Peter Kearney | University College Cork (original) (raw)

Papers by Peter Kearney

c Abstract We present a case of rapid onset acute cardiac failure developing as part of Neurolept... more c Abstract We present a case of rapid onset acute cardiac failure developing as part of Neuroleptic malignant syndrome in a 35-year-old woman following treatment with Thioridazine and Lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process. 2003 European Society of Cardiology. Published by Elsevier Science

Journal of the American College of Cardiology, 2014

ABSTRACT

European Journal of Heart Failure, 2003

We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignan... more We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignant syndrome in a 35-year-old woman following treatment with thioridazine and lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process.

Page 1. Impact of a national smoking ban on the rate of admissions to hospital with acute coronar... more Page 1. Impact of a national smoking ban on the rate of admissions to hospital with acute coronary syndromes Edmond Cronin1, Patricia Kearney2, Peter Kearney1, and Pat Sullivan3 1Cork University Hospital, 2University College Cork, and 3Mallow General Hospital, Ireland ...

Eurointervention Journal of Europcr in Collaboration With the Working Group on Interventional Cardiology of the European Society of Cardiology, Feb 1, 2006

Aims: The purpose of this registry is to collect data on trends in interventional cardiology with... more Aims: The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution in different regions in Europe. We report the data of the year 2003 and ...

Developments in Cardiovascular Medicine, 1993

Brain, behavior, and immunity, 2015

Cardiac Syndrome X (CSX), the presence of angina pectoris despite normal epicardial coronary arte... more Cardiac Syndrome X (CSX), the presence of angina pectoris despite normal epicardial coronary arteries seen on invasive angiography, is known to be associated with an elevation of several inflammatory biomarkers, suggesting a possible role for inflammation in its pathogenesis. We sought to establish if C-reactive protein (CRP) levels varied with disease severity and so whether it is a state or trait marker. We studied 16 CSX patients with typical angina pectoris, normal coronary arteries and an electrically positive exercise stress test (EST) and 13 age- and sex-matched healthy controls (HC). CSX patients were followed up at a subsequent visit with repeated exercise stress testing and CRP measurement. We found that CRP levels were significantly higher in the CSX group compared to the HC (1.5 [0.8-4.5] v 0.8 [0.4-1.4] mg/L, p=0.02). This elevation in CRP persisted throughout the study length. CRP correlated with time to symptoms on EST at enrolment and at the second visit (r=-0.690, d...

International journal of cardiac imaging, 1999

The study was performed to determine the morphological characteristics of normal and diseased pul... more The study was performed to determine the morphological characteristics of normal and diseased pulmonary arteries by ultrasound (intravascular ultrasound, IVUS) and histology. Forty-nine cadaver segments of pulmonary arteries from 16 postmortem patients were imaged in vitro by IVUS and compared to matched histological sections. The pulmonary vasculature of 11 patients with pulmonary hypertension was investigated in vivo by IVUS. In the in vitro study, 34 of a total of 143 histological sections of the segmental pulmonary arteries showed fibrotic wall components; the remaining 109 sections had regular components. Imaged by IVUS, the wall of the regular and fibrotic arteries revealed a single layer histologically, representing the intima, media, adventitia and connective tissue. Adjacent lung tissue could be detected by IVUS and was confirmed by the histological section. In three patients with a history of chronic embolic pulmonary hypertension, IVUS revealed thrombi or a double vessel ...

Catheterization and cardiovascular diagnosis, 1993

The present study focused on the accuracy and reproducability of measurements performed with a mi... more The present study focused on the accuracy and reproducability of measurements performed with a miniaturized pressure guidewire system (PGWS) under standardized in vitro conditions and in an isolated pig heart model. We used a pressure guide wire system provided by Pressure Guide, Radi Medical Systems, Uppsala, Sweden. Pressures were recorded by a fiber optic pressure sensor located laterally and 3 cm from the distal end. The basic principle is that the element modulates an optical reflection by pressure induced elastic movements. The light source is an emitting diode in the control unit. The PGWS replaces a standard 0.018 in. guidewire. The PGWS was introduced through a Y-adapter in a recirculating perfusion model, consisting of tubing with internal diameters from 1.00 to 4.00 mm. Different perfusion pressures (range 20-140 mm Hg) were generated by a pressure controlled roller pump. Different lumen sizes from 1 to 4 mm had no influence on the measurements. a) In a range from 20 to 1...

