European Heart Journal (2014) 35, 2497–2503
doi:10.1093/eurheartj/ehu289
Profile: Frans Van de Werf, MD, PhD, FESC,
FACC, FAHA
Frans Van de Werf is Emeritus Professor of Cardiology at the
University of Leuven, Belgium. His work on thrombolytic therapy for
myocardial infarction ushered in a new era in patient management and
outcomes.
Leuven University Medical School 2009
Born in Mechelen, Belgium, Van de Werf’s early ambition was to
become a civil engineer and he might have succeeded if his secondary
school had provided mathematics at a higher level. Possibly influenced by an uncle who was a surgeon, he opted for medicine and
enrolled at medical school in the University of Leuven in 1966 with
no particular preconceptions or aspirations.
During his undergraduate years at Leuven—which he says was and
is the best medical school in Belgium—he worked through the different medical specialities with equal interest and graduated as one of
the best students in his year. His strong academic record gave him
the pick of specialities and he opted for cardiology, which was at
that time attracting the brightest and the best.
At the suggestion of his professor he applied for a grant from the
Belgian National Fund for Research to study cardiology. He started
work on what would later become his PhD into the origins of the
third heart sound. At that time Leuven had an international reputation for mechanocardiography and phonocardiography and, although
they became obsolete later, they were used by Van de Werf along
with catheterizations and echo-Doppler examinations to demonstrate something unique in diastolic function concerning the reversal
of the transmitral pressure gradient in early and late diastole. To the
young postgraduate’s delight and enduring pride his findings were
published in both Circulation and the Journal of Clinical Investigation.
He later switched focus and is now widely recognized as an expert,
if not a pioneer, in fibrinolytic therapy and the treatment of acute MI.
He concedes that hard work has been a big part of his success, but he
also believes being in the right place, at the right time with the right
people has helped. He considers himself fortunate in having worked
at the same institution as prominent researcher De´sire´ Collen, who
discovered the properties of tissue plasminogen activator (t-PA).
Van de Werf believes that during the late 1980s a lot of different
threads came together to facilitate his research progress such as
the work on streptokinase by the likes of Peter Rentrop in
Hanover. He says: ‘After I saw the data presented at a conference
organised by Rentrop in Hanover in the late 1980s, there was no
doubt in my mind about it’. Van de Werf resolutely translated his
bench work with De´sire´ Collen’s new agent alteplase t-PA to the
bedside and used t-PA to treat the first patient in the world at the
university hospital in Leuven.
Manufacture of t-PA by recombinant DNA technology was swiftly
taken up and introduced into treatment regimens. Studies culminated
in the GUSTO 1 trial in which 40 000 patients with MI demonstrated
that t-PA was superior to streptokinase. Later studies by Van de Werf
on slightly modified t-PA (TNK-t-PA) would demonstrate that it is
equivalent to t-PA and also that it can be given as a single dose,
thus making it convenient for treating patients in the ambulance.
In the late 1980s, it became accepted that mechanical recanalization of the coronary artery with a balloon and stenting was superior
to lytic therapy and this is now considered to be the best reperfusion
therapy.
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
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Frans Van de Werf
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A very recent development surrounds the difficulty of a time delay in
being able to offer primary PCI to patients with MI. Given that PCI needs
to be performed within a maximum delay of 90–120 min after first
medical contact, treating patients with lytic therapy while they are en
route to a PCI hospital seems to be a good compromise if primary
PCI cannot be delivered within this time window. According to Van de
Werf, the recent STREAM trial has shown the benefits of this strategy.
Future studies should, he believes, centre on adjunctive antithrombotic therapy and how beneficial the new anti-platelet agents
are when they are given together with a lytic agent. A second proposal
involves testing a lower or half dose of a lytic agent in elderly patients to
reduce the risk of intra-cranial haemorrhage. The STREAM trial
showed how a reduced dose of tenecteplase appeared to be sufficient
in elderly patients to open the coronary artery and possibly reduce the
risk of an intra-cranial haemorrhage.
He is a fellow of the American College of Cardiology and the European Society of Cardiology, and has served on many major national
and international committees and boards. He has been a visiting
fellow at institutions of excellence around the world. His publications
exceed 600 and he has served on numerous editorial boards including the New England Journal of Medicine and Circulation. He was
editor-in-chief of the European Heart Journal between 2003 and 2009.
