Download Spotlight: Manuel Antunes, MD, PhD, DSc

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December 2, 2008
European Perspectives in Cardiology
Spotlight: Manuel Antunes, MD, PhD, DSc
An Expert on Mitral Valve Repair Who Took Inspiration From
Christiaan Barnard, MD, and Whose Career Has Taken Him
From Mozambique to South Africa and Thence to Portugal
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Manuel Antunes, MD, PhD, DSc, head of the Department of Cardiothoracic
Surgery, University Hospital, Coimbra, Portugal, and professor of
cardiothoracic surgery, University of Coimbra, talks to Mark icholls.
I
n December 1967, when Christiaan Barnard, MD, performed
the world’s first heart transplantation in Cape Town, South
Africa, Manuel Antunes was studying at medical school in
neighbouring Mozambique. Born in July 1948 in a small
village close to Leiria, a town in the centre of Portugal, he
had emigrated at the age of 5 with his family to
Mozambique, where he pursued a career in medicine.
Had I Been Able to Go Back to Mozambique, I
Would Probably Have Become a General Surgeon
Dr Barnard’s operation served not only as a watershed in cardiac surgery; Manuel Antunes, MD, PhD, DSc, says it also
inspired him to become a cardiac surgeon. And the environment in which he studied proved pivotal to making this a
reality. Professor Antunes explains, “I was probably touched
by the world’s first heart transplantation. Unrelated to this, I
moved to South Africa in 1975, which was to be for only 2
years, for a PhD. The independence of Mozambique and the
civil war that followed, associated with closure of the borders between the 2 countries for political reasons, prevented
me from going back and resulted in me following a career in
Johannesburg [South Africa]. Had I been able to go back to
Mozambique, I would probably have become a general surgeon, because cardiac surgery was not possible there.”
Professor Antunes graduated from medical school at
the University of Lourenço Marques, Lourenço Marques,
Mozambique, in 1972, and he received specialist training
in cardiothoracic surgery in South Africa. He started as a
junior resident and progressively occupied the full range
of positions (consultant, senior consultant, chief consultant, professor, and head of the department) in the Division
of Cardiothoracic Surgery of the Johannesburg Hospital
and the University of the Witwatersrand, Johannesburg.
Several key figures influenced his career. He says, “I
was most fortunate to work with Professor John Barlow
[MD], one of the most important figures of the cardiology
world during the whole of the 14 years I spent in South
Africa. I was also influenced in my interest in valve surgery, and especially in mitral valve repair, which is one of
my main interests, by Professor Alain Carpentier [MD],
with whom I worked for a brief period in 1980.”
Professor Antunes also cites the influence of Sir Magdi
Yacoub, FRS, professor of cardiothoracic surgery,
National Heart and Lung Institute, London, United
Kingdom, and American cardiac surgeons Floyd Loop,
MD, and Larry Bonchek, MD.
“The Beginnings of Mitral Valve Repair in the Early
1980s Were Moments of Particular Excitement”
Professor Antunes’ interests lie in valvular surgery, mitral
valvuloplasty, and cardiac transplantation. Until September
2008, he served as chair of the Postgraduate Education
On other pages...
Spotlight: Carina Blomström-Lundqvist, MD, PhD, FESC
Carina Blomström-Lundqvist, professor of cardiology,
Department of Cardiology, University Hospital,
University of Uppsala, Sweden, has been working on
arrhythmogenic right ventricular cardiomyopathy for
more than 20 years.
Page f135
The Italian Heart Foundation
Andrea Peracino, MD, vice president of the Italian
Heart Foundation, and Emanuela Folco, PhD, secretary
general, talk about how they are working to create a
united political voice to fight cardiovascular disease in
Italy.
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Committee of the European Association for Cardiothoracic
the European Association for Cardiothoracic Surgery. As
Surgery and as chair of the Working Group of Valvular Heart
chair of the European Society of Cardiology Working Group
Disease of the European Society of Cardiology. He says that
on Valvular Heart Disease, he participates in putting
Professor Barlow honed these interests; he comments, “He
together the programme of the Annual Congress of the
European Society of Cardiology.
