Cardiovascular disease remains the number one cause of mortality and morbidity worldwide, in both developed and developing countries. We have made big advances in diagnosis and treatment and the mortality rates for many cardiac diseases, particularly for ischaemic heart disease, have decreased over the last two years. But we have been less good at prevention, which is why prevalence of cardiovascular disease is increasing in many places in the world.
Significant achievements have been made in the capacity to properly diagnose the main cardiovascular diseases, which has had major implications for the way patients are managed. In addition, therapeutic developments in drugs, procedures and devices have improved outcomes.
Much of the progress in diagnosis is thanks to cardiovascular imaging. Ultrasound, magnetic resonance, cardiac computed tomography, nuclear medicine and molecular imaging have enhanced our understanding of many diseases, enabled us to make diagnoses earlier in the disease process, monitor procedures, and follow-up patients in a better way. Invasive and non-invasive imaging methods are now used in the diagnosis of coronary artery disease, for example. In the future I envisage magnetic resonance becoming a cardiology technique in its own right. Discoveries in the area of genetics have also improved our ability to diagnose specific conditions.
In the medication arena, important steps have been taken in the fields of heart failure, hypertension, ischaemic heart disease and antithrombotic treatment for the prevention of stroke in patients with atrial fibrillation.
In procedures and devices, the last two years have seen major strides in percutaneous prosthetic valves, notably for transcatheter aortic valve implantation, which originated in Europe. We are now extending our success to the mitral, pulmonary and tricuspid valves.
We are more equipped to treat coronary artery disease, including obstructive coronary artery disease. With primary percutaneous coronary intervention, we have substantially reduced the mortality of patients with acute myocardial infarction. We now have drug-
eluting stents and bioabsorbable stents.
In the arrhythmology world, the introduction of implantable cardioverter defibrillators and cardiac resynchronisation therapy have dramatically brightened the outlook of patients with heart failure and at risk for sudden death. More knowledge is needed on the process of atrial fibrillation, how we can modulate the course of disease and intervene at an earlier stage, and how to select patients for ablation.
Those with severe heart failure now have the option of a mechanical heart, which is destination therapy in some cases. Research in myocardial regenerative therapy is taking us towards replacing areas of injured myocardium and potential complete reconstruction of the heart.
Precision medicine, which involves being more specific for the individual patient and the individual process, is becoming a reality. Here, genomics and proteomics will be used to find new ways of dealing with certain mechanisms of disease and tailoring treatments.
The extended heart team concept has been created and includes basic and clinical scientists, plus all the specialties involved in the treatment of patients with cardiovascular disease – cardiologists, surgeons, anaesthesiologists and many other others. This patient-centred model is becoming increasingly valuable to our mission to reduce the burden of cardiovascular disease.