Continuous education is a necessity in the medical profession. In many specialities that are facing extremely fast development, there are countless sources of information providing novel and seemingly relevant data virtually every day. Thus, the proper selection of those having an impact on everyday clinical practice is becoming a real challenge. With no doubts, cardiology is one such rapidly developing medical branch, and cardiologists are seeking journals providing comprehensive, salient and objective reviews in order to update their knowledge. European Cardiology belongs to that group and needs to be congratulated for contributing to the education process.
In the current issue, several interesting readings covering timely topics in cardiology practice can be found, among which I would like to point out at the following: the need for improvement in stroke prevention in patients with atrial fibrillation (AF), sleep apnoea as a co-morbidity cardiologists should be more aware of, and finally heart failure (HF) with preserved ejection fraction as a growing epidemic in the 21st century.
Stroke is still a relatively common, and the most ominous, complication of AF. Thus, an optimal risk stratification and subsequent efficient prevention of thromboembolic complications should be always considered as key elements of the comprehensive management of patients with AF. In the context of recent discussions about wider indications for anticoagulants (based on modified risk scales) and availability of novel oral anticoagulants, it is worth confronting everyday practice with the European guidelines elegantly discussed in the current issue of European Cardiology by Andreas Müssigbrodt and Gerhard Hindricks.
Paradoxically, despite the fact that sleep-disordered breathing often complicates cardiac diseases (hypertension and HF being classical examples), the world of cardiology has been rather slow at recognising, and has shown little interest in, this co-morbidity. Only recently has it become evident that, with modern technology, sleep apnoea happens to be a target for intervention in cardiology as well. The topic is covered here by Erland Erdmann and colleagues.
HF is becoming a 21st century epidemic and this should be viewed as the 'paradoxical' price one needs to pay for substantial achievements in cardiology. At least half of all patients with HF tend to have symptoms coinciding with well preserved left ventricular ejection fraction. In the past, the term 'diastolic HF' was applied to such patients, but new guidelines rather prefer to label this condition 'HF with preserved ejection fraction' (HEFEF). Pathophysiological processes underlying HEPEF development and progression still remain enigmatic and, more importantly, the diagnostic algorithm is controversial and the therapeutic approaches are often not evidence-based. A review by Otto A Smiseth and colleagues comprehensively summarises this challenging clinical entity.