Together we achieve more

The mission of EuroPCR, the official meeting of the European Association of Percutaneous Cardiovascular Interventions (EAPCI, a registered branch of the ESC) is to contribute to the advancement of education and information in the field of cardiovascular intervention with the aim of reducing the burden of cardiovascular disease. The main thread of this year's programme focuses on two key messages: "what is best for my patient" and "together we achieve more".

Practitioners and patients are faced with an overwhelming amount of information on different treatment modalities and new technologies. It is challenging for practitioners to sift through the mass of information and apply it to the individual patient.

In deciding on the best treatment option for each individual patient, we must integrate a synthesis of knowledge and experience into a global appraisal of the patient's condition in order to power appropriate use of new technology and pharmacological products.

One of the goals of EuroPCR is to help attendees in the advancement of their own judgement in order to help themin answering the only question that really matters: "what is best for my patient".

What is the best for my patient

In asking ourselves this question we strive for excellence in health care. The first step is to recognise that what is best for my patient may still remain unclear and controversial, but making that first step should be part of the intellectual honesty with which we conduct our practice.

The sharing of experience, knowledge and different points of view in a climate of mutual confidence will help us answer this important question.

A strong collaboration between the different members of the cardiovascular community, with the full integration of cardiac andvascular surgeons in the decision-making process,will help us identify what is best for each individual patient.

The main theme of EuroPCR 2008 – "Together we achieve more" reflects this approach, as we grow our "collective intelligence" during the next four days here in Barcelona.

Clear-headed judgement

Judgement built in order to suggest "what is best for my patient" must be conducted on a basis of step-by-step reasoning with the sole aiming of reducing the risk of short or long-term mortality or irreversible events and to improve the quality of life of each individual patient.

The first step in the reasoning process is the "global appraisal of the patient", an essential, but often difficult task for practitioners that requires a synthesis of 'subjective' information (including intellectual, psychological, professional, cultural and ethnical differences) as well as 'objective' data (clinical, biological metrics, imaging data...). The subjective part may be influenced by the practitioner's interpretation (the "I think" factor). The search for excellence should be the motto of this global appraisal in synthesising all information, respecting ethical considerations and controlling any form of conflict of interest, for the best interest of our patients.

Knowledge

The second step is the integration of knowledge. Integration of knowledge in forming judgements entails a clear definition and comprehension of "what data matters". When asking ourselves what data matters, we should apply a pre-established scale of value to hierarchically rank the huge amounts of data available to us.

We encourage EuroPCR faculty members to link their comments and opinions to practice guidelines and to express why guidelines per se are necessary,but sometimes not sufficient to guide the decision-making process. To help attendees understand what data matters and allow them to apply their knowledge judiciously in the decision-making process requires the application of an ethic of information: the interpretation of datamust reject all forms of conflict of interest.

Guest faculty members are responsible for their actions when interpreting data derived from trials, studies or registries. Please be conscious of the influence you may have on the attendee's judgement when expressing opinions,suggestions,and recommendations while standing on the podium at EuroPCR.

Experience

The third step is the integration of experience in the reasoning process. On the one hand it is clear that our highest motivation comes from our own personal experience (good and bad), rather than from the way others think. On the other hand, your main objective in coming to EuroPCR is to improve your knowledge and expertise by hearing or seeing about the experience of others.

To be successful in this endeavour, the exchange of experience requires integrity, objective evaluation of reported experiences and positive criticism, with the sole aim of helping others as they strive to answer what is best for my patient?"

There is a strong intellectual force behind a practitioner when he expresses "I am not sure" or "I do not know". One of the cornerstones of EuroPCR has always been: express the truth to gain the trust. This requires that we use humility and honesty when voicing personal opinions.

One of the aims of EuroPCR is to unite the entire cardiology community in order to share experience, identify difficulties and to examine all possible solutions. The strong involvement of the cardiac and vascular surgeons - present in all the main sessions - encourages us to work in a positive and constructive way from diverging opinions to converging ones, and when possible, to establish a clear consensus. This is the path to a better understanding of what is best for each individual patient.

