Dr John McMurray: ESC Congress 2023 Has Something for Everyone

John McMurray, MD, FRCP, FESC

The European Society of Cardiology (ESC) Congress 2023 takes place August 25-28, 2023, in Amsterdam, the Netherlands. As ESC Congress chair, John McMurray, MD, FRCP, FESC, professor of medical cardiology at the University of Glasgow, explains to The American Journal of Managed Care^® (AJMC^®) how the meeting will spotlight heart failure, guideline updates, and late-breaking research in several areas of cardiology.

This interview has been lightly edited.

AJMC: What are some themes at ESC Congress 2023, and in which sessions are these themes highlighted?

McMurray: The spotlight of the congress is heart failure—it is still the consequence of many of the problems we try to prevent or treat in cardiology (eg, acute myocardial infarction) and indeed the cause of many as well (eg, atrial and ventricular arrhythmias). Heart failure is a problem that is relevant to all cardiologists and one in which there has been immense progress with both drugs and devices including new valve interventions. There is at least 1 digital health session for all aspects of cardiology, and we have a hub dedicated to digital health throughout the Congress. We also have an implementation track, highlighting the sessions which provide practical advice and insight into using the wonderful treatments in cardiology that we must ensure our patients receive. The great debate and hot papers sessions are always popular!

AJMC: What specific sessions or new formats at the meeting stand out to you, and why?

McMurray: As always, the Hotlines. We have 9 covering the whole of cardiology: acute coronary syndromes and coronary intervention, atrial fibrillation (AF; ablation, including in transplant candidates, and anticoagulation), acute and chronic heart failure, pacing and cardiac resynchronization therapy, cardiac arrest and resuscitation, shock, amyloidosis, myocarditis, cardiovascular oncology, and even COVID-19. Highlights include HEART-FID, NOAH-AFNET 6, ILUMIEN IV, and STEP-HFpEF.

AJMC: Which of the new guidelines most update or make the most changes compared to current practice?

McMurray: You have to come and find out! We have 4 very important new guidelines—endocarditis, cardiomyopathies, acute coronary syndromes, and cardiovascular disease in diabetes—and I think what is the first ever focused update of a guideline, the 2021 heart failure guideline, reflecting the exciting development in heart failure treatment over the past couple of years.

AJMC: What sessions, presentations, or topics at the meeting do you think are especially interesting?

McMurray: NOAH-AFNET 6 examines oral anticoagulation in patients with atrial high-rate episodes. This trial attempts to answer the very important clinical question of whether we should use anticoagulant therapy in patients with brief episodes of AF. We know that sustained AF leads to a high risk of stroke which can be effectively and safely—with respect to bleeding—reduced by treatment with an anticoagulant. But is this also true for short episodes of AF? A question that comes up almost every day.

In Hotline 2, the HEART-FID is of particular interest. Iron deficiency is very common in patients with heart failure and reduced ejection fraction, and intravenous iron seems to improve symptoms and exercise tolerance. However, the AFFIRM-HF and IRONMAN trials have left some uncertainty about the effects of this therapy on hospitalization and mortality. HEART-FID is by far the largest trial to date using this treatment and should help answer this question.

The trials in Hotline 4 will give us important new information about optical coherence tomography in coronary disease, a very hot topic. Are the days of angiography alone to guide percutaneous coronary intervention over? How does optical coherence tomography compare with intravascular ultrasound? As in some of the other Hotlines, this one will not only have large new trials but also meta-analyses putting these and prior trials together to give the most definitive answer to key questions. I’m pleased that we have important trials (eg, FIRE and FRAIL-AF) focused on older patients, who are an increasingly important segment of the population. I’m proud that we have what I believe is the largest-ever randomized mortality/morbidity trial with traditional Chinese medicine in heart failure (QUEST) and delighted with the many important trials being presented by investigators from countries in Asia.

Bottom line: there is something for everyone here!