18th IEEE Symposium on Computer-Based Medical Systems (CBMS'05), 2005

Page 1. Development of the National Cardiovascular Information System (NCIS) in Ireland M. Rachel... more Page 1. Development of the National Cardiovascular Information System (NCIS) in Ireland M. Rachel Flynn Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland rflynn@rcsi.ie Moira Lonergan ...

Ultrasound in Medicine & Biology, 1997

The aim of this paper is to report a method of atherosclerotic plaque tissue characterisation bas... more The aim of this paper is to report a method of atherosclerotic plaque tissue characterisation based on pattern recognition and assess its accuracy under conditions of potential clinical relevance. Methods and results: Excised saline infused human arteries were imaged using IVUS with RF acquisition. 40% of the vessels were re-imaged with human blood infusion. A database of ~12000 image regions-ofinterest (ROIs) of histologically established types was used to design a pattern recognition algorithm to predict the tissue type of a given ROI by comparing its RF-spectrum against the database, and also to estimate the confidence of prediction. Ex vivo validation demonstrated accuracies at the highest level of confidence as: 97%, 98%, 95%, and 98% for necrotic, lipidic, fibrotic and calcified regions respectively. Good agreement with histology was shown in an in vivo swine animal model. Conclusions: Ex vivo validation demonstrated the ability to characterise plaque tissue using an IVUS+RF system and a method incorporating (1) full spectral information (2) spectral similarity (3) estimating confidence of characterisation and, (4) ability to characterise plaque imaged through blood. Promising results were demonstrated in a live animal model. This approach may have potential for accurate and reproducible plaque characterisation in vivo. IVUS, virtual histology, imaging, plaque rupture

Journal of the American College of Cardiology, 1996

ecoentric non-dilated hypertrophy (ENDH) [n = 67]: RWT < 0.45 and LV dimension < 3.1 cm/m =. Comp... more ecoentric non-dilated hypertrophy (ENDH) [n = 67]: RWT < 0.45 and LV dimension < 3.1 cm/m =. Comparing LVH v. non-LVH S, stroke volume index ($VI), stroke work index (SWI), minute work index (MWl) and end systolic stress (ESS) were signiticantly greater p < O.01 in the non-LVH group. Total peripheral resistance (TPR) and E$S/ESVI, a measure of inotrepic state, was greater in the LVH group (p < 0.001). Comparisons of LVH remodeling subgroups indicated significant intragreup differences for SVI, SWl, MWI, TPR, peak systolic stress (P$S), ESS, and ESS/ESVI. SVL MWl and MWI, PSS and E$S were highest in the EOH group, and TPR and ESS/ESVI were highest in the DSH group. No inter-or intragreup differences were noted for fractional shortening or circumferential fiber shortening. These results demonstrate that in Stage I hypertensives, differences in LV performance measures and hemedynamics are present in comparison of LVH v. non-LVH, and bv type of LVH remodeling.

International Journal of Cardiology, 2006

Coronary embolism as a cause of myocardial infarction is an uncommon but important entity both in... more Coronary embolism as a cause of myocardial infarction is an uncommon but important entity both in terms of aetiology and treatment. Previous cases of coronary emboli in association with prosthetic mechanical valves have been reported previously but the mechanism of pharmacology and lack of patient awareness of medication importance is quite unique in this case. A 65-year-old male presented to the emergency room with an anterior ST elevation myocardial infarction after 14 h of symptoms. Past medical history included aortic valve replacement with a mechanical tilting-disc valve 18 months earlier for symptomatic severe calcific aortic stenosis. Pre-operative coronary angiography revealed normal coronary arteries. On this occasion, coronary angiography revealed an occluded LAD with an embolic occlusion at the midpoint of the vessel. Successful PTCA and stenting of the lesion were performed. Amazingly, the patient had decided 1 year earlier to stop taking his warfarin medication. He had begun taking a new &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;herbal remedy&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; which was helping with his joint pains but the combination with warfarin was causing excessive bleeding each day after facial shaving. He therefore decided to abruptly stop taking his warfarin without any medical advice. Embolic myocardial infarction is underdiagnosed and it is important to diagnose the source of embolism and treat the cause. Patient education is vital in our battle to prevent this entity in high-risk patients as in our case.

