BCS CONFERENCE EMAGAZINE - MONDAY 3 JUNE 2013
Bringing you news and views from BCS and our 2013 Annual Conference
|Welcome to the 2013 British Cardiovascular Society Annual Conference
Vice-President Education & Research,
Chair of Programme Committee
We are delighted to welcome you to ExCeL, London for our 2013 Conference and thank you for joining us!
As always we have worked hard to deliver a high quality and varied programme for you. Through dedicated tracks, and activities in the Education Hall (formerly Exhibition), our programme caters for everyone and we hope that you enjoy all that is on offer!
Over a 3 to 5 year cycle we cover all topics in the cardiology curriculum and through on-line formative assessment can provide additional evidence of CPD for the trainee portfolio and for consultant revalidation. With education from the sub-specialties and updates in clinical translational and basic science research our programme is presented in the following ‘tracks’:
- National Training Day including SAC session
- Education for Revalidation (E4R) including joint ESC and ACC sessions and the ‘Top 10 Trials’
- Affiliated Groups (AG)
- Clinical Science / Translational Research (CS/TR)
- Basic Science
Abstracts are presented in the Imaging, CS/TR and Basic Science tracks with the final of the BCS Young Research Workers Prize (YRWP) in the CS/TR track and the BAS/BSCR Young Investigator Award in the Basic Science track.
Dedicated BCS sessions focus on quality, commissioning, cardiovascular disease prevention and sports cardiology. Our Affiliates SCST, BANCC/BACPR/BSH and CCP(UK) hold full day symposia at the Conference to which all are welcome to attend.
Our ‘Named Lectures’ this year will be delivered by Prof Anthony DeMaria and Prof Alain Cribier.
Our theme this year is ‘Innovation’ and we are delighted to present, in association with Medical Futures, symposia in the main programme featuring the world’s foremost experts in innovation and commercialisation such as Andrew Cleeland, Alain Cribier, Anthony DeMaria, James Muller and Mandy Haberman. Take a walk through the ‘Innovation Mall’ in the Education Hall and meet experts to inspire you and help you get your idea kick started!
New for 2013
Each year we aim to bring something new to the programme! This year we have:
- Spotlight session: We are delighted to welcome Prof Jane Burns, a world expert in Kawasaki disease from San Diego (Tuesday)
- Adopt a session: Edwards Lifesciences have generously supported a session entitled ‘Aortic stenosis- the cutting edge’ and delivered in conjunction with the BHVS (Tuesday)
- BCS Quiz: A Home Nations showdown! Teams from Edinburgh, Leeds and Cardiff answers cardiology and general knowledge questions in a bid to win the trophy! Quiz master- Dr Rod Stables. Not to be missed! (Wednesday)
- CPEX demonstration with 2013 Olympic Gold Medallist- Andrew Triggs-Hodge. Andrews coach has kindly released him from a training session for us to put him through his paces and more! (Tuesday)
The Education Hall has a dedicated programme of educational events this year. See the following article, the programme booklet, the website or the app for more information.
Annual Dinner - Tuesday 4 June, 2013
Do not miss the opportunity to network both professionally and socially! Now a highlight of the Conference, if you haven’t booked your ticket online, check at the registration desk for last minute availability. The floor plan for the Annual Dinner will be in the registration area as well. Our guest speaker this year is from ITV News.
Download our App for further information about the Conference, follow us on twitter @BritishCardioSo or use #bcs2013. Look out for our daily e-magazine and check out the website www.bcs.com for webcasts of the sessions from each day.
I hope you have an enjoyable and educationally rewarding time at the 2013 BCS Annual Conference!
This year we introduce the ‘Education Hall’ in place of the Exhibition. The Hall includes industry stands but also a great deal more!
Running in parallel to the main programme there will be a programme of various activities in the Education Hall to increase the educational opportunities open to you:
Hot topics: Over 80 short (15-45 minute) focussed presentations covering FAQ’s in cardiology and professional topics will be delivered by experts throughout each day in 4 areas in the Education Hall - 3 BCS Hot Topic zones and in the Arena (Industry and Innovation Hot Topics). These are informal and are meant to be interactive so please take the opportunity to ask questions. Seating is provided but you are welcome to stand at the back as well. Grab a coffee or your lunch and take a seat! See the programme for the ‘Hot Topics’ for more information.