We encourage you to work towards a consensus with an open-mind and in a climate of confidence - in line with our motto "together we achieve more". The European Association for Cardiothoracic Surgery (EACTS) and the ESC Working Group for Cardiac Surgery have successfully applied the "together we achieve more" concept, and are an integral part of the scientific programme.We thank all surgeons and key opinion leaders who have accepted with enthusiasm to participate in the exercise of reaching a consensus.

In Room 1 on Friday, a session will be dedicated to the consensus reporting and we encourage all attendees to be present at this very important closing session.We trust that this session will picture the 2008 state of our collective intelligence!

Technology

The fourth step in the reasoning process is the understanding of what a new technology may potentially offer to improve my patient's outcome.

Innovation and technology are essential to reduce the burden of cardiovascular diseases and percutaneous interventions have reached their current state of the art thanks to entrepreneurial investment.

However, we must analyse the past history of percutaneous interventions with intellectual honesty.

To push the boundaries of surgery with similar short and long-term efficacy has been one of the objectives in the development of new technologies applied for less invasive percutaneous interventions. At the same time, the relationship with the surgical community has declined and globally deteriorated.

The irrational widespread extrapolation of data derived from selected low-risk populations included in the randomised trials on DES in complex patients who were good candidates for surgery, in the absence of solid evidence on the value added as compared to surgical revascularisation.

It has also sparked a debate on the long-term vigilance on safety issues and life-saving value of new technology applied during percutaneous interventions. This debate will eventually be very positive for patients as it will ensure a safer approach for implementation and use of new technology.

We are entering a new era in the history of percutaneous interventions: the transcatheter implantation of prosthetic valves in patients with severe aortic stenosis. The emergence of this new era creates a fantastic opportunity to re-establish the relationship with the surgical community, a necessary dialogue that is essential for the identification of what is best for each individual patient and will likely increase longevity and quality of life.

Careful patient selection, respect of ethics and the appropriate use of this technology requires us to reinforce the concept of a team approach. Positioning the cardiac surgeon as a gate-keeper will help us avoid the repetition of past mistakes and allow us to propose a consensus for an unbiased, long-term evaluation of these procedures.

Less invasive therapy may - but does not automatically portend better long-term outcome to patients with cardiovascular disease. Avoiding surgery, per principle, at all costs, by (ab)using new technologies must not be the main goal of our discipline.

The question pertains to the superiority or equivalence of one device-oriented procedure versus another. Problem-solving requires a team approach and perhaps in the near future, will lead to a new generation of "hybrid surgeons" correctly trained in the field of device and invasive interventions.

These comments can be equally applied to all fields of cardiac and vascular intervention.

To build a positive future, the entire community must be involved in the decision-making process and identify the added value of new technology as compared to existing treatment modalities. To achieve these objectives, rather than to compete or waste time in futile controversies,we must understand the power of "together we achieve more". This added value is based on a strong investment in innovation, education and training.

The virtuous cycle of investment-innovationnew- technology-improved outcomes is made possible thanks to entrepreneurial commitment on behalf of the industry. Here again,"together we achieve more" and the objectives of EuroPCR wouldn't be achievable without the full support of our industrial partners. We are convinced that our search of "what is best for my patient" requires involvement of the industry as an integral part of the health care system, the essential contributions of industry to both innovation and education,with mutual respect for our common interest in the patient's well being.

On behalf of the Board of Directors of EuroPCR and the leadership of EAPCI,we sincerely thank our industry partners for their continuous efforts and their key contribution to the success of the Course, year after year. Our equally sincere thanks go to all attendees of EuroPCR 2008 for nurturing our "collective intelligence" through their active participation in the sessions, debates, demonstrations and all forms of intellectual exchange and face to face interactions during the Course.

Jean Marco and William Wijns