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GENERAL REMARKS
The Lipid and Atherosclerosis Society of Southern Africa (LASSA) has joined the South African Heart Association (SA Heart) as part of the strategy that aligns all the special interest groups within the broad context of cardiovascular practice and research in South Africa. This alignment also links LASSA to the European Guidelines for management and prevention of heart disease. The adoption of the guidelines has been indicated in the South African Medical Journal.
LASSA was founded in 1988 as a special group aligned with the Society for Endocrinology and Metabolic Disease of South Africa, and has had a very fruitful association with this movement. Every two years meetings are held simultaneously with SEMDSA but in 2006 the meeting will not take place as a result of an international diabetes meeting in Cape Town. The association between LASSA and SEMDSA is set to continue but LASSA will strengthen links with SA Heart.
LASSA has a small membership that is linked to the attendance of the bi-ennial meetings. The support for research into severe dyslipidaemia in South Africa has unfortunately decreased, and the number of specialised lipid clinics is also small. Nevertheless, a resurgent interest may be witnessed as a result of dyslipidaemia and atherosclerosis in HIV disease and its treatment. A concern is the lack of academic posts and laboratory facilities and expertise for working up patients with severe dyslipidaemias. It is of interest to attempt setting up a national network of lipid clinics that can serve private and public sectors alike.
Activities are limited to academic meetings but LASSA will explore any additional links and will contribute to any relevant requests for input. The introduction of new guidelines lead to a meeting on 13 April in which representatives of medical aid schemes discussed the financial implications of the lower target concentration for LDL cholesterol. These evidence-based recommendations have been adopted from the European guidelines. LASSA was instrumental in preparing a supplement for the SA Heart Journal in September.
FINANCES
LASSA currently has R76000 in a current account and R106000 in a 32-day notice deposit with Standard Bank. This amount is mainly from profits obtained from the biannual LASSA Congresses held in conjunction with the Society of Endocrinology, Metabolism and Diabetes of Southern Africa (SEMDSA) meetings. LASSA membership fees are R50 per annum, but few members pay their annual fees despite reminders. Membership fees are required for annual membership fee to the International Atherosclerosis Society (IAS), currently $3-00 per member per annum. An educational fund is available in a Cape Town bank for special meetings and to support overseas visitors and other education events. The amount available is R79 941-00.
D Raal,
Secretary
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Nuclear Cardiology Group
Current Committee Members
Professor P Manga
Professor A Doubell
Professor A Ellman
Unfortunately the Nuclear Cardiology group has been fairly dormant for the last year. The guiding force behind this group was Dr V Naidoo who has subsequently emigrated to the UK. I have had discussions with some members of the nuclear physician group as to the viability of this group. There are some nuclear physicians who feel this group should continue. I have tasked Professor J Esser to get a consensus opinion from the nuclear physician group in general with regard to the continuation of the nuclear cardiology group. His report is being awaited.
Professor P Manga
Cardiac Arrhythmia Society of Southern Africa (CASSA)
As a Special Interest Group (SIG) of SA Heart, CASSA undertook to organize this year’s 6th Annual SA Heart Congress, entitled Bergrhythms. Ronnie Jardine (Vice-President of CASSA) and his team have done a magnificent job of organizing a stimulating meeting at a delightful venue. I believe they have succeeded in combining a strong arrhythmia bias with sufficient general cardiological interest, which may serve as a blueprint for future meetings organized by SIGs.
CASSA has been active in running a number of successful workshops in Cape Town and Johannesburg. We plan to take the message of sound arrhythmia management to many smaller centres next year, in the form of a travelling “road-show”.
The paucity of electrophysiologists and lack of training facilities in South Africa is of great concern. This results in a huge unmet need for sophisticated procedures, such as catheter ablation of arrhythmias and cardiac resynchronisation therapy (CRT) for heart failure. Skills and standards for performing CRT are of particular concern. CASSA is actively addressing the issues and will come up with concrete plans in the near future.
Rob Scott Millar, Chairperson
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The Paediatric Cardiac Society of South Africa
INTRODUCTION
The current Executive of the PCSSA was elected at the AGM in 2004 and has met twice over the last year, in Cape Town in February and in Johannesburg in July. We have tried to bring greater formality to our affairs and attempted to improve the structures and governance within our organisation.
The proposed amendments to our Constitution (which will be put to the Annual General Meeting on 18 October 2005) reflect these intentions. We believe in transparency in the operation of organisations such as ourselves and to improve communication with members and interested parties, three newsletters have been circulated over this period.