[Professor Barlow] constantly supported me in the painful
learning process of mitral repair, especially in the difficult
“If You Do ot Have the Time, Don’t Attempt to
setting of rheumatic valve disease in the very young black
Become a Cardiac Surgeon”
patients. I am also very keen on congenital heart surgery
Professor Antunes would advise anyone who wants to folbecause of my love for children and because it constitutes a
low a career in cardiology and cardiac surgery to study and
more creative type of surgery.”1
Professor Antunes returned to Portugal in 1988 to his
work hard. He adds, “If you want to be a doctor, make sure
present posts at the hospital and the historic university,
that you are prepared to dedicate your life to patients. Then,
where he teaches at both the undergraduate and postgraduate
study, study, study … work, work, work. If you do not have
levels. His research has an entirely clinical focus and mostly
the time, don’t attempt to become a cardiac surgeon.”
relates to his preferred areas of surOf his work in Portugal,
gical activity, particularly looking at
Professor Antunes takes the most
personal pride in having created a
mitral valve repair. In South Africa,
cardiac surgery department and
he participated briefly in animal
team, which he describes as “at least
research (using baboons) on heart
average European standard.” Now
transplantation.
age 60, he is working toward retireHe says, “I have always enjoyed
ment, but he comments, “I need to
all aspects of my work, but the
consolidate my team to make sure
beginnings of mitral valve repair in
that I can retire with peace of
the early 1980s were moments of
mind.” Away from medicine, his
particular excitement because of the
interests include reading, music,
pioneering aspect of its use in the
gardening, and soccer, and he plans
pure
rheumatic
population.”
to write and travel more when he
Professor Antunes has conducted
retires. Married to Maria da Luz, he
more than 600 communications and
lectures at international congresses, Professor Antunes with Professor Sir Yacoub, during a lives in Coimbra, and they have 3
and he has published 230 articles. visit by Professor Sir Yacoub to Coimbra to celebrate children.
The publications he considers his the heart transplantation programme in Portugal.
Although Professor Antunes
most important include his book Photograph courtesy of Professor Antunes.
foresees significant developments
Mitral Valve Repair,2 which until
in cardiac surgery, he has concerns
recently represented the only monograph on this type of surabout such rapid developments. He says, “The next decade
gery, and several original articles on mitral valvuloplasty.3,4
will revolutionise the field of cardiac surgery. Minimally
He has also participated in a number of international collabinvasive and robotic surgery will evolve, and hybrid proceorative studies.
dures with interventional cardiology will constitute a good
Professor Antunes’ work has received funding from state
portion of our activity. But I am sceptical about many of
institutions, hospitals, and universities, and he has won a
these procedures that have taken off without solid scientific
number of awards for his clinical, academic, and scientific
foundations.” He believes the major breakthroughs will
activities. These include the Merit Prize of the Southern
come in genetic and tissue engineering for repair of the damAfrica Cardiac Society, 1980; Award for Most Outstanding
aged myocardium and heart valves.
Citizen, JCC, Johannesburg, 1987; Gold Medal, City of
Leiria, 1999; Gold Medal, City of Coimbra, Portugal, 2006;
References
1. Klass BG, Levin SE, Dansky R, Milner S, Colsen P, Antunes MJ,
and Paul Harris Fellowship by Rotary International, 2007.
Kinsley RH. Surgical correction of ventricular septal defects in black
Professor Antunes also takes interest in the management
and white children—an 11-year study. S Afr Med J. 1990;78:656–659.
of clinical services and has written a book on the Portuguese
2. Antunes M. Mitral Valve Repair. Percha, Germany: RS Schulz; 1989.
3. Antunes MJ, Magalhaes MP, Colsen PR, Kinsley RH. Valvuloplasty
National Health Service, published in 2001. He serves as
for rheumatic mitral valve disease. A surgical challenge. J Thorac
editor, associate editor, and reviewer for a number of jourCardiovasc Surg. 1987;94:44–56.
nals, and he is a member of the American Association for
4. Butchart EG, Gohlke-Bärwolf C, Antunes MJ, Tornos P, De Caterina
Thoracic Surgery, the Society of Thoracic Surgeons, the
R, Cormier B, Prendergast B, Iung B, Bjornstad H, Leport C, Hall RJ,
Vahanian A; Working Groups on Valvular Heart Disease, Thrombosis,
European Association for Cardiothoracic Surgery, and the
and Cardiac Rehabilitation and Exercise Physiology, European
European Society of Cardiology. Currently president-elect
Society of Cardiology. Recommendations for the management of
of the Portuguese Cardiac Society, he will assume office for
patients after heart valve surgery. Eur Heart J. 2005;26:2463–2471.
a 2-year period in April 2009, and he also serves as coordinator of the postgraduate courses of the annual meeting of
Mark icholls is a freelance medical journalist.
