The AEPC in Europe. Dr. András Szatmári
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The AEPC in Europe. Dr. András Szatmári President AEPC
Transcript of The AEPC in Europe. Dr. András Szatmári
The AEPC in Europe.
Dr. András SzatmáriPresident AEPC
The „Rule”
• Professional need
• Institutional development
• Political acceptance
The „Rule”
Professional need
pediatric cardiology in the past
The Past• Rheumatic fever was the still the target
• Hardly any possibility for treatment of CHD
• Technology was still missing
• No interventional treatment availableuntil the „Rashkind procedure”(60’)
• Surgeons approached CHD differently
The Past• Almost everything, what the paediatric cardiologist did was
„pioneering”
• AEPC was founded by the pioneers ment, as a
„club of friends”
The „Rule”
• Professional need
• Institutional development
• Political acceptance
The „Rule”
Institutional development
the „past”
Links in the past
Paediatrics
Heart surgery
CardiologyPaediatric cardiology
AEPC
The „Rule”
• Professional need
• Institutional development
• Political acceptance
The „Rule”
Political acceptance ?
• Legal recognition
• Financing
(unless quality is appropriate and costs are reasonably low…)
The „Rule”
Professional need
pediatric cardiology at present
The Present• Rheumatic fever is almost disappeared in Europe
• Wide range of treatment possibilities for CHD
• Technology is booming, knowledge cummulates
• Specialization: „interventionalist”, „imaging people”, „arrhythmologist”, „fetal cardiologist” etc.
• Surgeons begin to approach CHD as a specialty
•„congenital heart surgeon”
The Present Data
• Numbers / facts ( 10 M inhabitants, 100 000 live births / y )
– CHD incidence ~ 1 % (900 - 1000 / y)– ~ 30-40 % requires treatment (300 – 400 / y)
• ~ 50 % (!) < 1 y age (150 -200 /y)
– Multi-stage treatment, „redo”: cummulation– Still small numbers !!– Number of cases quality : linear correlation
600-700 procedures / y / 10 M inhabitants
The Present
S p a i n P o r t u g a l
F r a n c e
I t a l y
G e r m a n y
I r e l a n d
M o r o c c o A l g e r i a T u n i s i a M a l t a
S e r b i a
C z e c h R e p .
P o l a n d N e t h .
L u x .
B e l g i u m
S w i t z . A u s t r i a H u n g a r y
R o m a n i a
B u l g a r i a
T u r k e y G r e e c e
A l b .
R u s s i a
F i n l a n d
S w e d e n
N o r w a y
G r e e n l a n d
I c e l a n d
F a r o e I s l a n d s
D e n m a r k
L i e c h .
( D e n m a r k )
( D e n m a r k ) J a n M a y e n
( N o r w a y )
E s t o n i a
L a t v i a
L i t h u a n i a
B e l a r u s
U k r a i n e
M o l d o v a
M o n a c o
S a n M a r i n o
R u s s i a
S l o v a k i a
U . K .
B o s . & H e r z .
M a c e .
M o n t .
S l o v e n i a
C r o a t i a
G r e e n l a n d S e a
N o r w e g i a n S e a
A t l a n t i c O c e a n
M e d i t e r r a n e a n S e a
E u r o p e
1 9 9 6 M A G E L L A N G e o g r a p h i x S M S a n t a B a r b a r a , C A 8 0 5 6 8 5 - 3 1 0 0
Surgery vs. catheter intervention
0
100
200
300
400
500
600
700
surgery 273 264 440 421 533 619 587 594 530 560 537
intervention 20 55 84 123 131 160 220 194 210 250 204
1985 …. 1994 … 1998 1999 2000 2001 2002 2003 2004 2005 2006
Surgery
0
200
400
600
800
opus 273 264 440 421 582 619 587 594 530 560 537
cpb 111 119 320 317 355 373 368 360 299 340 311
mortality 50 42 29 20 19 22 22 23 19 15 20
85 … 94 … 98 99 0 1 2 3 4 5200
6
The Present
• complexity of the patients increased
• patients survive and reach adult age
• number of „marker” cases is still limited : experience, quality
• Costs increase constantly
• need for improving quality
S p a i n P o r t u g a l
F r a n c e
I t a l y
G e r m a n y
I r e l a n d
M o r o c c o A l g e r i a T u n i s i a M a l t a
S e r b i a
C z e c h R e p .
P o l a n d N e t h .
L u x .
B e l g i u m
S w i t z . A u s t r i a H u n g a r y
R o m a n i a
B u l g a r i a
T u r k e y G r e e c e
A l b .
R u s s i a
F i n l a n d
S w e d e n
N o r w a y
G r e e n l a n d
I c e l a n d
F a r o e I s l a n d s
D e n m a r k
L i e c h .
( D e n m a r k )
( D e n m a r k ) J a n M a y e n
( N o r w a y )
E s t o n i a
L a t v i a
L i t h u a n i a
B e l a r u s
U k r a i n e
M o l d o v a
M o n a c o
S a n M a r i n o
R u s s i a
S l o v a k i a
U . K .
B o s . & H e r z .
M a c e .
M o n t .
S l o v e n i a
C r o a t i a
G r e e n l a n d S e a
N o r w e g i a n S e a
A t l a n t i c O c e a n
M e d i t e r r a n e a n S e a
E u r o p e
1 9 9 6 M A G E L L A N G e o g r a p h i x S M S a n t a B a r b a r a , C A 8 0 5 6 8 5 - 3 1 0 0
2 hours flight-time
International cooperation
The „Rule”
Institutional development
the „present”
Paediatric cardiology at present in Europe
AEPC worldwide is the only continentally (Europe)
organized association for paediatric cardiology.
AEPC - professional relations
Congenital cardiology
AEPC
Adult cardiology
ESC
ECHSA
CESP,EAP
EACTA
Intensive anaesthesiology
Heart surgery
Peadiatrics
EAE
EACTS
EHRAGUCH
STS
UEMS
The institutional representations
EU committee
ESC
CESP, IAPCardiology Section
AEPC
surgery
Council of HC Ministers
paediatricsGPs
National societies
The Present
AEPC is far more, than a „club of friends” today !
The Future• To achieve quality, concentration of material and human resources
are / will be required
• Closer cooperation among the involved professionals is / will be obligatory
• Re-arrangement of the professionals will occur!!
The Future
• Political acceptance
• CIVILIAN INITIATIVE AND SUPPORT ARE NEEDED !
Danke !