We are a Special Interest Group (SIG) of the South African Heart Association (SA Heart) and have sought to further develop and strengthen that relationship. With the interests of PCSSA in mind, we have supported SA Heart’s efforts to bring order to their relationship with the SIGS. Although we wish to grow our activities on a regional basis, the major burden of responsibility remains the organisation of our annual scientific meeting and we look forward to a successful symposium in October. Expansion of our operations at a regional level depends on funding and in this regard we are pleased to report some growth in our reserves. We are hopeful resolution of the negotiation within SA Heart on the distribution of profits from the annual congress will fairly reflect our effort and contribution and bring us to an even healthier position.
FINANCIAL STATEMENT FOR YEAR ENDED 31 MARCH 2005
Our Treasurer Ray Dansky has prepared our Annual Financial Statement for year ended 31 March 2005. These have been audited by Mr Colin Bartkunsky (C.A.) and are appended to this annual report. Net assets of PCSSA as at 31 March 2005 were R 178 823.
SPONSORSHIP
We have been fortunate this past year to raise sponsorship for the activities of our society from several companies. Principally, this has been from Netcare, which has again supported our annual scientific meeting. Abbott Laboratories has also been generous in its support and in this regard we look forward to working with them on the further development and implementation where possible, of the Guidelines for the use of palivizumab in South Africa. We also wish to acknowledge with thanks the assistance received from Phillips Medical and Paragmed.
RELATIONSHIP WITH SA HEART
In January this year the President of SA Heart invited comment on a draft document on the relationship between SA Heart and the Special Interest Groups. Our response to this discussion paper was positive and we emphasised that PCSSA is very comfortable with our affiliation to and strong relationship with SA Heart. We see ourselves as an important organization within SA Heart and at the centre of its business. PCSSA has ensured our annual congress runs simultaneous with SA Heart Annual Congress, at the same venue and at the same time, running concurrently. We have for some years made it clear to our members that to be a member of our Society, they need also be a member of SA Heart. With membership of SA Heart, our members are just as important in SA Heart as cardiologists or surgeons not involved with children. We agreed that in our country, multiple separate meetings organized by the SIGs at different times through the calendar year, dilute the activities of SA Heart, add extra congestion to a busy schedule of local and international events and dilutes the ability to gain much needed sponsorship for what we feel should be the pre-eminent event of the year, the Annual Congress of SA Heart.
After input from PCSSA and various other SIGs, the President and Secretary of PCSSA attended a National Council Meeting of SA Heart on 4 June 2005. A final draft of this document will be presented to the AGM of SA Heart on Monday 17 October 2005. We were asked to comment on this document and have done so. The only area we feel requires clarity regards distribution of profits from the annual scientific session of SA Heart, namely the congress.
The annual meeting will be organised alternately by a regional group (RG) and a SIG. Accordingly, we noted that as long as PCSSA is a special interest group of SA Heart there would always be a SIG, namely PCSSA, involved in the organisation of the annual scientific session/congress. In the year when the Annual scientific session is organised by a RG and a SIG, according to the document, PCSSA can expect a 30% share of the profits. We have proposed that the text of the document is more specific in this regard.
In the year where the scientific session is organised by two SIGs (as in 2005 with CASSA and PCSSA), the division of profits (after the 50:50 split, SAHeart:SIG), between the SIGs is ambiguous. The document reflects a concern that, “the division of profits accruing must be divided up according to active participation in the organising committee, securing of sponsorship and international speakers, and not based solely on the content portion of the academic program that may apply to a particular group.” We have argued that for several years the PCSSA contribution to the organisation of the annual scientific session has gone way beyond the “content portions of the academic programme”. Again we want a more formalised approach and proposed that in a year where the annual scientific session is organised by two or more SIGs, the 50% share of the profits (because SA Heart will retain 50% anyway) will be divided equally between the participating SIGs.
We trust that the efforts of PCSSA will receive the recognition we deserve through incorporation of these changes into the final document.
MEMBERSHIP OF PCSSA
PCSSA is a special interest group of the South African Heart Association. To join PCSSA one needs join SA Heart as either an ordinary or associate member and pay an additional R100.00 subscription per annum to PCSSA. We have campaigned hard for higher levels of membership from our constituency but thus far have been disappointed with the results. We will approach this with increased vigour over the next year.
TRAINING GUIDELINES AND ADMISSION CRITERIA
The exams for Certification in Paediatric Cardiology commenced in 2003. So far there has been success for all three candidates. Exams were held in Johannesburg in 2003 and Cape Town in 2004. Both exams were arranged and convened by Dr Antoinette Cilliers. The October 2005 exam will be held in Johannesburg with one candidate.
