc countries, Widimsky says. “Many Slovakian doctors are coming to work including Bulgaria, Romania, Belarus, Ukraine, and, to in the Czech Republic due to better pay, and there is generally a some extent, even near-neighbour Slovakia, lag at least 10 to move of doctors from East to West.” He adds, “Several hundred 15 years behind the Czech Republic in terms of practice and doctors have left for Western Europe due to better salaries.” treatment availability. It is interesting that changes in Poland This flux, he concludes, may cause problems in Eastern were not as fast as in the Czech Republic, despite it being the countries in the next 5 to 10 years. The challenge to politicians first to topple communism through elections in the summer is therefore to create conditions that will persuade highly of 1989. Dr Widimsky puts this down to Poland’s worse eco- trained and skilled cardiologists to stay and help improve nomic state at the beginning of its new era compared with their countries’ health systems and overall health in the that of the Czech Republic. Nevertheless, he is sure the trend postcommunist era. towards improvement is the same. Monika Polak is a freelance medical journalist. He reiterates that almost all of the differences between Reference East and West are due to a low level of reimbursement. “Many 1. World Health Organization Regional Office for Europe. Health for Eastern European countries not only give small amounts of All database website. Available at: http://data.euro.who.int/hfadb. money in absolute terms to health care, but also the relative Accessed August 22, 2006. budget for health [as a percentage of gross domestic product The opinions expressed in Circulation: European (GDP)] is suboptimal when compared with Western Europe.” Perspectives in Cardiology are not necessarily those of the He adds, “Where funds are available, as in the Czech editors or of the American Heart Association. Downloaded from circ.ahajournals.org by on July 22, 2010
  4. 4. f155 Circulation October 3, 2006 started with a small nucleus of just 50 people. He was the Spotlight: Alberto Circulation: European Perspectives president of the society from 1978 to 1980. Because work in hypertension was developing so quickly, Zanchetti, MD, FESC and much of the work was being carried out by Europeans, he and his colleagues decided to found a society based in Europe. In 1983, they began European meetings in Milan Dr Alberto Zanchetti, emeritus which initially occurred every 2 years, focussing on clinical professor at the University of hypertension research. The European Society of Hypertension Milan and scientific director of (ESH) was formally set up in 1989, and Dr Zanchetti was Istituto Auxologico Italiano, president from 1993 to 1995. Milan, Italy, is a leading figure “I felt it as a privilege that an important scientific society in the world of hypertension. He developed from the meetings I had started in Milan. The impor- tance of scientific societies is to keep people in a given spoke to Jennifer Taylor, BSc. discipline together, and to emphasise relationships,” he says. Those relationships might be within countries, between s a founding member of both the International Society countries, or worldwide. “Diverse professions, including cardi- A of Hypertension and the European Society of Hypertension, Dr Alberto Zanchetti has a wealth of experi- ologists, nephrologists, endocrinologists, and pharmacologists, are all united by an interest in hypertension,” he explains. ence and knowledge in the area of hypertension. He studied Initially, the ESH met every 2 years, but with increasing at the University of Parma, his home city, and graduated numbers of attendees and abstract submissions, the meet- in medicine in 1950. From there he went to the University ings were held annually from 2000 onwards. The location of of Pisa, where he trained in neurophysiology under the meetings alternates between Milan, where it all started, the world-renowned professor of physiology, Giuseppe and another European city. The 17th European Meeting on Moruzzi, MD. Hypertension will be held at the Fiera Milano Congressi Dr Zanchetti spent a year, from 1953 to 1954, at the Centre in Milan from June 15 to 19, 2007. The ESH currently University of Oregon, United States, again looking at neuro- includes 1155 members. physiology and the neural control of circulation. During this Another important development that Dr Zanchetti is time he was a fellow of the Rockefeller Foundation. involved in is the Journal of Hypertension, which began in This foundation, along with other US institutions and the 1983 as the official journal of the ISH, and is now also University of Siena, Tuscany, Italy, funded Dr Zanchetti; this endorsed by the ESH. Dr Zanchetti has been editor-in-chief allowed him to set up his own laboratory in Siena. He worked of the journal for the past 12 years. “This is a very important there as associate professor of internal medicine and became means for communication and providing information and involved in the neuropathophysiology and treatment of discussion,” he says. hypertension. He studied the neural sympathetic control of More recently, the activities of the ESH have extended the circulation in animal models and human subjects, with beyond arranging scientific meetings. For example, the particular attention to reflex control and behavioural factors, annual European such as sleep and emotions. Summer School During this time, Dr Zanchetti was inspired by Cesare of Hypertension Bartorelli, MD, professor of internal medicine at the University invites young of Siena. Dr Zanchetti says, “These were very exciting years, investigators from the first years when hypertension became a treatable disease, so various European it was an interesting time for the study of hypertension.” The countries for a week development of drugs to treat hypertension started in the 1950s of intensive training and continued at a rapid pace. in the science of In 1967, he moved to the University of Milan. As a larger hypertension. The university, it offered