‘6 minutes with…’ There are also 6 minute informal interviews with some of the BCS Executive and guest speakers at the meeting including the Presidents of the BCS, ESC and ACC. Informal but informative! See the Hot topics programme for more information. The interviews will be in the ‘Hot Topic’ zones
Innovation Mall with experts in intellectual property, design, entrepreneurship, start-up and investment to help you develop that idea you have. Wander through and feel inspired! Don’t miss the ‘Innovation Hot Topics’ in the Arena as well. See the online schedule.
Live team based simulation (Wednesday): Experience the virtual cath lab- participate or watch delegates deal with complications during a PCI! There will be 3 exercises during the day. Take a seat or watch from the back!
Improved simulation learning experience: this year we have a greater number and choice of simulators including a renal denervation simulator. These are open to trainees and consultants - to learn/develop a new skill or simply challenge your knowledge/techniques. The sessions are for an hour with up to 2 delegates at one time. There is a choice of objectives. On completion you will receive a certificate for your portfolio.
Education on the stands: As well as industry ‘Hot topics’ in the Arena, many of the industry stands will be hosting educational activities. Please visit the stands where the emphasis this year is on education. We thank all our exhibitors for their valuable contribution to the conference.
And back for another year- the cyclathon (on the CRY stand). See how far you can cycle compared to your colleagues, raise money for charity and you may win a prize! Go on…give it a go!
We do hope that you enjoy the extended educational opportunities available in the Education Hall which are designed to be more informal and interactive than the Main Programme. We would welcome your feedback for future years!
Atrial Fibrillation: Managing the epidemic
10.45 – 12.15, King George (Capital Suite 8-9)
Of course, alcohol, ischaemia, valvular heart disease, hypertension, electrolyte imbalance etc may act as triggers for the acute episode of AF but even after correction of these triggers, AF will often recur at some point - although we cannot predict with any accuracy when this may happen.
||Dr Simon Fynn
Consultant Cardiologist and Clinical Director for Cardiology, Papworth Hospital
This session, on the E4R Track, concerns an area of Cardiology that is of great importance to all involved in healthcare provision. The session comprises 3 talks from key leaders within the field and covers areas of great importance to anyone dealing with patients with atrial fibrillation (AF).
It is well known that AF is the commonest sustained arrhythmia in the western world and is generally an arrhythmia associated with the ageing process. For most patients who present acutely with AF, we have anti-arrhythmic drugs or electrical cardioversion to restore sinus rhythm. However, the rather depressing reality is that AF is highly likely to return at some point in the future.
This longer term management of AF for any given patient can be a difficult decision-making process. There are several different approaches and the one that may suit a particular patient with AF, may not be the best approach for their next door neighbour / uncle / brother etc who may also have AF! Whether one opts to control a patient’s “rhythm” or “rate” will largely be governed by the symptomatic burden that the patient has to bear. We currently do not have robust evidence to tell patients that being in sinus rhythm long term will prolong their life expectancy, as much as many believe this to be the case. Most of the electrophysiological (EP) community are united in the belief that catheter ablation for AF, in the right patient (i.e. patients with paroxysmal AF and structurally normal hearts) is an excellent treatment and associated with a significant reduction in the burden of AF. However, whether these patients can expect a ‘cure’ of their AF is a debateable point. Also a highly debated topic within the EP community is the place of catheter ablation for patients with persistent AF. These patients may need multiple procedures to achieve sinus rhythm – a fact that does not go unnoticed by the commissioners of healthcare. Exciting developments are evolving in this area of AF ablation in which ‘focal drivers’ and ‘rotors’ maintaining AF can be specifically targeted during an ablation procedure. It is very much hoped that these early encouraging results reported by a few centres can be replicated by other institutions.
At least of equal importance to the AF sufferer as symptom burden, is the risk of stroke. There has been an increasing recognition over recent years that aspirin provides very poor protection and for many patients with AF formal anticoagulation should be considered.