Training guidelines and criteria for admission to the examination were drafted in 2002 for the College of Paediatricians, by Dr John Lawrenson and Dr Jeff Harrisberg. These criteria and requirements are available on the SA Heart website. The latest change to the "Admission to the examination criteria" has been the duration of training, now 36 months. This extension of the training period has been approved by the Health Professions Council of South Africa (HPCCSA) as of 29 September 2004). The request to lengthen the training time was initiated by Prof A Doubell when it was found that it was difficult to adequately train a cardiologist in 24 months because of all the procedures required to obtain a certain level of competency in viz. diagnostic and interventional catheterisation and echocardiography. After consultation with PCSSA and under guidance of Dr Antoinette Cilliers, "Paediatric Cardiology" adopted the 3 years proposal because of similar problems in training. The request for the extension went through the College of Medicine at a meeting held in Johannesburg early in 2004.
CARDIAC CATHETERISTION LABORATORY REGISTRY AND DATA COLLECTION
The Cardiac catheterisation Laboratory registry and data collection project of SA Heart has reached a fairly advanced stage under the leadership of Prof Anton Doubell and is now being tested in the adult cardiology unit at Tygerberg Hospital. Drs Harold Pribut, Jeff Harrisberg and John Lawrenson represented PCSSA in the initial planning. John Lawrenson will be further involved with Mr Tony Scott (the author of the database) in the design and implementation of the paediatric component of the registry and will liase with the members and centres accordingly.
HEARTLINK
Children’s HeartLink (CHL) is a United States based international charity dedicated to the prevention and treatment of heart disease in needy children. After their mission to South Africa in 2004, led by John Cushing, Director of International Programs CHL reported to the Medtronic Foundation (the primary funders) on their observations and recommendations on how CHL might help with the advancement of paediatric cardiac services in South Africa.
Following these recommendations, the Medtronic Foundation selected a project “To improve the retention and development of critical care nurses in South Africa”.
CHL has recently received funding from them for a two-year 'demonstration'
project. John Cushing has corresponded recently about a probable second visit to our country, between 13 and 20 November 2005, with the specific intention of selecting a “partner site”.
Although PCSSA was involved in the consultation process in 2004 and has been informed of the progress with this project, we have not been asked to make any recommendations to CHL about their project or site selection.
THE 4TH WORLD CONGRESS OF PAEDIATRIC CARDIOLOGY AND CARDIAC SURGERY
The President attended the 4th World Congress in Buenos Aires between 18 and 22 September 2005 as an official representative of PCSSA. The full proceedings of the congress will be available shortly in digital format. Antoinette Cilliers, John Hewitson and John Lawrenson (Executive members of PCSSA), Susan Vosloo and Andre also attended the congress. John Hewitson and John Lawrenson were both members of the Faculty having been invited to speak on “Operating in an environment with high HIV prevalence” and on “Myocarditis; Diagnostic challenges, antiviral therapy and immunosuppressive treatment”. Their participation in the scientific programme reflects their high standing internationally in heart disease in children and brings great credit to PCSSA.
The experience was only positive and on the strength of our participation we will propose to the AGM that PCSSA submits a formal bid to host the 6th World Congress of Paediatric Cardiology and Cardiac Surgery in Cape Town in 2013.
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NETCARE PAEDIATRIC CARDIAC SYMPOSIUM: 16-19TH OCTOBER 2005
Our annual scientific meeting will be held between Sunday 16 and Wednesday 19 October 2005 as part of the Annual Congress of SA Heart Association. Our co-organiser for this conference is our fellow Special Interest Group (SIG), the cardiac Arrhythmia Society of South Africa. Once again, for the third year running, we are grateful for the sponsorship received by the meeting is sponsored by NETCARE.
We have noted the theme of the overall congress is arrhythmia and have therefore included as one of our invited speakers Phil Sauls, the Director of the Children’s Heart Programme of South Carolina, Professor of Paediatrics in the Medical University of South Carolina and Medical Director of the MUSC Children’s Hospital in Charleston. However, we have an excellent surgical programme headed by Tom Karl, Chief of Paediatric Cardio thoracic Surgery, Professor of Surgery and Paediatrics and Surgical Director of Paediatric Cardiac ICU at the University of California San Francisco (UCSF) Children’s Hospital. There is also a strong focus on interventional cardiology and we are fortunate to have the participation of Shakeel Qureshi, Consultant Paediatric Cardiologist at the United Medical and Dental Schools of Guy’s and St Thomas’ Hospitals, London.
