The British Cardiovascular Society (BCS) Annual Conference 2022 was held on the 6–8th June in Manchester, UK. This year saw a return to meeting in-person, drawing delegates away from their Zoom screens and welcoming them back to the Manchester Central Convention Complex. Moreover, this year marked the centenary of the society and were honoured by a visit from Her Royal Highness, The Princess Royal. Dr Alexandra Abel reports selected highlights from BCS 2022.
100 years in cardiology
Born in 1922 and originally known as “The Cardiac Club”, the British Cardiovascular Society (BCS) is the world’s oldest professional cardiac society. To celebrate “100 years in cardiology”, five centenary lectures were given at BCS 2022 by world-renowned speakers (… three of whom were called John): Professor John Camm (heart rhythm); Professor Barbara Casadei (cardiovascular research in the UK); Professor John McMurray: (heart failure); Professor John Deanfield (coronary artery disease); and Professor Catherine Otto (cardiac imaging). The centenary lectures charted the impressive evolution of cardiovascular science over the last century, but I particularly enjoyed learning about the history of the society and its founding members.
The BCS was founded by a group of physicians, which included Sir Thomas Lewis and Sir James Mackenzie. The original object of the club was: “the advancement of cardiology and the promotion of friendship among those interested in diseases of the heart.”1 It was a rather exclusive club, and members risked eviction if they missed two consecutive meetings without satisfactory explanation! A century later, the BCS has evolved into a thriving charitable organisation for “the advancement of knowledge of diseases of the heart and circulation for the benefit of the public.” Though, one would hope the promotion of friendship has remained part of the hidden curriculum of the society.
Professor Camm (St. George’s University Hospitals NHS Foundation Trust, London) explained that Sir Thomas Lewis had a great friendship (and rivalry) with Sir James Mackenzie. Together, they founded the journal Heart. Lewis hated the term “cardiologist” and wanted us to be called “cardiovascular specialists”. It is apt, therefore, that the BCS is now a “cardiovascular society”. This terminology also serves to encompass and celebrate the range of professionals involved in cardiovascular care. Professor Camm explained that Lewis’ great contribution in arrhythmology was the study of atrial fibrillation (AF). Lewis once remarked, “the notion of the patient continuing to live with an auricle incapable of contraction is a somewhat novel idea. It seems necessary to devote a little study to this condition.” One hundred years on, there has been rather more than a little study in this area; at BCS 2022, there were several sessions dedicated to AF, covering topics from screening to new approaches in AF ablation. I’d like to think Sir Thomas would have enjoyed the debate between eminent electrophysiologists on whether all whales are in AF. That’s all whales, not all of Wales. Apparently, at least one whale is in sinus rhythm.
For anyone who wishes to explore the history of the BCS in greater depth, I would highly recommend The BCS Museum (http://www.bcsmuseum.org/). The collection includes an archive of manuscripts, original papers, and biographical material. In addition, “100 voices” is a series of recorded oral histories available as podcasts on the BCS website in the members area. The centenary edition of Heart also showcases an excellent collection of commentaries and reviews, celebrating 100 years of cardiology.
Women in Cardiology
The fifteen founding members of The Cardiac Club were men. Eighteen years later, in 1940, Dr Janet Aitken and Dr Doris Baker were the first women physicians to become members of the society.2 We’ve come a long way in supporting women in cardiology over the last century, but there is still work to be done. The BCS Women in Cardiology (WIC) team (https://www.womenincardiology.uk/) aim to increase the number of women coming into training and support those already working in the specialty.
Mr Simon Flemming (Barts Health NHS Trust, London) is probably the first orthopaedic surgeon to speak at the BCS annual conference. At BCS 2022, he shared his experience in allyship and advocacy. Civility and respect produce better outcomes (including staff retention and patient outcomes); however, bullying and harassment is still present in some specialties, including cardiology, and disproportionately affects women. Mr Flemming explained that one of the reasons cultural change is so difficult within large organisations like the NHS, is that the current model has already worked for the people at the top. His advice to all was:
- don’t be a passive bystander – what you permit, you promote; and
- systems change is needed (not just personal responsibility): we need to change people’s core values and how they view the world in which they exist.
He noted that successful cultural transformation often allows people to make mistakes but expects them to learn from them and do better.
Dr Sarah Birkhoelzer (University of Oxford) discussed flexible training and WIC. Among the main reasons trainees give for their choice of subspecialty are:
- working acceptable hours and
- working conditions.
Flexible and less than full time (LTFT) training is becoming an increasingly desirable option for trainees and consultants. The number of consultants working LTFT has been rising over the last decade both for women and men. Dr Birkhoelzer emphasised the need to make this an accessible option, and to support those who choose LTFT at any stage of their career.
Trainees regularly spend more hours than they are contracted each week in service provision (not including the extra hours required for audits, research, or preparing for exams). Dr Birkhoelzer emphasised that we should not wear exhaustion as a badge of pride. Physicians are 1.5 times more likely to die by suicide than the rest of the population and female physicians have double the risk of suicide. Her take-home message was to check in with our colleagues and ask them: “How are you?”.
My main highlight of BCS 2022 was attending the WIC dinner, which was held at the Grand Pacific. Thank you to Dr Rebecca Dobson, BCS WIC representative, for organising this brilliant event. I have never seen so many women in cardiology in one room – all with different stories to tell. I left feeling a sense of community that is often lost in the modern NHS.