International Journal of Cardiology, 2006

The role of primary hyperparathyroidism (PHPT) in heart disease is still somewhat uncertain in ma... more The role of primary hyperparathyroidism (PHPT) in heart disease is still somewhat uncertain in many respects. Patients with PHPT seem to have an increase in mortality and this seems mainly due to an overrepresentation of cardiovascular death. PHPT is reported to be associated with hypertension, disturbances in the renin-angiotensin-aldosterone system, cardiac arrhythmias as well as structural and functional alterations in the vascular wall. There is an increased prevalence of cardiac structural abnormalities such as LVH and functional properties of the heart may be affected by the hyperparathyroid condition as well. We report the case of a 65-year-old woman with no cardiac risk factors apart from her age and type 2 diabetes who presented in cardiogenic shock. Extensive evaluation for the aetiology of the cardiomyopathy revealed solely a diagnosis of primary hyperparathyroidism. Cardiac manifestations of primary hyperparathyroidism have been reported before but to our knowledge this is the first description of severe left ventricular function secondary to PHPT. We believe that this atypical presentation of primary hyperparathyroidism causing left ventricular cardiomyopathy warrants further attention, and that a diagnosis of primary hyperparathyroidism should always be considered in patients with systolic as well as diastolic left ventricular dysfunction, and no other obvious cause.

Heart Rhythm, 2005

Heart Rhythm, Volume 2, Issue 5, Pages S23-S24, May 2005, Authors:Conor D. Barrett; M. Rachel Fly... more Heart Rhythm, Volume 2, Issue 5, Pages S23-S24, May 2005, Authors:Conor D. Barrett; M. Rachel Flynn; Joseph Galvin; Moira Lonergan; Emer Shelley; Peter Kearney; Marteen L. Simoons; Francisco G. Cosio, MD. Heart Rhythm. ...

European Heart Journal, 2010

Cardiovascular disease remains the primary cause of mortality, and a major cause of disability in... more Cardiovascular disease remains the primary cause of mortality, and a major cause of disability in the developed world. 1 This significant burden necessitates ongoing improvements in patient management, to minimize the impact of cardiovascular conditions ...

European Heart Journal, 2004

Aims The purpose of this registry is to collect data on trends in interventional cardiology withi... more Aims The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer re-vascularisation approaches and its distribution in different regions in Europe. We report the data of the year 2001 and give an overview of the development of coronary interventions since 1992, when the first data collection was performed.

European Heart Journal, 2010

Disclaimer. The ESC Guidelines represent the views of the ESC and were arrived at after careful c... more Disclaimer. The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written. Health professionals are encouraged to take them fully into account when exercising their clinical judgement. The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient's guardian or carer. It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription. Data derived from a single randomized clinical trial or large non-randomized studies.

European Heart Journal, 2006

The European Society of Cardiology (ESC) organized a one-day workshop with clinicians, health eco... more The European Society of Cardiology (ESC) organized a one-day workshop with clinicians, health economic experts, and health technology appraisal experts to discuss the equity of patient access to novel medical technologies in Europe. Two index technologies were considered: implantable cardioverter defibrillators (ICDs) and drug-eluting stents (DES). The use of ICDs range from 35 implants/ million population in Portugal to 166 implants/million population in Germany, whereas for implants of DES (as percentage of total stents) it is lowest in Germany at 14% and high in Portugal at 65%. These differences can in part be explained by a lack of structured implementation of guidelines, the direct cost in relation to the overall healthcare budget, and to differences in procedures and models applied by Health Technology Assessment (HTA) agencies in Europe. The workshop participants concluded that physicians need to be involved in a more structured way in HTA and need to become better acquainted with its methods and terminology. Clinical guidelines should be systematically translated, explained, disseminated, updated, and adopted by cardiologists in Europe. Clinically appropriate, consistent and transparent health economic models need to be developed and high-quality international outcome and cost data should be used. A process for funding of a technology should be developed after a positive recommendation from HTA agencies. Both the ESC and the national cardiac societies should build-up health economic expertise and engage more actively in discussions with stakeholders involved in the provision of healthcare.

c Abstract We present a case of rapid onset acute cardiac failure developing as part of Neurolept... more c Abstract We present a case of rapid onset acute cardiac failure developing as part of Neuroleptic malignant syndrome in a 35-year-old woman following treatment with Thioridazine and Lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process. 2003 European Society of Cardiology. Published by Elsevier Science

Journal of the American College of Cardiology, 2014

ABSTRACT

European Journal of Heart Failure, 2003

We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignan... more We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignant syndrome in a 35-year-old woman following treatment with thioridazine and lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process.