Van de Werf’s work has been formally recognized at home and
abroad, but aside from the plaudits, he takes great satisfaction from
the fact that the results of his work are one of the success stories
of modern medicine. He is keen for that story to continue and has recently announced a number of special scholarships supported by
money set aside from clinical trials to provide funding for two or
three research fellowships into cardiovascular medicine.
Dr Frans Van de Werf has received research grants and honoraria
from several companies involved in the development of lytic and
antithrombotic agents for acute coronary syndromes.
Hubert Pouleur
No one doubts that clinicians and drug companies are locked
in a complex embrace, but Dr Hubert G. Pouleur, MD, PhD,
vice-president and cardiovascular disease area expert, Pfizer,
Inc., New York City, is someone who understands the issue
more than most
Jobs for cardiologists in the pharmaceutical industry do not get much
higher than this. Dr Hubert G. Pouleur, MD, PhD, is vice-president
and cardiovascular disease area expert for Pfizer, Inc., based in
New York, USA. As such, he chairs a committee responsible for
reviewing and technically endorsing what are called the ‘development
and life cycle’ plans of all products produced by the company for the
treatment of cardiovascular disease.
He and his colleagues therefore make decisions on projects that
thousands of investigators in Europe and elsewhere are working
on, from the earliest ‘proof of concept’ through to licensing. His
routine work also includes the evaluation of risk and safety management plans and technical assessments of major investment decisions—often for billions of dollars-being made by the company.
It is a far cry from the time, 20 years ago, when he was pursuing a successful academiccareer inBelgium.Thiswasat the medical school ofthe
Catholic University of Leuven, Leuven, a relatively small city, but supercharged with intellectual vitality and a commercial and governmental
life that reflects its close proximity to Brussels. Here, he followed a
conventional path, from MD to a full professorship in his early 40s.
He ran a research team of 10, and was the principal investigator of
the NIH-sponsored trial SOLVD, but already there were signs of
another path. Although his academic life was based in Leuven, he
had spent a year as an NIH Fogarty Fellow at the University of California at San Diego, where he worked on the haemodynamics of heart
failure with Dr John Ross Jr.—famed for trans-septal catheterization.
And during his last 5 years in Leuven he worked part-time with the UK
arm of a US-headquartered pharmaceutical company, trialling ranolazine and providing clinical advice for the approval of nicardipine.
He recalls: ‘During my time in Leuven I got to know most of the big
players in the cardiovascular field. I was always trying to attract Fellows
from elsewhere – my goal was to have a Japanese Fellow, because I
knew I was competing with US universities and I was very proud eventually to get one, from the University of Kyoto! I was getting offers from
pharmaceutical companies and one day when I was fishing with a friend
he suggested I take a job as a Distinguished Clinical Scientist at Syntex
Pharmaceuticals, Maidenhead, UK – even though I was neither distinguished nor a scientist! I used to fly out and back one day a week’.
‘It helped me to make the transition from academia to industry. It’s
not easy for some academics – their expectations are too high. They
believe the pharmaceutical industry is a kind of academia with bigger
resources and often want to do things not aligned with what management wants! You need both basic and applied research, but obviously
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How to cross the border between academia
and the pharmaceutical industry
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Centre for Therapeutic
Innovation, Boston
Lab, Centre for
Therapeutic Innovation,
Boston
in industry there is much more applied research and you need to
prioritise. Here at Pfizer we have set up the Centres for Therapeutic
Innovation scheme which attempts to bridge the two’.
‘Club 30’: twenty-year anniversary
‘Club 30’ of the Polish Cardiac Society continues the extraordinary
and successful idea of Prof. Leszek Ceremuz˙yn´ski
Leszek Ceremuz˙yn´ski
How it began . . .
To change the world for the better, you need to be a perceptive observer, a charismatic visionary and, above all, like and respect the
people who appear on your road. Such a person was Prof. Leszek
Ceremuz˙yn´ski, an experienced cardiologist, an internationally recognized scientist and a remarkable organizer. Although at the time he
was an established professor of cardiology, he was fully aware of
the problems that young, talented and ambitious cardiologists in
training experienced during the 1990s in Poland.
