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Time to Fall in Love with ECHO

Evgenij Potapov, MD, PhD
Thomas Krabatsch, MD, PhD
German Heart Institute
Berlin, Germany

There is no need to explain here that VAD technology is good. At least, not to us. But there is a huge need to explain it to others. How can this best be done?

These days every other cardiac surgery department that implants VADs organizes some kind of VAD meeting. Meanwhile, the main VAD meetings such as the ISHLT and ASAIO annual conferences, the MCS Meeting in Berlin, and the EUMS meetings are attracting more and more attendees. Workshops, like ISHLT's MCS Academy or the MCS Workshop in Berlin, are continuously overbooked. The demand is evident, but are we targeting the right audience? Are we concentrating too much on ourselves? Are these meetings just for insiders, for "VAD junkies" - an increasing number of already addicted? Most importantly, how do we raise awareness about this kind of heart failure treatment in the wider medical community of GPs, cardiologists and family doctors - the key players involved in spreading acceptance of this treatment?

Meetings cost time and money, and both are limited. What's more, only a small number of GPs and family doctors actually attend such specialized conferences. So, should we continue talking to each other about the same topics on different continents, refining our solutions and perfecting our presentations, or should we use our limited resources in a different way?

Our publications, at least our main outcome studies, will eventually persuade our colleagues to endorse the VAD option. But this a long process, since not every physician reads the NEJM, Circulation or even the JHLT on a daily basis, and outcome studies are years behind real-life practice.

From our point of view, educating the next generation of general practitioners and young residents (who will themselves soon be in positions of responsibility) in the cardiology or internal medicine departments of our local community hospitals or home care facilities would be the best solution. New treatment options require explanation and education on the basic level of medical care of heart failure patients: Mitral clip in patients with an EF of <25%? Why not discuss LVAD as primary option? CRT or CABG in ICMP with huge scar? Why not consider primarily LVAD? A 75-year-old agile, mentally fit heart failure patient with cardiac cachexia? Why resort to palliative care?

Generally speaking, in Europe and the USA there are between 20 and 50 hospitals and cardiologists around one VAD center. A weekly lecture would be required to meet such a demand and this involves a lot of hard work—every week the same presentation, the same questions. In Berlin we initiated such a program, albeit with some skepticism. We wrote letters and offered to provide a lecturer who would speak on the modern treatment of heart failure, accompanied by one technician and one or two VAD patients. Within two months we had received more than a 50% positive response and now every week one of our two VAD surgeons is on the road giving lectures. More often than not the lecture goes on for longer than the scheduled 1 hour and our patients have turned out to be the highlight. We hope to make the rounds of all internal medicine, cardiology and intensive care facilities in Berlin and the surrounding area within the space of one year, before starting the cycle over again.

Ultimately, our success will be measured by decreasing numbers of referred INTERMACS level 1 patients, and increasing both the number of referrals of patients in INTERMACS class 3-4 and of requests for destination therapy. By the end of 2014 we will be able to judge the success of our education program, but until then we still have a lot hard work to do.

Last but not least, providing further training to members of the emergency services-police, fire brigade and paramedics-is a crucial part of our program in Berlin, and has now been integrated into the annual continuing education plan of the city's emergency services. VAD emergency guidelines are currently being prepared under the supervision of the MCS Council and, once finalized, will be integrated into the education plan.

Disclosure Statement: The authors have no conflicts of interest to disclose.

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