Furthermore, for those patients who warrant this, there needs to be a sound reason not to recommend such an approach. It is estimated that a patient needs to have over 250 falls per year before this becomes a contra-indication to anticoagulation! In terms of which anticoagulant to use, there are now ‘new kids on the block’ – recommended by NICE – which are at least the equivalent of warfarin in reducing stroke risk. In contrast to many new drugs, these new anticoagulants are greatly appealing to patients, with no requirement for regular blood testing and little known interaction with foods and other medications. The challenge will be determining which patients should be recommended these newer, more expensive anticoagulants in a “cash-strapped” NHS.
Training Day: SAC
13.45 - 15.15, St Katherine (Capital Suite 2-4)
Dr Jim Hall, Dr Ian Wilson
BCS Vice-President Training and VP Training Elect
The SAC session is open to all delegates but is of particular importance to both trainees and trainers. This years’ session has 4 short presentations followed by some time for Q and A.
David Holdsworth and Afzal Sohaib will present the results of the BJCA survey which reflects trainees’ views of the delivery of the present curriculum. Previous surveys have been particularly helpful to the SAC in terms of modifying practices to produce better training programmes and we look forward to hearing the latest views. This is complemented in Russell Smiths
presentation of the GMC survey, again a reflection of the trainees and trainers perception of training in the different UK deaneries and how the SAC uses this information to improve programmes.
Of concern to many trainees is the workforce projection and Jim Hall addresses this issue in his presentation of the latest projections from information obtained from both RCP and BCS databases. Ian Wilson will conclude the presentations with an update on the WPBA pilot and some proposals on curricular modifications
Team Simulation and the Simulator area|
Dr Andrew Wragg
Simulation Lead for BCS Programme Committee
||At the BCS Annual Conference this year we again have an extensive and expanded programme of simulator training.
Simulator training sessions are available throughout the three days of the conference and cover many of the technical skills that cardiologists require to practice. Although these sessions are invaluable to trainees, consultants are also encouraged to attend. All sessions are delivered by experienced consultants.
This year the training will be more structured and track to specific objectives from the 2010 cardiology curriculum. All pre-arranged sessions will last 60 minutes and will consist of a one-on-one tutorial with an experienced consultant trainer. On successful completion of a booked session the British Cardiovascular Society will award a Training Certificate. Training sessions will be available at the Simulator Area in the Education Hall throughout the Annual Conference.
Technical simulators are available covering:
- Diagnostic angiography (radial and femoral)
- Percutaneous coronary intervention (basic and complex PCI including IVUS, bifurcation, multi-vessel disease, radial PCI and STEMI)
- Transcatheter aortic valve implantation
- Electrophysiology (Pacemaker, ICD & CRT Lead Placement, device programming and trans-septal puncture)
- Transthoracic and transoesophageal echocardiography (with pathology)
- Surgical skills training for cardiologists (incision and suture techniques)
For the first time we are also introducing:
- Renal denervation
- Human factors training and crisis resource management (Wednesday only)
For more information visit the BCS website
||Renal denervation is an emerging technology for the treatment of resistant hypertension. We are fortunate to be one of the first conferences where renal denervation simulation will be available. This will be a great opportunity for consultants who have an interest in this new therapy to receive training from established operators on a high fidelity simulator, with the chance to explore many cases with different anatomical challenges.
Specific objectives will cover:
- Evidence and indication for renal denervation
- Case selection
- Diagnostic work up
- Denervation catheter manipulation and use
- Appreciating anatomical and pathological issues related to arterial anatomy
- Managing the patient and potential complications
For more information visit the BCS website
To book a simulator session please visit http://www.bcs.com/simulatorbooking/
While at the Conference you can go to the BCS.com stand (number B58) to use one of the laptops there to register yourself for an available slot.
A limited number of drop-in sessions will also be available and non-medical delegates are very welcome to try their hand.
E4R Track Highlights
Dr Chris Burrell
BCS Programme Committee
Achieve the 60% pass-mark and receive a BCS certificate for the relevant Chapter of the curriculum for your revalidation portfolio.
||2013 sees the start of the GMC’s revalidation for all doctors – yes, even highly trained cardiologists like you will be asked to demonstrate continuing professional development across the range of disciplines you cover. In an attempt to facilitate this process and make it more palatable for you, the British Cardiovascular Society has developed a high quality and yet entertaining educational programme to be delivered at the Annual Conference over a 5-year rolling cycle. This year will be the third year of the first cycle, but don’t worry – it isn’t too late to catch up!