Page 1. Impact of a national smoking ban on the rate of admissions to hospital with acute coronar... more Page 1. Impact of a national smoking ban on the rate of admissions to hospital with acute coronary syndromes Edmond Cronin1, Patricia Kearney2, Peter Kearney1, and Pat Sullivan3 1Cork University Hospital, 2University College Cork, and 3Mallow General Hospital, Ireland ...

Eurointervention Journal of Europcr in Collaboration With the Working Group on Interventional Cardiology of the European Society of Cardiology, Feb 1, 2006

Aims: The purpose of this registry is to collect data on trends in interventional cardiology with... more Aims: The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution in different regions in Europe. We report the data of the year 2003 and ...

Developments in Cardiovascular Medicine, 1993

Brain, behavior, and immunity, 2015

Cardiac Syndrome X (CSX), the presence of angina pectoris despite normal epicardial coronary arte... more Cardiac Syndrome X (CSX), the presence of angina pectoris despite normal epicardial coronary arteries seen on invasive angiography, is known to be associated with an elevation of several inflammatory biomarkers, suggesting a possible role for inflammation in its pathogenesis. We sought to establish if C-reactive protein (CRP) levels varied with disease severity and so whether it is a state or trait marker. We studied 16 CSX patients with typical angina pectoris, normal coronary arteries and an electrically positive exercise stress test (EST) and 13 age- and sex-matched healthy controls (HC). CSX patients were followed up at a subsequent visit with repeated exercise stress testing and CRP measurement. We found that CRP levels were significantly higher in the CSX group compared to the HC (1.5 [0.8-4.5] v 0.8 [0.4-1.4] mg/L, p=0.02). This elevation in CRP persisted throughout the study length. CRP correlated with time to symptoms on EST at enrolment and at the second visit (r=-0.690, d...

International journal of cardiac imaging, 1999

The study was performed to determine the morphological characteristics of normal and diseased pul... more The study was performed to determine the morphological characteristics of normal and diseased pulmonary arteries by ultrasound (intravascular ultrasound, IVUS) and histology. Forty-nine cadaver segments of pulmonary arteries from 16 postmortem patients were imaged in vitro by IVUS and compared to matched histological sections. The pulmonary vasculature of 11 patients with pulmonary hypertension was investigated in vivo by IVUS. In the in vitro study, 34 of a total of 143 histological sections of the segmental pulmonary arteries showed fibrotic wall components; the remaining 109 sections had regular components. Imaged by IVUS, the wall of the regular and fibrotic arteries revealed a single layer histologically, representing the intima, media, adventitia and connective tissue. Adjacent lung tissue could be detected by IVUS and was confirmed by the histological section. In three patients with a history of chronic embolic pulmonary hypertension, IVUS revealed thrombi or a double vessel ...

Catheterization and cardiovascular diagnosis, 1993

The present study focused on the accuracy and reproducability of measurements performed with a mi... more The present study focused on the accuracy and reproducability of measurements performed with a miniaturized pressure guidewire system (PGWS) under standardized in vitro conditions and in an isolated pig heart model. We used a pressure guide wire system provided by Pressure Guide, Radi Medical Systems, Uppsala, Sweden. Pressures were recorded by a fiber optic pressure sensor located laterally and 3 cm from the distal end. The basic principle is that the element modulates an optical reflection by pressure induced elastic movements. The light source is an emitting diode in the control unit. The PGWS replaces a standard 0.018 in. guidewire. The PGWS was introduced through a Y-adapter in a recirculating perfusion model, consisting of tubing with internal diameters from 1.00 to 4.00 mm. Different perfusion pressures (range 20-140 mm Hg) were generated by a pressure controlled roller pump. Different lumen sizes from 1 to 4 mm had no influence on the measurements. a) In a range from 20 to 1...