He recognized the need for a forum for the most promising young
cardiologists to meet informally and socially. They would share the
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Dr Pouleur finally made the jump to industry in 1993, when he
went to work for Pfizer, Inc., in New York and Groton, CT. Here,
he put his clinical expertise to use, notably in a team that recommended the licensing of atorvastatin. After 3 years, his experience
grew (with the job title vice-president, Cardiovascular and Metabolics, Clinical Development and Life Cycle Management) in the
quasi-academic setting of the Pharmaceutical Research Institute of
the Bristol Myers Squibb Co, Princeton, NJ. He recruited MDs and
clinical scientists to build up a team of .115 people involved in the
filing and approval of a number of new drugs and also worked on a
portfolio of products that brought in ‘more than $4 billion in sales’.
In 2001, he was head-hunted back to Pfizer, where he became
senior medical director, with worldwide responsibilities for cardiovascular, metabolic and endocrine products. His career with Pfizer
took off, with promotions to senior executive positions involved
with major policy decisions. The sheer variety of his work, and the
challenges it presented, were indeed a far cry from academia. Therapeutically, it ranged over COX-2 inhibitors, cannabinoid receptor
antagonist and the new oral anticoagulant apixaban, as well as the
disappointing, ill-fated cholesterylester transfer protein inhibitor
torcetrapib.
Part of Dr Pouleur’s job is to keep in close contact with university
departments in the cardiovascular area—not for commercial
reasons, but to discuss new ideas. Looking ahead to the next
5 years, he said: ‘It’s been particularly rewarding to see the advent
of statins – from a series of trials, not only by Pfizer, but by others,
which have changed the guidelines for managing risk factors in ischaemic heart disease and created a return estimated at $1.3 trillion in
value to the world community! And it seems that the lower the
cholesterol the greater the benefit’.
‘Over the next 5 years we will see the introduction of monoclonal
PCSK9 inhibitors – the question is, does an even lower cholesterol
level, say, LDL cholesterol of 20 mg/dL, lower risk even more and
is it safe? The PCSK9 inhibitors, such as bococizumab [the proposed
generic name for RN316 (PF-04950615)] now in Phase III trials
should help to answer this. I also think that the novel oral anticoagulants (NOACs) will be used more and more. Not that warfarin will
disappear - it is an extremely effective drug, but, unlike NOACs, it
affects many coagulation factors besides prothrombin, and even
with good control of the INR there are complications, particularly
intracranial bleeding’.
‘Other areas where new treatments will be required – though I’m
not sure they will happen in 5 years – include tackling the huge
burden of diabetes and better treatments for congestive heart
failure. Although we realize that heart failure is a syndrome, not a
single disease, we are short of targets. Also, in coronary heart
disease, inflammation may be a culprit, though many drugs that
reduce inflammation systemically don’t reduce cardiovascular
events and may increase them. So, I think we still need a much
better understanding of the inflammatory process in atherosclerosis,
otherwise we keep ‘shooting in the dark’!’
If nothing else, Dr Pouleur’s career demonstrates the complexity
and variety of tasks that any cardiologist entering the pharmaceutical
industry must expect to embrace. And, in an era of shrinking grant
allocations, he believes that he and his colleagues are well placed to
make good the social responsibility that was once only attributed
to the prerogative of governments and other major funding bodies.
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common problems of the younger generation, which in turn would
facilitate future professional cooperation, including clinical and scientific networking. He used to say that friendships established in youth
would enable people to cooperate harmoniously when they become
mature professors.
As the then president of the Polish Cardiac Society, Leszek Ceremuz˙yn´ski convinced the Board to establish a new section ‘The Club
30’. In January 1994 he delegated Krzysztof Narkiewicz to organize
the inaugural meeting which took place on 16 September 1994,
just 20 years ago!
Strict rules of membership
Traditional symbols
Membership is very prestigious in the cardiology community in
Poland. There are currently 85 active and 102 inactive (over 40
years old) members. Members are recognized by their wearing a
club badge (the shape of a small red heart with the number 30 on
it) designed by Prof. Ceremuz˙yn´ski (Figure 1A). All new members of
‘Club 30’ are solemnly incorporated to the community during the
opening ceremony of the annual International Congress of the
PCS, and receive such club badges (Figure 2).
There is also a sculpture as the symbol of the presidency of ‘Club
30’ which passes on to subsequent presidents (Figure 1B), former presidents receiving a small copy as a souvenir. There is also a captain’s
hat and a ring belonging to the current president of ‘Club 30’,
which are transferred to succeeding presidents (Figure 1C and D).