The 2010 Cardiology Core Curriculum for trainees has been modified and simplified into a ‘Revalidation Curriculum’ of 6 Chapters, comprising 18 Topics (see details at the BCS.com website). Each year at the Annual Conference, the Education for Revalidation (e4r) track will comprise seven 90 minute sessions covering at least one topic from each of the 6 Chapters. After the session, or after the conference, you will be able to complete an online formative assessment (again, at the BCS.com website) of 9 or 10 MCQ’s relating directly to the session.
The emphasis of the educational sessions is on optimising your own management of complex cardiac patients through demonstrating the best evidence-based pathways of care, together with some review of the evidence and the underlying principles.
For example, Atrial Fibrillation: Managing the Epidemic’ (Monday, 10.45-12.15) will cover: the acute management of atrial fibrillation, with emphasis on measures to avoid (recurrent) AF as well as the optimal management of acute episodes; the increasingly complex issues of thrombo-prophylaxis, including how to tailor drug therapy to individual patients’ needs from the range of factor Xa inhibitors and other alternatives to
coumarins now available; and consideration of the appropriate role for DC cardioversion and radiofrequency ablation, indicating which patients are most likely to benefit and what long term outcomes we might expect.
Also look out for the session on ‘Prosthetic Heart Valves’ (Monday, 13.45-15.15), which will include discussion of appropriate surveillance intervals and the most suitable imaging modalities to request, as well as a comprehensive review of difficult management challenges for patients with valve replacements, including patient-prosthesis mis-match, valve failure, complex anti-coagulation issues and the management infective endocarditis in prosthetic heart valves.
‘Device Therapy in Heart Failure’ (Tuesday, 08.30-10.00) will include an outline of the best medical therapy (prior to considering a device), followed by separate talks covering cardiac resynchronisation therapy (CRT-P), implantable defibrillators (CRT-D), left ventricular assist devices (LVAD’s) and, finally, cardiac transplantation; and an ‘Approach to Complex CHD’ (Wednesday, 10.45-12.15) will walk you through the management of patients with complex congenital heart disease ‘in the echo lab’ (understanding the anatomy), ‘in the clinic’ (advising long term management) and ‘at the front door’ of the hospital (dealing with emergencies in complex CHD patients).
We may not see much syphilitic aortitis these days, but in the ‘Aorta Unfolded’ (Tuesday, 13.45-15.15), the optimal 21st century management of both acute aortic syndromes and chronic aortopathies will be reviewed in detail after some revision of aortic pathology. Add to these, sessions ‘Optimising Primary PCI Care in the UK’ (Monday, 16.00-17.00) and an alphabetical guide to some more uncommon cardiac syndromes ‘ABC of Cardiac Syndromes’ (Wednesday, 08.30-10.00) and you will be well on the way to your first set of revalidation certificates!
A walk up Quality Street
16.00 – 17.00, Auditorium
||Dr Simon Ray
Vice-President Clinical Standards and Chair BCS Quality Improvement Working Group
It will not have escaped anyone’s notice that the medical profession and healthcare in general are under intense public and political scrutiny in a way which has never been the case before. The findings of the Francis Report into care at Mid Staffs make unpleasant reading in any context and it is clear that there is growing pressure for a culture of transparency and accountability within the health service.
As a speciality cardiac surgery went through this in the wake of the Bristol Paediatric Surgery crisis and has taken on board the message that it is a reasonable expectation that not only should doctors be competent but that they should be able to demonstrate their competence and be seen to address any concerns that their performance may be slipping.
Modern medial professionalism goes further than publication of outcomes and demonstration of competence and requires that doctors keep the needs of their patients paramount and view their services through their patients’ eyes. Sir Donald Irvine, former President of the GMC, has for many years been a leading advocate for transparency and a strong patient focus in healthcare. He will give an overview of the principles underlying this approach and argue passionately for a change in the culture of the health service to place patients at the centre of everything that we do as members of cardiology teams.