18th IEEE Symposium on Computer-Based Medical Systems (CBMS'05), 2005

Page 1. Development of the National Cardiovascular Information System (NCIS) in Ireland M. Rachel... more Page 1. Development of the National Cardiovascular Information System (NCIS) in Ireland M. Rachel Flynn Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland rflynn@rcsi.ie Moira Lonergan ...

Ultrasound in Medicine & Biology, 1997

The aim of this paper is to report a method of atherosclerotic plaque tissue characterisation bas... more The aim of this paper is to report a method of atherosclerotic plaque tissue characterisation based on pattern recognition and assess its accuracy under conditions of potential clinical relevance. Methods and results: Excised saline infused human arteries were imaged using IVUS with RF acquisition. 40% of the vessels were re-imaged with human blood infusion. A database of ~12000 image regions-ofinterest (ROIs) of histologically established types was used to design a pattern recognition algorithm to predict the tissue type of a given ROI by comparing its RF-spectrum against the database, and also to estimate the confidence of prediction. Ex vivo validation demonstrated accuracies at the highest level of confidence as: 97%, 98%, 95%, and 98% for necrotic, lipidic, fibrotic and calcified regions respectively. Good agreement with histology was shown in an in vivo swine animal model. Conclusions: Ex vivo validation demonstrated the ability to characterise plaque tissue using an IVUS+RF system and a method incorporating (1) full spectral information (2) spectral similarity (3) estimating confidence of characterisation and, (4) ability to characterise plaque imaged through blood. Promising results were demonstrated in a live animal model. This approach may have potential for accurate and reproducible plaque characterisation in vivo. IVUS, virtual histology, imaging, plaque rupture

Journal of the American College of Cardiology, 1996

ecoentric non-dilated hypertrophy (ENDH) [n = 67]: RWT < 0.45 and LV dimension < 3.1 cm/m =. Comp... more ecoentric non-dilated hypertrophy (ENDH) [n = 67]: RWT < 0.45 and LV dimension < 3.1 cm/m =. Comparing LVH v. non-LVH S, stroke volume index ($VI), stroke work index (SWI), minute work index (MWl) and end systolic stress (ESS) were signiticantly greater p < O.01 in the non-LVH group. Total peripheral resistance (TPR) and E$S/ESVI, a measure of inotrepic state, was greater in the LVH group (p < 0.001). Comparisons of LVH remodeling subgroups indicated significant intragreup differences for SVI, SWl, MWI, TPR, peak systolic stress (P$S), ESS, and ESS/ESVI. SVL MWl and MWI, PSS and E$S were highest in the EOH group, and TPR and ESS/ESVI were highest in the DSH group. No inter-or intragreup differences were noted for fractional shortening or circumferential fiber shortening. These results demonstrate that in Stage I hypertensives, differences in LV performance measures and hemedynamics are present in comparison of LVH v. non-LVH, and bv type of LVH remodeling.

International Journal of Cardiology, 2006

Coronary embolism as a cause of myocardial infarction is an uncommon but important entity both in... more Coronary embolism as a cause of myocardial infarction is an uncommon but important entity both in terms of aetiology and treatment. Previous cases of coronary emboli in association with prosthetic mechanical valves have been reported previously but the mechanism of pharmacology and lack of patient awareness of medication importance is quite unique in this case. A 65-year-old male presented to the emergency room with an anterior ST elevation myocardial infarction after 14 h of symptoms. Past medical history included aortic valve replacement with a mechanical tilting-disc valve 18 months earlier for symptomatic severe calcific aortic stenosis. Pre-operative coronary angiography revealed normal coronary arteries. On this occasion, coronary angiography revealed an occluded LAD with an embolic occlusion at the midpoint of the vessel. Successful PTCA and stenting of the lesion were performed. Amazingly, the patient had decided 1 year earlier to stop taking his warfarin medication. He had begun taking a new &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;herbal remedy&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; which was helping with his joint pains but the combination with warfarin was causing excessive bleeding each day after facial shaving. He therefore decided to abruptly stop taking his warfarin without any medical advice. Embolic myocardial infarction is underdiagnosed and it is important to diagnose the source of embolism and treat the cause. Patient education is vital in our battle to prevent this entity in high-risk patients as in our case.