Figure 1 Traditional symbols of
‘Club30’: (A) Club badge, (B) Presidential sculpture, (C) Captain’s hat, (D)
Ring used by the president. Courtesy
of K. J. Filipiak & E. A. Jankowska.
Club mission
‘Club 30’ organizes its own sessions during the annual International
Congress of the PCS. Traditionally, one session is structured
around difficult cases and an associated panel discussion [in 2013,
two representatives of the Cardiologists of Tomorrow (COT)
Nucleus of the ESC participated in such a session], another is a
very concise and lively summary of the news from the annual ESC
Congress (in 2013, the title was ‘Best from Amsterdam’). In recent
years, ‘Club 30’ has also co-organized sessions during several conferences of the working groups of the PCS (e.g. in the field of preventive
cardiology, heart failure and arrhythmias).
One of the aims of the ‘Club 30’ is the promotion and facilitation
of research activities at the highest level among its members. Every
year ‘Club 30’ presents an award named after Prof. Ceremuz˙yn´ski
for an original paper published by a member, as the first author in a
journal with the highest impact factor. It is worthy of note that
winning papers have been published by members of ‘Club 30’ in
top cardiology journals, e.g. JAMA, Circulation, EHJ. In its scientific
stream, ‘Club 30’ launched the multicentre CAPS-LOCK-HF
(Complex Assessment of Psychological Status LOCated in Heart
Failure) study, co-ordinated by Ewa A. Jankowska and Agnieszka
Rydlewska from Wroclaw, where 11 participating centres recruited
758 patients with systolic heart failure in only a few months (joint
papers to be published in due course).
Members of ‘Club 30’ undertake several measures to involve
medical students into activities of the PCS, particularly in research
projects. Several sessions during the medical students’ conferences
were organized under the honorary auspices of ‘Club 30’. During
the International Congresses of the PCS in 2011 and 2013, ‘Club
30’ co-organized the original papers competition of students. In
2013, the competition took place in English due to the international
jury with the involvement of the members of the ‘Club 30’ Board, and
members of the ESC COT Nucleus were invited. Importantly, a few
candidates had already joined ‘Club 30’ while they were still medical
students!
Traditionally, an important element of ‘Club 30’ activities are the
annual spring general meetings which take place in attractive tourist
Figure 2 Incorporation of new
members into ‘Club 30’ at XVII
International Congress of the Polish
Cardiac Society, 2013 in Wroclaw
(courtesy CASUS-BTL).
Figure 3 The nine presidents of
‘Club 30’ of the Polish Cardiac Society
1994–2015. Courtesy of K. J. Filipiak &
E. A. Jankowska.
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‘Club 30’ did not aim to include all young cardiologists in training. Ceremuz˙yn´ski’s idea was for an elite forum for future eminent Polish cardiologists. To become a member of ‘Club 30’, a young candidate had
to prove that he/she was sufficiently talented, passionate, and energetic to join this section. A candidate had to be a member of the
Polish Cardiac Society (PCS), ,40 years old (hence the name
‘Club 30’) and be the first author of an abstract presented during
the ESC, AHA, or ACC Congresses initially. Subsequently, the
second criterion became stricter and changed to the first authorship
of an original scientific paper published in a journal with an impact
factor. The published thesis had to be defended during the spring
meeting of the club and be accepted by the community by vote.
To date, there have been nine Presidents of ‘Club 30’ coming from
different cardiology centres in Poland (Figure 3).
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areas of Poland. Members spend an unforgettable weekend there together with their families. During these weekend meetings, candidates present their papers, there are scientific discussions, but also
these are opportunities to get to know each other better within
‘Club 30’ and socialize during sports, games, singing, and dancing.
Similarly, members of ‘Club 30’ organize their meeting during the
International Congresses of the PCS and during the annual
congresses of the ESC.
Achievements of its members
What is ‘Club 30’ today?
‘Club 30’ is a unique young community in the cardiology world. Although it has strict formal rules and obligations related to the
status of the section in the PCS, ‘Club 30’ is first of all a group of
friends supporting each other. The meetings have a formal scientific
programme and stormy discussions.
Although ‘Club 30’ is maturing and has now reached its 20 year anniversary, paradoxically its members are not ageing in their minds.
