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- Anthony N. DeMaria, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology⁎ ()
- ↵⁎Address correspondence to:
Anthony N. DeMaria, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology, 3655 Nobel Drive, Suite 400, San Diego, California 92122
I have just returned from the European Society of Cardiology (ESC) meeting in Stockholm. As is true of the Scientific Sessions of the American College of Cardiology and the American Heart Association, the meeting was large, comprehensive, and attended by physicians from around the world. Perhaps more so than the meetings held in the U.S., the ESC meeting reinforced the sense that the world is “getting smaller” and that cardiologists in different countries share many mutual interests. It is my sense that we are rapidly entering the era of international cardiology.
It is not surprising that people with common issues come together to share experiences, discuss problems, and develop a vision for the future. Clearly this commonalty exists with regard to cardiovascular medicine. Cardiovascular disorders continue to be the major source of morbidity and mortality in a large part of the world. The need for better risk stratification, earlier diagnosis, and more effective therapy creates a strong bond among all cardiovascular specialists. Scientific truths know no language or cultural boundaries, and we in medicine decided a long time ago that our knowledge is too important not to share. The exchange of new information in medicine sets the standard for openness and speed of transmission. Similarly, our laboratories have traditionally been open to training any individual with the desire and qualifications. One need only look at the pages of the Journal of the American College of Cardiology(JACC) and other journals to see the interaction of institutions and laboratories in different countries. Clearly, mutual clinical, research, and educational issues have provided a strong magnet bringing cardiovascular specialists together.
JACCstands as an excellent example of the international face of cardiology. For the past five years more than 60% of submissions have originated from outside the U.S. Many of those coming from inside the U.S. have been authored by visiting scientists from overseas. We are drawing a greater number of reviewers, editorialists, and editorial board members from the international community. Our content increasingly reflects issues and data specific to other parts of the world. JACCis truly a cardiology journal of the international community.
Although issues that are commonly shared provide the greatest stimulus for bringing together cardiologists from around the world, it is my impression that it is our differences that are currently piquing the greatest interest. Just as socioeconomic and cultural differences exist among countries, so do variations in medicine. In the past, it seemed that busy physicians were only interested in things that directly affected them. Why read about a disease that is rarely seen or a drug that is not available? However, as the world has gotten smaller, I sense a growing interest in many of the unique issues faced by physicians in other countries.
The spectrum of disorders encountered from country to country may often differ dramatically. In the U.S., we see very few cases of rheumatic or Chagas heart disease, which is still prevalent in other parts of the world. Similarly, Kawasaki’s disease is much less common than in Japan. (I suppose that Taka Tsubo Heart, originally described in Hiroshima, and now referred to as transient apical ballooning when seen elsewhere, should serve as a cautionary note regarding the uniqueness of disease). Conversely, the metabolic syndrome has reached near epidemic proportions in the U.S. The differences in disease spectrum now seem to be generating considerable curiosity.
The availability of technology is another major difference in cardiovascular medicine throughout the world. Of the many technological advances in diagnostics, noninvasive imaging modalities such as magnetic resonance and multi-detector computed tomography are obvious examples. While providing excellent capabilities, such instruments are complex and expensive and, therefore, are often unavailable. Countries differ with regard to the pharmaceuticals that are available both due to expense and to regulatory procedures. The prevalence of catheterization laboratories and surgical suites often varies. Urgent percutaneous coronary intervention and heart transplantation which may be the rule for patients in one country may be nearly impossible to offer to patients in another. Interestingly, the optimal utilization of such technology continues to be debated.
The system under which the health care is delivered is yet another major variable in different parts of the world. We in the U.S. are moving from private practice fee for service medicine by individual physicians and small groups to more managed care. The government plays a more major role in health care delivery in many other countries. The regionalization of medicine seen in much of the world has implications not only for clinical care, but also for clinical investigation, much of which is moving out of the U.S. Autonomy and compensation are additional factors dependent upon the health care system operative in a given country.
Clearly, many of the differences in cardiovascular medicine throughout the world are related to socioeconomic factors. If similar resources were available to all countries, one could anticipate that many of the variables between them would melt away. However, even with economic parity, it seems apparent that significant differences would exist with regard to many aspects of cardiovascular medicine. It is in rationalizing these differences that I believe we cardiovascular specialists have the most to gain from one another.
In view of the emerging interest in and importance of international aspects of cardiology, we at JACChave decided to specifically address this topic. Although all the details have not been finalized, we plan to introduce international pages in JACCearly next year. These pages will be prepared by individuals from throughout the world and will discuss issues of importance involving the practice of cardiovascular medicine, research, or health care delivery systems. We anticipate that, although these issues may be well known to those who live in these areas, they will be of interest to those who do not. These pages will also acknowledge again that JACCis indeed an international journal.
- American College of Cardiology Foundation