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December 2, 2008
Spotlight: Carina Blomström-Lundqvist, MD, PhD, FESC
“A Big Future in Arrhythmias—It’s Exploding!
The Mechanisms of Atrial Fibrillation, Ventricular Fibrillation,
and Sudden Death Are Still ot Solved”
Carina Blomström-Lundqvist, professor of cardiology, Department of
Cardiology, University Hospital, University of Uppsala, Sweden,
talks to Barry Shurlock, MA, PhD.
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B
rought up in Stockholm, Sweden, by a father who worked
as an engineer and had distinguished himself as a roundthe-world yachtsman, Carina Lundqvist first considered
reading physics but found herself persuaded to study
medicine, which many considered more appropriate for
women. As the first physician in her family, she does not
regret her change of direction, but she does admire the intellectual challenges of physics.
After completing basic university medical training at the
University of Uppsala, Uppsala, Sweden, and then at
Linköping University Hospital, Linköping, Sweden, her
interest in the basic sciences nudged her toward cardiovascular haemodynamics and then electrophysiology (in
Swedish, “electrocardiology”), where the challenge of
unravelling intracardiac electrocardiographic traces seemed
as close to physics as she could get.
and localising accessory pathways. Then I went on to work
in the catheter lab, doing my own ablation procedures.”
The research articles of which Professor BlomströmLundqvist feels particularly proud include an early one that
“demonstrated for the first time that ARVC patients are at
high risk of dying,” which she says led—after 15 years—to
the recommendation of implantable cardioverter-defibrillators as first-line therapy for ventricular tacycardia.1 She also
takes pride in having been a coauthor of a report of a
European multicentre study that helped elucidate the
mechanisms of sudden death in ARVC.2 More recent
notable publications include studies with colleagues that
have shown the benefits for atrial fibrillation (AF) of Cox
Maze II surgery,3 and the finding from a Swedish trial that
epicardial left atrial cryoablation for permanent AF has a
more significant effect than mitral valve surgery.4,5
Working on Arrhythmogenic Right Ventricular
Cardiomyopathy for More Than 20 Years
After more than 20 years in the field, Carina BlomströmLundqvist, MD, PhD, FESC (her middle name comes from
her physician husband) now hopes to focus on long-term
follow-up studies of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), using genetic and clinical
markers. She says, “The diagnosis of ARVC is frequently
difficult to make in the absence of typical right ventricular
morphological findings, which is a problem, especially in
diagnosing relatives of patients with ARVC.”
Professor Blomström-Lundqvist first tackled ARVC in
her PhD, supervised by Professor Bertil S. Olssen, MD, at
the University of Gothenburg, Sweden, where she trained in
cardiology. She says, “I actually started my PhD studying
dilated cardiomyopathy. But after 6 months I found it too
‘medical’ and not sufficiently challenging—too much like
internal medicine. Some colleagues were studying
arrhythmias, which I found much more interesting—interpreting electrocardiographic traces, working out the different
mechanisms of such things as supraventricular tachycardia.
It was a time when catheter ablation was being introduced and
implantable cardioverter-defibrillators were being implanted
for the first time. Electrophysiology was exploding in the
mid-1980s, and it was all very exciting! My clinical work
was devoted to ablation procedures—I had very good
training at Gothenburg. We attended arrhythmia surgery
procedures—measuring [the electrophysiological variables]
“A Large umber of Original Ideas Are Taken From
Europe and Implemented in the Rest of the World”
Professor Blomström-Lundqvist strongly advocates the
benefits of changing location from time to time. She says,
“Moving place is a great challenge. You get to learn how
other people do things.” Although early in her career she
had some thoughts of working abroad, she has only done
so once, in 1989, when she spent a period with paediatric
cardiologist Jim Perry, MD, at the Texas Children’s
Hospital, Houston, Tex, learning techniques for performing
catheter ablation on small children. She then successfully
introduced the procedure into Sweden at the University
Hospital, Uppsala.
In 1989, Professor Blomström-Lundqvist took a senior
consultant post at the University Hospital, Lund; after 4
years there, she moved to Uppsala to head up the
Electrophysiology Laboratory in the Department of
Cardiology at the University Hospital. She now holds a
chair of cardiology that allows her to spend 30% of her
time in research and 70% in clinical work.