THE YEAR AHEAD
The Executive anticipates consolidating its leadership position in paediatric cardiology and surgery in South Africa. Next years annual congress will be organised by the Free State Regional Group and PCSSA. There are three new initiatives which we will undertake in our second term. There are increasing concerns that cardiac ultrasound or echocardiograms are being performed by persons (doctors and technologists) not trained in congenital heart disease. This has led to serious mismanagement of babies and children and to advice, which is not in their best interests. The burden of responsibility for this situation lies with paediatric cardiology where we have failed to provide leadership on behalf of children. After consultation with other interest groups PCSSA needs to establish guidelines on this subject, which will serve as the professions position on cardiac ultrasound in children.
The second issue relates to the use of our funds where we will create a formal path for application for congress support and hope to be able to establish a fellowship programme for specialists in training. Lastly, we will prepare our bid to host the World Congress!
My thanks to my colleagues in PCSSA for the hard work and support.
Dr Christopher Hugo-Hamman,
President
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South African Society of Cardiovascular Intervention (SASCI)
The past year has seen South African Society of Cardiovascular Intervention (SASCI) executive fullfill its mandate to establish a viable independent Special Interest Group within SA Heart Association attending to the many needs of the community of interventional cardiology in South Africa. 2005 has been an important year for SASCI with numerous initiatives coming to fruition.
The Executive Committee elected or seconded to a 2-year term of office ending in 2005 is: -
Chairman: Dr Tom Mabin (Education; liaison)
Secretary and Vice-Chairman: Dr Farrel Hellig (Database)
Treasurer: Dr Clive Corbett
Members:
Prof Danie Marx (Ethics),
Dr Mike Bennet (Guidelines),
Dr Graham Cassel (Industry; congress),
Dr Jai Patel (Tariffs),
Dr Steve Spilkin,
Dr Adie Horak,
Rob Kleinloog (surgical),
Dr Jeff Harrisberg (paediatric),
Mr Albert Denoon (Industry),
Mrs Heather Henry (Industry)
Executive Officer (nominated): Mr George Nel
All SASCI initiatives and actions should be evaluated in accordance with the stated objectives (as contained in our Constitution). These objectives are as follows.
- Operate as an educational institute of a public character by means of facilitating local, national, and international meetings.
- Promote collaboration between members and provide facilities for data collection on cardiovascular revascularisation activities in South Africa.
- Promote research opportunities and participation in national and international trials in the sub-specialty.
- Offer consensus on issues in the sub-specialty to professional societies, healthcare funders and industry in South Africa.
During the year SASCI have been proactive in all areas of interest with SASCI Executive Officer, Mr George Nel providing invaluable assistance in promoting our activities whilst maintaining a back office that ensures coordinated efforts.
The SASCI HELPLINE (083-458-5954) offers access to the Exco for enquiries; requests for assistance, lobbying etc. Requests are dealt with in a professional, confidential and efficient manner to provide a vital service to all.
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Our aim to promote educational opportunities for our members and colleagues has seen a number of major activities in line with SASCI objectives stated in the constitution.
- The establishment of an exchange programme between SA and UK for interventional cardiology registrars. Dr Sanjay U Maharaj (University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban) has been appointed as the first recipient of the Boston Scientific RC Fraser International Fellowship in Cardiovascular Intervention. During 2006 an additional two National Fellowships are planned.
- Carotid Workshop (SASCI - VASSA Joint Symposium in Endovascular Therapy for Carotid Artery Disease) was held in February 2005. This collaborative meeting brought together 70 delegates from the range of specialities (cardiologists, neurologists, vascular surgeons and interventional radiologists) interested in endovascular therapy. The international speaker, Dr Peter Gaines (Consultant Vascular Radiologist, Sheffield Vascular Institute) provided insights through his vast experience in both the clinical practice as well as scientific investigation of the field of carotid endovascular therapy. An expert local faculty supported him. Feedback from delegates indicates that the meeting has been of tremendous value.
During the Carotid Workshop nominees from the three societies that represent those involved in endovascular therapy (SASCI, VASSA and IRSSA) decided to collaborate within a formal “Endovascular Working Group” which will focus on issues such as tariffs, training, guidelines and accreditation. The working group aims to function as a unified voice for discussions between the stakeholders (practitioners, funders and hospital groups) in order to advance the proper implementation of the rapidly evolving field of endovascular therapy. The guidelines for carotid endovascular therapy were reviewed and an updated version is soon to be published.
