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Cardiology is undergoing massive changes as prevalence of cardiovascular disease continues to increase while resources decrease. Imaging can help in more than one way, a leading German cardiologist explained at EACVI2023 last month in Barcelona, Spain.

The burden of cardiovascular disease (CVD) is tremendous and varies from country to country, according to Stephan Achenbach, Chairman of the Department of Cardiology at Friedrich-Alexander-University of Erlangen-Nürnberg, Germany.

‘The burden is very high in central Asia, eastern Europe and Africa,’ Achenbach told delegates in the Keynote lecture that kickstarted the first unified multi-modality meeting of the European Association of Cardiovascular Imaging (EACVI). ‘There’s a lower burden in western Europe, Australia and high income North America.’

Prof. Dr. med. Stephan Achenbach

Three diseases particularly contribute to CVD burden: intracerebral hemorrhage, ischemic heart disease and ischemic stroke. These last two diseases are actually the major cause of death worldwide.
‘CVD causes almost 18 million deaths per year,’ he said. ‘That’s almost the double of cancer, which is another terrible disease.’

However, the progress that cardiovascular medicine has made recently is second to none, he was quick to add.

‘Looking at life expectancy in the United States over a time period of 30 years, the average life expectancy increased by nearly six years,’ he said. ‘That’s mainly due to improvements in treatment and management, and, to some extent, prevention of CVD, especially coronary artery disease.’

In spite of the strides made in CVD management, the burden is not decreasing – quite the opposite. While 12.3M patients died of cardiovascular disease in the world in 1990, 17.3M did in 2013 – a 41% increase.

So what is causing this paradox? Although treatment has improved, the increasing population and especially the increasing number of elderly patients are causing more CVD deaths every year.
‘The increasing population is responsible for more than 25 percent of cardiovascular deaths and more than 55 percent are due to aging,’ Achenbach said. ‘These deaths overcompensate by far the improvements we’ve made in CVD management.’

More patients, older patients: a ticking time bomb

It is important to remember that CVD are diseases of the older age, he argued. ‘In Germany, for example, there is an exponential increase in the prevalence and number of deaths when age goes beyond 70 in women and 60 in men. CVD in the aging population is exponentially more frequent than in younger cohorts.’

The prevalence of valvular heart disease in particular increases exponentially as the population grows older, a trend which is expected to continue over the next decades, with a massive growth in the number of people aged 70 or more.

‘If there’s an exponential increase of valvular heart disease with age, even a slight increase in the average patient population will lead to a massive increase in the number of patients who will need CVD care. That is something we cannot neglect,’ Achenbach said.

The phenomenon is already tangible in hospitals, he added. ‘You can feel how the number of patients is increasing from year to year. And this is only the beginning.’

In a study looking at heart failure (HF) in 4M patients between 2004 and 2014 in the UK, researchers observed a 2% increase in HF incidence, a 12% increase in annual new diagnoses and a 23% increase in HF prevalence, due to the increasing volume of elderly patients.

With aging, the number of comorbidities is also increasing. The average number of significant comorbidities in patients with HF was 3.4 in 2004 and 5.4 in 2014.
‘Comorbidities become more and more frequent because patients are getting older,’ he said. ‘There’s so much we can and should do. But there’s also a problem of resources.’

In Germany, 1.2M 65 year-old people leave the workforce every year, compared with 750,000 20 year-old who start working.

‘The newcomers want a better work life balance than in the past and the boomers who leave the workforce will live longer than ever before,’ he said. ‘We don’t have a solution, but this will be a problem for cardiology and medicine in general.’

Cardiac imaging has a tremendous opportunity to make cardiovascular care more effective and efficient – by helping make more accurate diagnoses and better therapeutic decisions based on imaging findings, and by guiding interventional procedures to ensure their optimal effect and avoid complications, especially in the elderly.

‘Along with the changes that AI will bring about in imaging, by relieving imagers from repetitive tasks, and by providing tremendous potential to enhance diagnostic and prognostic accuracy, I expect a massive change from the traditional “diagnostic“ role of cardiac imaging, which will become an essential component of therapeutic management,’ he said.

This will be a challenge and come at a cost, he conceded. ‘Imagers will need to have highly specialized knowledge not only in imaging, but also in disease etiology and therapeutic options. If we want to be valuable as imagers, we have to acquire this knowledge otherwise it’s going to be the interventionist reading the imaging scans and making their own decisions. We really have to keep that in mind,’ he concluded. 

Bio:  Prof. Dr. med. Stephan Achenbach is Chairman of the Department of Cardiology and Professor of Medicine at the University of Erlangen, Germany.  His main clinical interests and areas of research are cardiac interventions and cardiac imaging with a special focus on computed tomography of the heart and the use of imaging to support coronary and structural interventional procedures.

Stephan Achenbach was the President of the Society of Cardiovascular Computed Tomography from 2005-2007, as well as the President of the European Society of Cardiology (ESC) for the mandate 2020 to 2022.