Professor Blomström-Lundqvist names Michel
Haissaguerre, MD, as someone she thinks has greatly influenced recent scientific developments in her field; in the
1990s, Dr Haissaguerre introduced radiofrequency catheter
ablation for AF in his ground-breaking work at Haut
Lévêque Heart Hospital, Bordeaux, France. One of
Professor Blomström-Lundqvist’s own research interests
involves developing these techniques further in the context
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of off-pump thoracoscopic
through the merging of Eurocatheter ablation surgery. She
pean Society of Cardiology
says, “Dr Haissaguerre is an
working groups on cardiac
extremely talented scientist
pacing and arrhythmias; the
and a good example of how a
new association has a growing
large number of original ideas
membership of more than
are taken from Europe and
2000. She says, “The most
implemented in the rest of the
important achievement is to
world. In our ongoing studies of
have created one strong organradiofrequency catheter ablaisation which, within the very
tion for AF, we want to assess
short time frame of 5 years,
the role of vagal denervation in
has become the leading organthe successful performance of
isation in arrhythmology in
the procedure.”
Europe.” She knows, however,
At Uppsala, Professor
that this new organisation has
Blomström-Lundqvist started
a hard task to reach the same
a long period of serving on a
level as established and wellwide variety of committees
resourced bodies such as the
and boards—the Swedish
US-based Heart Rhythm
Society of Cardiology, the
Society, founded in 1979, and
Swedish Society of Medicine,
now with a membership of
Some members of the research team working with Professor
the European Society of Blomstrom-Lundqvist at Uppsala University Hospital. From left nearly 5000 from more than
Cardiology, the European to right: Anders Jonzon, senior consultant; Professor Blomstrom- 70
countries.
Professor
Heart Rhythm Association, the Lundqvist; Helena Malmborg, consultant; Stefan Lonnerholm, Blomström-Lundqvist says,
American College of Cardio- senior consultant; Bozena Ostrowska, consultant; Leif ilsson, “There is a big future in
logy, the North American senior consultant; Joanna Wessbergh, study nurse; Per arrhythmias—it’s exploding!
Society of Pacing and Blomstrom, senior consultant. Photograph courtesy of Sevim The mechanisms of AF,
Electrophysiology, and the Yildiz, Uppsala University Hospital.
ventricular fibrillation, and
International Coalition of Pacing and Electrophysiology
sudden death are still not solved.” She would love to see
Organisations. These appointments have involved a wide
her students crack one of these great unknowns, but she
variety of subjects—practice guidelines, education, science,
says, “It’s very difficult to get younger doctors interested
ethics, information, and linguistics. She says, “You can learn
in research. It’s hard to motivate them. They ask, ‘What
from the way organisations work, and you have a chance to
will it give to me?’ Our politicians want people to be
lead the organisation towards a common goal—to dissemigood at administration and finance rather than having
nate knowledge, improve education, create opportunities for
research competence. It’s the trend everywhere, and it’s
research—whatever the aims are.”
very dangerous.”
Professor Blomström-Lundqvist has just finished organising the 200th anniversary of the Swedish Society of
References
1. Blomström-Lundqvist C, Sabel KG, Olsson SB. A long term follow up
Medicine, which claims to be the oldest general medical
of 15 patients with arrhythmogenic right ventricular dysplasia. Br
association in Europe (the British Medical Association did
Heart J. 1987;58:477–488.
not come into existence until 1832, and then under a differ2. Corrado D, Basso C, Thiene G, McKenna WJ, Davies MJ, Fontaliran F,
Nava A, Silvestri F, Blomstrom-Lundqvist C, Wlodarska EK, Fontaine
ent name). Along with holding a large number of Swedish
G, Camerini F. Spectrum of clinicopathologic manifestations of
Society of Medicine seminars, she has raised a large sum
arrhythmogenic right ventricular cardiomyopathy/dysplasia: a multiof money to fund future medical research.
center study. J Am Coll Cardiol. 1997;30:1512–1520.
“Politicians Want People to Be Good at Administration
and Finance Rather Than Having Research Competence”
Professor Blomström-Lundqvist now wants to spend more
time on her research and has begun “learning to say no” to
requests that do not have an international dimension. But she
would still like to extend the influence of Europe in the
world of pacing and electrophysiology. She points out that
cultural differences between various parts of the developing
world often require the tailoring of education and guidelines
from advanced industrial nations for local application. One
positive development has come with the European Heart
Rhythm Association, which came into being in recent years
3. Lönnerholm S, Blomström P, Nilsson L, Oxelbark S, Jideus L,
Blomström-Lundqvist C. Effects of the maze operation on health-related quality of life in patients with atrial fibrillation. Circulation.