The founder of ‘Club 30’, Prof. Ceremuz˙yn´ski wrote on the 15th anniversary of ‘Club 30’ ‘. . . Club 30 is a teenager today. It is a great age. It
has the inexhaustible force to move mountains, is full of aroused curiosity which continues to increase and overflows with ambition and
youthful idealism . . .’ A tragic car accident in 2009 ended his work.
We have remained faithful to his dreams and ideals.
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The members of ‘Club 30’ have started to shape the contemporary
face of Polish cardiology and significantly contribute to Polish
achievements and activities within the ESC. They are gradually becoming the leaders in diverse areas of Polish cardiology, becoming
involved in various clinical, scientific, social, and political activities.
Waldemar Banasiak was the first president of the PCS who
originated from ‘Club 30’. Currently, four members of the PCS
Board have their roots in ‘Club 30’. The previous and current
editor-in-chiefs of ‘Kardiologia Polska’, respectively, Piotr Kułakowski
and Krzysztof J. Filipiak, are also the members of ‘Club 30’. The same is
with the previous and current chairmen of the Congress Programme
Committee of the PCS, namely Piotr Ponikowski and Dariusz Dudek,
respectively.
Members of ‘Club 30’ have contributed and still contribute to
the activities of the ESC. Piotr Ponikowski is the ESC Councillor
(2012–14) and former president of the HFA (2010–12). Dariusz
Dudek is a member of EAPCI Board and Tomasz Zdrojewski was
a member of the EACPR Board. Three of them have been or
are members of the Congress Programme Committee of the ESC. It
is worthy of note that Krzysztof Narkiewicz was the president of
the friendly society, namely European Society of Hypertension
(2009–11). Some of them work actively within working groups of
valvular heart disease, e-cardiology, cardiovascular pharmacology,
myocardial function, atherosclerosis, and vascular biology, and are
involved in the ESC Guidelines committee. Members of ‘Club 30’
have actively contributed to the development of the COT initiative
since its inception.
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Country of the month initiative
of EACPR: Germany
The structure of health care in Germany reported by the National
Cardiovascular Disease Prevention Coordinators, Prof. Helmut
Gohlke and Prof. Ulrich Keil
Helmut K. H. Gohlke, MD FESC
FACC, Cardiologist, Associate Professor, University of Freiburg
Ulrich Keil, MD PhD EFESC, Professor Emeritus, Department of Epidemiology and Social Medicine, University
of Mu¨nster
Continued
Lifestyle and risk factors Overall (%) Men (%) Women (%)
................................................................................
Health care
Germany has a compulsory health insurance system in which every
person residing in Germany is covered for diagnosis and treatment
of diseases and cardiac rehabilitation (CR). About 0.2% of the
population has no health insurance. The general health care and
consultation is managed by physicians—general practitioner and
specialists—in private practice. Both can refer patients to the appropriate hospital as deemed necessary. In 2011 there were 380 physicians per 100 000 inhabitants (OECD average: 320) working in the
health-care system; about half of these were in private practice.1
Hypertension (.140/
90 mmHg) (age ≥65)
55
54
57
Type 2 diabetes
Salt intake/day
6.6
6.7
9g
6.5
6.5 g
Alcohol consumption
27 g/day
Risky alcohol consumption
(highest % in the 19– 28
years group)
33
22
AUDIT Ca ≥5/4 points for
males/females (alcohol
use disorders
identification test)
45
32
a
Alcohol use disorders identification test.3
Main actors and prevention
methods
Risk factors
Lifestyle and prevalence of risk factors in Germany2
Lifestyle and risk factors Overall (%) Men (%) Women (%)
................................................................................
Smoking
30
Overweight (BMI 25– ,30) 36
34
44
26
29
Obesity (BMI ≥30)
16
16
16
Continued
There is no detectable governmental strategy for cardiovascular prevention. Preventive activities are supported by non-governmental
organizations (NGOs): the German Heart Foundation (GHF), a
patient organization with 80 000 members; the German Cardiac
Society; the German Society of Cardiovascular Prevention and Rehabilitation; with respect to smoking by a Task Force Non Smoking
and Pulmonary and Cancer Societies. There are preventive checkups by general practitioners: At the age of 35, there is a cardio
check-up evaluating risk factors.