International Journal of Cardiology, 2006

The role of primary hyperparathyroidism (PHPT) in heart disease is still somewhat uncertain in ma... more The role of primary hyperparathyroidism (PHPT) in heart disease is still somewhat uncertain in many respects. Patients with PHPT seem to have an increase in mortality and this seems mainly due to an overrepresentation of cardiovascular death. PHPT is reported to be associated with hypertension, disturbances in the renin-angiotensin-aldosterone system, cardiac arrhythmias as well as structural and functional alterations in the vascular wall. There is an increased prevalence of cardiac structural abnormalities such as LVH and functional properties of the heart may be affected by the hyperparathyroid condition as well. We report the case of a 65-year-old woman with no cardiac risk factors apart from her age and type 2 diabetes who presented in cardiogenic shock. Extensive evaluation for the aetiology of the cardiomyopathy revealed solely a diagnosis of primary hyperparathyroidism. Cardiac manifestations of primary hyperparathyroidism have been reported before but to our knowledge this is the first description of severe left ventricular function secondary to PHPT. We believe that this atypical presentation of primary hyperparathyroidism causing left ventricular cardiomyopathy warrants further attention, and that a diagnosis of primary hyperparathyroidism should always be considered in patients with systolic as well as diastolic left ventricular dysfunction, and no other obvious cause.

Heart Rhythm, 2005

Heart Rhythm, Volume 2, Issue 5, Pages S23-S24, May 2005, Authors:Conor D. Barrett; M. Rachel Fly... more Heart Rhythm, Volume 2, Issue 5, Pages S23-S24, May 2005, Authors:Conor D. Barrett; M. Rachel Flynn; Joseph Galvin; Moira Lonergan; Emer Shelley; Peter Kearney; Marteen L. Simoons; Francisco G. Cosio, MD. Heart Rhythm. ...

European Heart Journal, 2010

Cardiovascular disease remains the primary cause of mortality, and a major cause of disability in... more Cardiovascular disease remains the primary cause of mortality, and a major cause of disability in the developed world. 1 This significant burden necessitates ongoing improvements in patient management, to minimize the impact of cardiovascular conditions ...

European Heart Journal, 2004

Aims The purpose of this registry is to collect data on trends in interventional cardiology withi... more Aims The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer re-vascularisation approaches and its distribution in different regions in Europe. We report the data of the year 2001 and give an overview of the development of coronary interventions since 1992, when the first data collection was performed.

European Heart Journal, 2010

Disclaimer. The ESC Guidelines represent the views of the ESC and were arrived at after careful c... more Disclaimer. The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written. Health professionals are encouraged to take them fully into account when exercising their clinical judgement. The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient's guardian or carer. It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription. Data derived from a single randomized clinical trial or large non-randomized studies.

European Heart Journal, 2006

The European Society of Cardiology (ESC) organized a one-day workshop with clinicians, health eco... more The European Society of Cardiology (ESC) organized a one-day workshop with clinicians, health economic experts, and health technology appraisal experts to discuss the equity of patient access to novel medical technologies in Europe. Two index technologies were considered: implantable cardioverter defibrillators (ICDs) and drug-eluting stents (DES). The use of ICDs range from 35 implants/ million population in Portugal to 166 implants/million population in Germany, whereas for implants of DES (as percentage of total stents) it is lowest in Germany at 14% and high in Portugal at 65%. These differences can in part be explained by a lack of structured implementation of guidelines, the direct cost in relation to the overall healthcare budget, and to differences in procedures and models applied by Health Technology Assessment (HTA) agencies in Europe. The workshop participants concluded that physicians need to be involved in a more structured way in HTA and need to become better acquainted with its methods and terminology. Clinical guidelines should be systematically translated, explained, disseminated, updated, and adopted by cardiologists in Europe. Clinically appropriate, consistent and transparent health economic models need to be developed and high-quality international outcome and cost data should be used. A process for funding of a technology should be developed after a positive recommendation from HTA agencies. Both the ESC and the national cardiac societies should build-up health economic expertise and engage more actively in discussions with stakeholders involved in the provision of healthcare.