2000;101:2607–2611.
4. Blomström-Lundqvist C, Johansson B, Berglin E, Nilsson L, Jensen
SM, Thelin S, Holmgren A, Edvardsson N, Källner G, Blomström P. A
randomized double-blind study of epicardial left atrial cryoablation for
permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF).
Eur Heart J. 2007;28:2902–2908.
5. Malmborg H, Lönnerholm S, Blomström-Lundqvist C. Acute and clinical effects of cryoballoon pulmonary vein isolation in patients with
symptomatic paroxysmal and persistent atrial fibrillation. Europace.
2008;10:1277–1280.
Barry Shurlock is a freelance medical journalist.
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December 2, 2008
The Italian Heart Foundation
Working to Create a United Political Voice
to Fight Cardiovascular Disease in Italy
Andrea Peracino, MD, vice president of the Italian Heart
Foundation, and Emanuela Folco, PhD, secretary general,
talk to Robert Short, BSc.
T
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he Italian Heart Foundation (Fondazione Italiana per il
Cuore; IHF), the leading heart foundation in Italy, has
worked with the many cardiology societies in Italy and sees
itself as having a role in bringing these societies together
politically (see www.fondazionecuore.it). Established in
1990, the IHF became a registered foundation in 2004.
Health and Medicine; and the Italian Society of Gender
Health and Medicine. The conference took place under the
auspices of 42 learned societies including the International
Atherosclerosis Society and the World Heart Federation.
The IHF has played an active role in primary prevention
for many years. Indeed, Dr Folco recognises the president
of the IHF and the Giovanni Lorenzini Foundation,
Rodolfo Paoletti, MD, PhD, as the first person in Italy to
have promoted the concept of lowering cholesterol as a
health target.
Close Links With International Organisations
The IHF has close links with the Giovanni Lorenzini
Foundation, an international foundation that has wider
interests than cardiovascular disease. Both organisations
cooperate at the national and international levels. Indeed,
Responsible for Promoting and Organising the Italian
Andrea Peracino, MD, vice president of the IHF, also
World Heart Day Since 2001
serves as vice president of the Giovanni Lorenzini Medical
The IHF has a good reputation for working closely with
Foundation. Dr Peracino trained as a
cardiologists from the various cardiopathologist and has broad experience in
logy groups, and it plays an important
industry and in hospital administration,
role in the difficult job of bringing the
having served as scientific director of
groups of cardiologists together. Dr
one of the leading hospitals in Italy and
Folco explains, “We are not a scientific
as chief executive officer of an internasociety, so the cardiology societies
tional pharmaceutical company. The Logo of the Italian Heart Foundation. don’t see us as a competitor. And we
IHF also forms part of the World Heart Courtesy of the Italian Heart Foundation.
have been in the field of primary preFederation and the European
vention for many years, so we
Heart Network, and it has links
know them all, we like working
Major Aims of the Italian Heart Foundation
to the International Atherowith them, and we develop projsclerosis Society.
ects together. We see ourselves
● To disseminate scientific information.
as a glue to keep all these groups
● To develop relationships between specialists, general
Organisation of Scientific
together.”
practitioners, and the general population
● To interact with government bodies to promote the
Congresses to Promote
Dr Peracino says, “We are
prevention of cardiovascular diseases
Primary Prevention
trying as the IHF to enable these
Emanuela Folco, PhD, secretary ● To carry out studies and research projects
associations—and ourselves—to
general for the IHF, says, “The
speak with one single voice.
IHF has as its main activity the promotion of primary preThat is our strategy. We currently use World Heart Day to
vention through the education of physicians and provision
build towards that aim. This event is an opportunity where
of information to the lay public. These goals are achieved
we put together, in working relationships toward a common
through the organisation of scientific congresses, mainly
purpose, many scientific societies, many national and local
international, and through educational campaigns.”
organisations, and many local activities.” ConaCuore, the
A conference held in Venice in October 2008—the
national confederation of patient associations, represents
Seventh International Symposium on Multiple Risk
one of the important national organisations. This powerful
Factors in Cardiovascular Diseases: Prevention and
patient group brings together about 119 local associations
Intervention: Health Policy—served as one such event for
and has the support of about 2 million people.