- SASCI hosted a coronary and vascular workshop for registrars and junior consultants at Milpark Hospital on 7th May 2005. Twenty delegates from provincial hospitals across South Africa attended this inaugural workshop. Gaining exposure through observation of live interventional cases as well as lectures. This training initiative aimed at the public sector was made possible by the generous funding from members of the private health services sector and time allocated by participating specialists (as operators, moderators and lecturers) as well as cath lab staff.
The workshop consisted of four ‘live cases,’ which was conducted by local experts, focusing on contemporary coronary and carotid interventional catheterisation procedures. Three of the four cases were indigent patients made possible through extensive support from all sponsors and staff. Lecture topics covered the use of Anti-Thrombotic and Anti-Platelet therapy in the Intensive Care Unit and Catheterisation Laboratory and Role of Bare Metal - and Drug Eluting Stents. In order to extend the learning achieved the various operators, moderators and lecturers have contributed their unique perspective on the day’s proceedings (published in the SA Heart Journal of June 2005).
The “SASCI Coronary and Vascular workshop for registrars and junior consultants” will become an annual event with a high possibility of similar additional events sanctioned by SASCI during 2006. The host site for 2006 will be Albert Luthuli in Durban.
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- SASCI focus for the last quarter of 2005 will be the 3rd Indian Ocean Meeting of Cardiovascular Disease (27th November to 1st December 2005, Mauritius Island) which are jointly organised by France-Reunion, South Africa (SASCI) and Australia. An excellent and truly international faculty has been confirmed and it promises to be a great meeting in all respects. A number of our colleagues are participating in the programme from both academic and private sectors. We have received strong support from local industry and anticipate a large attendance from South Africa.
SA Heart congress in the Drakensberg this year unfortunately coincides with TCT meeting in Washington. For that reason SASCI plan to hold the AGM this year in Mauritius where we expect a greater number of our members to be present. SA Heart Congress 2006 will be held in Bloemfontein and SASCI are planning a two-day satellite meeting in conjunction with that, with live transmissions and a focused interventional programme.
- Regular regional case presentations and meetings amongst colleagues and staff were promoted through the Cordis Breakfast Club (CBC) initiative. The aim of the CBC is to provide and foster an environment suitable for the discussion/debate of interesting case studies, allowing for contributions and learning for all, while being social. This has been a fantastic initiative providing an interactive environment for all attendees. The 1st Cape Town meeting (during 2004) was attended by a handful of cardiologists and select industry. Since then the initiative has grown to such an extent that the most recent Cape Town meeting attracted 90 delegates (cardiologists, cardiothoracic surgeons, anaesthetists, medical technologists, radiographers and nursing staff). During May the inaugural Pretoria CBC took place in the format of an open debate with the focus on multi-vessel stenting “Disease entity and latest available information”.
The CBC program will be expanded to other regions during 2006.
Other noteworthy issues during 2005 were:
- Early 2005 saw the precipitous withdrawal of the Taxus drug eluting stent from the market on directive from the MCC. SASCI protested strongly against the manner in which this was done, without any prior warning to the Society, colleagues or the company involved. Despite repeated attempts to establish reasons for this, the MCC has yet to acknowledge these approaches by SASCI. The decision was finally rescinded 2 months later, without adequate explanation. SASCI have issued statements abhorring the unprofessional and ultimately illegal manner in which this was done. We believe that this cavalier attitude of individuals within the MCC is reprehensible and hopefully will not be repeated.
- We have been encouraged by the progress now being made with the database committee and hope that a working cathlab database will soon be available for all interested parties.
- The private practice committee has been active in promoting new tariffs and procedure codes with SAMA and some of these will benefit interventional activities.
- SASCI have broadly adopted the ESC guidelines on interventional procedures but have established a subcommittee to make adaptations according to local needs.
- We have established ourselves as the recognised resource for liaison between members and health funders for information on best practice, guidelines and tariff issues.
- Industry Representation has assured a close liaison between us and we continue to actively pursue collaboration on issues of common interest. These include facilitation of education resources, advice on device applications, guidelines, liaison with hospital groups etc. We remain very grateful to the industry for the financial support received.
- SASCI membership now constituted 70 active interventional cardiologists (Addendum 1 Membership List). We believe the survival of a strong Special Interest Group in interventional cardiology is in the best interest of all players in the field, physicians, industry vendors, health funders, hospital groups and patients. For this reason, we appeal to all to support SASCI and use us to fulfil all our objectives.
- SASCI Financial Report Year End March 2005 (as a registered Section 21 company SASCI has official Financial Statements available for scrutiny)
Income R 529,041
Expenses R 501.420
Retained Surplus end of Year R 346,196
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George Nel, Executive Officer
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