The WIC team host regular webinars and online chats. These can be viewed and accessed on their events page (https://www.womenincardiology.uk/events). You can also follow them on Twitter @BCSWIC (https://twitter.com/bcswic).
A royal visit
We were extremely fortunate to welcome The Princess Royal to BCS 2022. Her Royal Highness (HRH) Princess Anne attended the conference in person to deliver a short address, during which she praised the work being done by the WIC team to encourage more women to consider a career in cardiology. HRH was also able to observe an echocardiogram, performed on a volunteer. HRH pointed out the need for excellent communication during examinations and investigations. We might forget that routine procedures, such as echocardiograms, are entirely alien to many patients. HRH reminded us of the need to explain what we are doing every step of the way – an important message since many of us have likely forgotten what it is like not to know what an echo should involve.
Health inequalities in cardiovascular disease
Professor Amitava Banerjee (University College London) delivered an incredibly important “hot topic” on health inequalities. You are four times more likely to die prematurely from cardiovascular disease in the most deprived areas of the UK, compared with the least deprived areas. Internationally, the low-income countries carry most of the burden of disease. Professor Banerjee emphasised the need to move on from describing disparities to addressing inequalities in practical terms.
Professor Banerjee explained that we are aiming for justice, but for justice to prevail, we must first understand what barriers are in place, and how to remove them. There is a need for research and innovation in low-income countries; however, countries with the highest disease burden have the lowest number of publications. Professor Banerjee recommended journals waive their fees for low-income countries. Moreover, traditionally research has been quite discovery oriented, but we haven’t implemented all of what we know – Professor Banerjee emphasised the need to focus on the implementation of evidence in under-served areas, and greater coverage of global health in our curriculum.
Professor Vijay Kunadian (Newcastle University) is the first female professor of interventional cardiology in the UK. She delivered an excellent talk in relation to her role as commissioner for the Lancet Commission on reducing the global burden of cardiovascular disease in women by 2030. Professor Kunadian explained that women do not just have traditional risk factors for cardiovascular disease (e.g., factors associated with pregnancy; higher breathing rates during intervention etc.). Over a third of deaths in women worldwide are from cardiovascular disease; however, it is under-recognised, under-diagnosed (e.g., under-referred for angiography), under-treated (e.g., under prescribed medications such as beta-blockers), and women are under-represented in clinical trials.3
Professor Kunadian shared the overarching recommendations of the commission:
- close knowledge gaps (e.g., more women in randomised controlled trials);
- enhance awareness of cardiovascular disease in women;
- target well-established sex-specific, under-recognised risk factors (e.g., hypertension, dyslipidaemia, etc.);
- strengthen healthcare systems and engage health professionals.
I would highly recommend reading the full report,3 as well as related comment,4 and perspectives.5
The Young Investigator Award
The Young Research Worker’s Prize was inaugurated in 1974 to celebrate young researchers in the field of cardiovascular medicine. The prize later became known as The Young Investigator Award (YIA) and included separate basic and clinical science categories to allow a broad range of work to be considered. At BCS 2022, the top five competitors had the unenviable task of condensing months (or years) of work into a five-minute presentation, followed by five minutes of questions from the judging panel.
Dr Raghav Bhatia (St. George’s University Hospitals NHS Trust, London) discussed the prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players; Dr Ziwen Li (University of Edinburgh) demonstrated a multi-omics approach to generate novel mechanistic insights and new targets for cardiovascular regeneration in the ischaemic adult heart; Dr Hamish MacLachlan (St. George’s, University of London) presented outcomes of a nationwide cardiac screening programme in young individuals; Dr Christopher Orsborne (University of Manchester) presented a novel internally validated risk predication model for adverse cardiac outcome in Fabry Disease; and Dr Marco Spartera (University of Oxford) demonstrated that reduced left atrial rotational flow is independently associated with the risk of embolic brain infarcts.
Dr Christopher Orsborne was declared the winner of the YIA 2022. Many congratulations to Dr Orsborne, and to the four runners up, on their hard work and excellent presentations.
Diary dates and resources
- For further information about the goings on at BCS 2022, please search the hashtag #BSC100 and #BCS2022 on Twitter. In particular, see the tweets of @SarahHudsonUK, who comprehensively documents cardiology conferences for the benefit of others.
- The BCS Annual Conference 2023 will be held on the 5–7th June 2023.
Conflicts of interest
None declared
Dr Alexandra Abel
Clinical teaching fellow
Hull York Medical School, Castle Hill Hospital, HU16 5JQ
([email protected])
References
1. Coats CJ. History of the British Cardiovascular Society. Heart 2022;108:761–6. http://doi.org/10.1136/heartjnl-2021-320139
2. Boon NA. British Cardiovascular Society: from club to community. Heart 2022;108:749–50. http://doi.org/10.1136/heartjnl-2021-320140
3. Vogel B, Acevedo M, Appelman Y, et al. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021;397:2385–438. https://doi.org/10.1016/S0140-6736(21)00684-X
4. Mocumbi AO. Women’s cardiovascular health: shifting towards equity and justice. Lancet 2021;397:2315–7. https://doi.org/10.1016/S0140-6736(21)01017-5
5. Lane R. Roxana Mehran: driving force in women’s cardiovascular health. Lance 2021;397(10292):2326. https://doi.org/10.1016/S0140-6736(21)01100-4
