DEPARTMENT OF MEDICAL HISTORY
Department of Medical History
European cardiology: 50 years
F W A Verheugt, J F Martin, L Ryden
Cardiology is one of the most rapidly evolving specialties
in clinical medicine. Diagnostic and treatment strategies
of a high standard have been developed, most of these in
Europe. Electrocardiography was invented in the early
1
900s by Einthoven in the Netherlands, who was
awarded the Nobel price in 1924. Heart catheterisation
was introduced by Forssman in 1937, who for this,
shared the Nobel price with Cournard and Bernard in
1
956. Permanent pacing was first done in 1958, and the
tilting-disk heart valves were introduced in the 60s, both
in Stockholm, Sweden.
Thrombolytic treatment for acute myocardial infarction
originates from Russia and the first percutaneous
coronary intervention was done in 1977 by Grüntzig in
Zürich. Vascular biology was founded by Moncada and
Vane in the 70s in the UK. The physiology and
pharmacology of the -adrenergic receptor was
discovered by Black in the 70s, also in the UK. Both Van
and Black became Nobel laureates for their work in 1982,
and 1988, respectively.
Figure 1: Number of hospital discharge diagnoses of
Many other advances in cardiology were developed in
the USA, and as in Europe the new achievements were
clinically tested and assessed in large clinical trials. Yet,
there was a certain rivalry between Europe and the USA
with regard to organisation and funding of basic and
clinical research. In the USA, single large institutions are
capable of funding research, whereas in Europe national
foundations are generally too small to generate large
grants. With this situation, fundamental and clinical
research is hampered. A challenge for the 21st century
will be to achieve new means or mechanisms for funding
research, possibly with support from the industry and
with the maintenance of academic independence.
cardiovascular disease per 1000 inhabitants per country in
Europe in 1995
Reproduced with permission from the European Society of Cardiology.
scientifically oriented working groups covering
cardiovascular medicine from a broad perspective. The
society is involved in education and the coordination of
clinical research of virtually all European cardiologists.
The yearly congress of the European Society of
Cardiology and the courses at the European Heart
House, erected in 1992, can easily compete with the
yearly US meetings and similar activities of both the
American College of Cardiology and the American Heart
Association. Therefore, European cardiology is as well
organised now as its counterparts in the USA and other
parts of the world. Furthermore, increasingly
cardiovascular disease and practice is registered in
Europe (figures 1 and 2).
Strength of European cardiology
With the founding of the European Community, funding
of research can be granted by European bodies like the
European Commission, which represents
a major
opportunity for European biomedical research in general,
and especially for cardiology. Nowadays, most clinical
research is funded by pharmaceutical sponsors so there is
an opportunity to counterbalance the current situation.
The European Society of Cardiology was founded in
Threats for European cardiology
More and more European bodies are funding basic and
clinical research, but to obtain grants is still rather
difficult. It is hard to oversee the complete field of
cardiovascular research in Europe, which is partly
because national funding can cause duplication of
research. Unified efforts in European organisations can
overcome this fragmentation. The combined power of all
cardiological centres in Europe is still largely underused
and can only be enforced by European concerted action.
The European Society of Cardiology is increasingly
sponsoring and training individual scientists from parts of
Europe where funding is more difficult. These scientists
are supported as fellows in centres of excellence of
European cardiology. But this programme is only a small
initiative. If European biomedical funding is not
1
950 and has, especially during the last decade, become a
major organisation and centre of knowledge. It consists
of 47 National Societies of Cardiology and 26
Lancet 2000; 356: 671–72
Department of Cardiology, Heartcenter, University Hospital,
University of Nijmegen, 6500 HB Nijmegen, Netherlands
(
F W A Verheugt MD); University College, London, UK (J F Martin MD);
and Karolinska Hospital, Stockholm, Sweden (L Ryden MD)
Correspondence to: Prof W A Verheugt
(
e-mail: f.verheugt@cardio.azn.nl)
THE LANCET • Vol 356 • August 19, 2000
671
For personal use only. Not to be reproduced without permission of The Lancet.