more opportunities for his career and for society has 2 awards a hospital position. “A bigger university was gratifying,” he for scientists in says. For many years he was chief of a clinical unit of hypertension, incl- internal medicine at a University of Milan-affiliated hospital, uding the Alberto the Ospedale Maggiore Policlinico. Zanchetti Award, He was director of the Centre for Clinical Physiology and which is dedicated Hypertension at this institution and was involved in a great to excellence in deal of clinical work. An outpatient clinic for hypertension clinical research. Dr Zanchetti has been editor-in-chief of was held regularly, and there was a ward for inpatients with Dr Zanchetti has the Journal of Hypertension for 12 years. cardiovascular disease. not only been In 1965, Dr Zanchetti was a founding member of the involved in setting the scene for work in hypertension. He International Society of Hypertension (ISH). The society continues to work at the cutting edge of new research and Downloaded from circ.ahajournals.org by on July 22, 2010
  5. 5. f 156 Circulation October 3, 2006 developments. He says challenges for the future in hyper- Researchers are now investigating the relationship Circulation: European Perspectives tension include improving compliance with existing between hypertension and metabolic diseases, including treatments, the increasing incidence of the condition, links diabetes and obesity, which he refers to as “the plague of the with other diseases, and genetics. “It’s a ripe field because modern society.” we have several classes of agents that are successful in The genetic background of hypertension is also receiv- decreasing blood pressure,” says Dr Zanchetti. “When I was ing much attention. “There is no doubt hypertension has a a medical student, there were no drugs.” genetic component,” says Dr Zanchetti. He adds that it is But from a therapeutic point of view, despite the number not caused by just a single gene, but is a very complex of agents, the lowering of blood pressure is not as successful polygenetic condition, where many genes interact with as it could be. A lot of work needs to be done to make doctors environmental factors. “This makes the study difficult and and patients compliant with what is now possible. is another problem to tackle,” he says. “Hypertension is on the rise in the developed and develop- However, the challenge is already being faced. A large ing world with an aging population,” Dr Zanchetti says, and European programme is set to begin studying the genetics he points out that better control of famine and infectious dis- of hypertension in a few months, with a grant from the eases in the developing world will mean more people will be European Commission. Dr Zanchetti is chairing the pro- affected by cardiovascular diseases — hypertension in partic- gramme, called “InGenious HyperCare,” which will ular. “Now we have many agents that are no longer covered involve 32 centres in Europe. by patent, so they are relatively cheap and hopefully can be Jennifer Taylor is a freelance medical writer. used in developing countries,” he says. The journal publishes original articles, commentaries, and Journals Focus: reviews, and also the abstract book of the annual meeting of the Scandinavian Cardiovascular Swedish Heart Association as a supplement. To increase read- ing value, the editors encourage outstanding researchers within Journal and outside the Nordic countries to present views and reviews on timely and possibly controversial issues. The editors plan to The Scandinavian increase the journal’s production of editorial commentary and Cardiovascular Journal is material that cardiologists and other doctors with a special published 6 times a year, interest in cardiology would like to see. They invite all readers, research groups, and potential authors to support the journal’s and has 2 editors. The editor collaborative project of for cardiovascular surgery promoting cardiovascular is Rolf Ekroth, MD, PhD, research across specialty and for cardiology, Knut borders. Gjesdal, MD (pictured To that end, they wel- right). They spoke to David come contributions from the entire field of such Loshak, BA. research — basic and he Scandinavian Cardiovascular Journal began life in clinical, thoracic surgery, T 1967 as the Scandinavian Journal of Thoracic and Cardiovascular Surgery. In 1997, its 30th year, it extended its transplantation, interven- tional cardiology, and scope from surgery to cardiovascular concerns generally. extracorporeal technology. Working with Dr Ekroth, professor of thoracic surgery and Since their appoint- chief physician at the Department of Metabolic and ment 6 years ago, the Cardiovascular Research/Cardiothoracic Surgery, Sahlgrenska editors have striven to Academy and University Hospital, Sweden, and Dr Gjesdal, increase the flow of professor of cardiology at the Heart and Lung Center and high-quality papers by shortening the time from submis- the Cardiology Department, Ullevål University Hospital, sion to publication to 6 months in most cases via a small University of Oslo, Norway, are 2 associate editors. There is “executive board” that works closely with the editorial also a 20-member editorial board recruited from the 5 Nordic board. In addition, there is the ability to fast-track papers countries: Denmark, Finland, Iceland, Norway, and Sweden. that justify urgent publication. The journal aims to promote cardiovascular research in the David Loshak is a freelance medical journalist. broadest sense. It is the official organ of the Swedish Heart Association, the Swedish Association for Thoracic Surgery, and Editor: Thomas F. Lüscher, MD, FRCP, FACC the Norwegian Cardiothoracic Society. The profile of the jour- Managing Editor: Keith Barnard, MB, BS, MRCS, LRCP nal is international, but a Nordic touch is also evident, reflecting We welcome your comments. E-mail the managing editor at regional and national attitudes and professional practice. Keith.Barnard@wolterskluwer.com Downloaded from circ.ahajournals.org by on July 22, 2010