Meaningful transparency requires that reliable data is collected such that outcomes can be assessed and benchmarked to agreed standards or risk models and here the cardiac national audit datasets are a matchless resource. Also required are robust and proportionate responses to manage any apparent outliers. This is far from easy to achieve and requires considerable investment of time and expertise. Cardiac surgery has led the way and outcomes of individual surgeons are now publicly available. Simon Kendall will describe how this has been achieved and where the SCTS is heading with their transparency agenda. Interventional cardiology is now following suit as one of 10 specialities where individual operator outcome data will be published later this year. BCIS are developing a process to enable publication and Peter Ludman will describe the particular challenges involved and how this will be achieved this year and further developed in the future.
With the support of Sir Donald Irvine and building on the initial experience of revalidation the BCS is developing its own programme to support cardiologists in all subspecialties to achieve and to demonstrate high standards of practice. There is a general recognition that the requirements of revalidation as currently configured set a relatively low bar and define acceptable performance rather than good or excellent practice, and that we should as a specialty be aiming higher. The BCS programme will include support for the develop of transparency of outcomes, through co-funding of an analytical post for the cardiac audits based at NICOR, adoption of patient related experience measures (PREMS), the provision of high quality life-long learning programs and continuing involvement in standard setting and clinical guidelines through interaction with NICE, the
ESC and other bodies. We will be developing a web portal to assist members in accessing educational and other resources to support good practice and will be working with the major affiliated groups to develop a cardiology dashboard to summarise individual practitioner’s achievements.
Strickland Goodall Lecture
17.00 - 18.00, Auditorium
Dr Iain Simpson
Chair and BCS President
In 1936, colleagues, friends and patients of Dr J Strickland Goodall established a fund to found a lecture and gold medal in his memory. The Worshipful Society of Apothecaries of London is the trustee of this fund and the subject of the lectureship should be some aspect of cardiology in its widest sense: physiological, anatomical and pathological, as well as clinical. The Society has hosted this lecture since 1983, the first lecture given by the late Professor Philip Poole-Wilson. Over the past three decades, many eminent cardiologists including Professor A John Camm, Professor Celia Oakley, Professor David Wood, Professor Derek Yellon, and Professor Keith Fox have delivered the Strickland Goodall lecture. Most recently, in 2011, Professor Kenneth Chien who enthralled the Society with his lecture entitled “Re-engineering regenerative cardiovascular medicine: towards heart stem cell therapeutics”.
Today, the British Cardiovascular Society is delighted to report that the 2013 Strickland Goodall lecturer will be Professor Anthony DeMaria. Professor DeMaria is the Judith and Jack White Chair in Cardiology at the University of California, San Diego, USA. A Master of the American College of Cardiology, and one if its former Presidents, Professor DeMaria is Editor in Chief of the Journal of American College of Cardiology. He graduated in medicine from the New Jersey College of Medicine in 1968. Following his medical residency at the United States Public Health Service Hospital in Staten Island, New York, he completed his cardiology fellowship training at the University of California, subsequently joining its faculty.
In 1981, he accepted the position as Chief of Cardiology at the University of Kentucky in Lexington, Kentucky where he remained until 1992 when he accepted the position as Professor of Medicine and Chief, Division of Cardiology at the University of California, San Diego. In 2004 he founded the UCSD Sulpizio Family Cardiovascular Centre. His is a world authority in cardiac imaging techniques, particularly echocardiography having published over 530 scientific articles. He is one of the true international leaders in cardiovascular medicine.
So, don’t miss his Strickland Goodall lecture later today entitled “Translating clinical research into clinical practice”. It promises to be another wonderful addition to the long tradition of the Strickland Goodall lecture series.
BCS Annual Dinner and Awards,
4 June, ExCeL, 19.00 till late
Dr Sarah Clarke
Chair Programme Committee
Vice President Education and Research
Do not miss the opportunity to network both professionally and socially! Now a highlight of the Conference, you will be welcomed at a champagne reception infiltrated by magicians and accompanied by a string ensemble. Your table will have a chance to win a magnum of champagne through the table top quiz to be completed as you take your seats: a good way to meet the other guests at your table! A three course dinner follows with fine wine and there is a cash bar.
During the evening the President, Dr Iain Simpson will present the Young Research Worker Prize for 2013 and over coffee we welcome our guest after-dinner speaker from ITV News.
If you haven’t booked a ticket for the Annual Dinner, you can check at the registration desk for last minute availability. Tickets sell fast!
The drinks reception (from 7pm) and dinner will be in the Capital Suite on Tuesday evening which will be transformed for the event! See you there!
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