doctors. The IHF sponsored this together with the
The IHF has promoted and organised the Italian World
Fondazione Giovanni Lorenzini Medical Science
Heart Day since 2001. It does this in collaboration with the
Foundation, Milan, Italy; the Giovanni Lorenzini Medical
important institutions of the country, such as the Italian
Foundation, Houston, Tex; the European Society of Gender
Ministry for Health, the Ministry for University and
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December 2, 2008
Research, and the Ministry for Agriculture. The Italian Red
the public. It receives no government funding. Dr Folco
Cross, the National Association of Carabinieri, the
explains, “In Italy, there is very little culture for legacies
National Sports Federations, the Union of European
and door-to-door fund-raising, and the heart charities have
Football Associations, ConaCuore, and the Italian
to compete with cancer.” The cancer organisations do seem
Federation of Cardiology also take part in the collaborato get most of the attention and most of the political help.
tion, along with 20 scientific societies. During the World
A law exists that allows an individual or institution to
Heart Day ceremonies each year, a gold medal goes to a
donate a percentage of earnings to a charity. Of the 4
celebrity for the distinction of “Health Champion” of the year.
biggest beneficiaries of this law, 3 are cancer organisations.
Although the IHF operates internationally and has powAbout 10% to 20% of the funds go to research through
erful links and support, it remains a small organisation in
scholarships to young investigators—either to study in
itself. Dr Folco says, “Therefore, we focus on specific
Italy or to go abroad, for a minimum of 6 months and a
activities like the World Heart Day. Getting the major footmaximum of 2 years. The IHF awards about 3 or 4 such
ball teams involved in the event was an important coup for
awards each year. Dr Peracino says that research funding
the IHF, because it was broadcast throughout the Arabic
tends to go to specific projects that the IHF has an interest
world through inviting Al
in pursuing, rather than through
Jazeera to cover the event.”
grant applications. He comments,
The IHF numbered among the
“When we have a project, we
earliest foundations in Europe to
decide to direct funds to some
run the “Go Red for Women”
group of people or group of
campaign (called “Red Dress
young researchers.”
Italia” in Italy). It has important
links with the Italian Chamber of
“othing Has Been Done to
Fashion, Elizabeth Arden, and
Launch the European Heart
Vogue Italy, and it uses these
Health Charter ationally”
connections to get health mesPolitical influence through cultisages and information out to the
vating the interest of politicians
population using press events,
in heart disease has proved an
media contacts, television interelusive target. Says Dr Folco,
views, and testimonials, and by
“While we would like to have a
distributing brochures and
strategy for engagement with
leaflets at grocery stores, superpoliticians, one issue is that, in
markets, and shops.
Italy, every 2 years the politicians
Another major initiative has
and the ‘system’ change. In Italy,
come with the creation of the
we now do not even have a health
Italian and European Societies
ministry.”
for Gender Health and Medicine.
Although many heart foundaDr Folco stresses that people
tions say that the European Heart
should not confuse “gender medHealth Charter has proved a useicine” with or limited it to
ful political lever to engineer and
“women’s health.” Both socispeed progress, the IHF reports
eties cover all diseases and not The IHF has been responsible for promoting and organ- that, after a promising start in
just heart disease. She says, “We ising the Italian World Heart Day since 2001. Image Milan, it has not seen wider
are developing a Web site. For courtesy of the Italian Heart Foundation.
application in Italy. Dr Folco
each area, we are trying to define
explains, “We launched it very
the difference between genders. And, of course, cardiovassuccessfully in Milan. And we, of course, invited the politicular disease is one of the main areas.”
cians. No one came from the central government. But, still,
we wanted to launch it nationally. However, the Centre for
Funding Comes Primarily From the Institutions
Disease Control, responsible for prevention, has in the
Linked With the IHF, and Also From Banks and
meantime gone through a lot of restructuring, and nothing
Insurance Companies
has been done to launch the charter nationally.”
The IHF raises funds primarily from its partner institutions,
and from banks and insurance companies, rather than from
Robert Short is a medical journalist.
Editor: Thomas F. Lüscher, MD, FRCP, FACC
Managing Editor: Lindy van den Berghe, BMedSci, BM, BS
We welcome comments. E-mail [email protected]
The opinions expressed in Circulation: European Perspectives
in Cardiology are not necessarily those
of the editors or of the American Heart Association.
European Perspectives
Circulation. 2008;118:f133-f138
doi: 10.1161/CIRCULATIONAHA.108.191139
Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231
Copyright © 2008 American Heart Association, Inc. All rights reserved.
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