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‘At the time of the unification of Germany in 1990, life expectancy in the East
was considerably lower than in the West. Since 1990 the German East-West
mortality difference narrowed rapidly, particularly for women aged 50– 64, for
whom the mortality in the East declined below that of the West in 2000. This
East-West mortality cross-over for German women is attributable to smoking:
When smoking-attributable deaths are removed, the mortality cross-over
vanishes’. (Adapted from key messages of the article ‘Reversing East-West
mortality difference among German women, and the role of smoking’ by
M. Myrskyla¨ and R. Scholz, Int J Epidemiology 2013; 42: 549– 558.)
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Prevention activities
The GHF publishes short brochures for lay people summarizing the
preventive recommendations regarding nutrition, cholesterol, exercise, and general lifestyle but also secondary pharmacological prevention. Each year in November the GHF launches a national educational
campaign with one specific topic: cardiovascular risk factors, prevention and early recognition of myocardial infarction (MI) or symptoms
of heart failure, of valvular heart diseases or of rhythm disturbances,
in particular atrial fibrillation with its associated risks. More than 1200
seminars are offered in November throughout the country by local
hospitals, rehabilitation clinics and local physicians—usually cardiologists. The campaigns are also supported by regional and national
news media reaching some 40 million people.
The GHF also promotes physical activity in schools for 8–10year-old children by running the project ‘Skipping Hearts’: workshops to teach rope skipping and local competitions are organized
by GHF’s instructors. So far, ‘Skipping Hearts’ has reached .3200
schools (exceeding 150 000 students).
The ‘Task Force Non Smoking’4 represents 11 medical societies
(cardiac, pulmonary, cancer, addiction, general prevention, physicians’ associations) in Germany, dealing with the consequences of
smoking; the Task Force tries to improve non-smokers’ rights by
lobbying for better legislation.
25 –40% in a phase III CR programme.5,6 If the patient is already
retired, CR will be paid for by the health insurance.
Aims for the future
† Risk factor counselling has to be reimbursed by insurance
companies.
† Risk stratification by a scoring system should become part of the
check-up at 35 years of age.
† Smoking bans have to be extended; restriction of advertising—as
outlined in the FCTC (WHO Framework Convention on Tobacco
Control)—has to be implemented.
† The implementation of the new EU-Tobacco Products Directive
has to be observed and supported or demanded.
† Fruit and vegetable consumption should be increased; trans-fatty
acids (TFAs) should be labelled as such and consumption
reduced. For example, in Austria and Denmark TFAs are banned
from industrial products.
† Obesity and reduced physical activity in children are increasing
problems for society. Both inactivity and overweight are associated and should be approached by political, societal, educational,
and medical means.
Cardiac rehabilitation
References
Since 1974, phase II CR after MI and cardiac surgery and for a number of
other indications (listed in the table) is guaranteed by law.5 Traditionally, a 3-week course of CR takes place in a residential setting with emphasis on exercise training, risk factors, and secondary prevention.
In recent years, however, ambulatory CR has become a wellestablished alternative method if the quality criteria of the
residential setting are met. Cardiac rehabilitation is paid for by
the retirement funds with the proven assumption that early CR
improves the return to work rate, delays premature retirement
and is cost-effective from the perspective of the retirement fund.
About 50 –60% of qualifying patients participate in a phase II and
1. Information about Germany in relation to other OECD Countries.
http://www.oecdbetterlifeindex.org/countries/germany (2 September
2014).
2. Gesundheitsberichterstattung des Bundes [Reports on the health care system in
Germany put together by the state]. http://www.gbe-bund.de/gbe10/pkg_isgbe5.
prc_isgbe?p_uid=gastd&p_aid=&p_sprache=D (2 September 2014).
3. Saitz R. Unhealthy alcohol use. N Engl J Med 2005;352:596 –607.
4. [Access to Task Force Non Smoking/Aktionsbu¨ndnis Nichtrauchen]. http://www.
abnr.de/index.php?article_id=1 (2 September 2014).
5. Karoff M, Held K, Bjarnason-Wehrens B. Cardiac Rehabilitation I Germany. Eur J
Prevent Cardiol 2007;14:18–27.
6. Bjarnason-Wehrens B, McGee H, Zwisler A-D, Piepoli MF, Benzer W, Schmid J-P,
Dendale P, Pogosova N-GV, Zdrenghea D, Niebauer J, Mendes M. Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey.
Eur J Prevent Cardiol 2010;17;410 – 418.
CardioPulse contact: Andros Tofield, Managing Editor. Email: [email protected]
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Andros Tofield