ESC Congress 2024 Recap: New Guidelines, Breakthrough Trials, and Personalized Cardiology

From new clinical guidelines to late-breaking trial results, the 2024 European Society of Cardiology (ESC) Congress in London brought together thousands of clinicians, researchers, and health care professionals to discuss the latest advances in cardiovascular medicine. The American Journal of Managed Care^® spoke with lead investigators, presenters, and the chair of this year’s Congress, John McMurray, MD, in London, where they shared the meeting highlights and recapped important data.

Mc Murray, a professor of Medical Cardiology at the University of Glasgow in Scotland and the United Kingdom, had the privilege of witnessing firsthand the remarkable energy, global participation, and groundbreaking research that defined the event.

“The biggest highlight for me of the Congress was that even though we're the European society, 5 of the 10 top countries, in terms of submission of abstracts, were from outside Europe: China, the United States, Japan, Korea, and Australia,” McMurray said. “So, this was a truly international congress and there was a great spur of international collaboration, exchange of views, learning from other people's perspectives, and that's what makes this a great Congress.”

New Clinical Guidelines: A Step Towards Personalized Care

One of the major highlights of the Congress was the introduction of 4 new clinical guidelines. Dipti Itchhaporia, MD, MACC, FAHA, FESC, the chair of the Health Equity Task Force and the immediate past president of the American College of Cardiology (ACC), and Martha Gulati, MD, director of Preventive Cardiology at the Smidt Heart Institute at Cedars-Sinai, explained that the presentation of ESC guideline updates is a cornerstone of the Congress each year.

McMurray, who presented the updated guidelines during the opening ceremony, shared an overview of the importance of personalized and individualized patient care:

1. Atrial Fibrillation: The new guidelines stressed the importance of individualized care, considering patient characteristics and comorbidities in managing atrial fibrillation.
2. Hypertension: The guidelines on hypertension presented new approaches, including innovative quadruple and triple combination therapies in single-pill forms, aimed at improving adherence and achieving blood pressure targets more effectively.
3. Peripheral Artery Disease and Aortic Diseases: These guidelines addressed new methods for diagnosing and managing peripheral artery disease and aortic conditions.
4. Chronic Coronary Syndromes: A significant portion of this guideline focused on the emerging recognition of patients who experience chest pain due to myocardial ischemia, even in the absence of obstructive coronary artery disease.

These new guidelines generated considerable discussion among attendees, reflecting the evolving landscape of cardiovascular care.

Late-Breaking Clinical Trials: Transforming Cardiovascular Treatment

The Congress featured 12 “Hot Lines” and unveiled 38 new, large-scale clinical trials, many of which were published in major journals and are already available online. Some of the most notable studies included:

• FINEARTS-HF Trial: This trial demonstrated that finerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA), significantly reduces the risk of heart failure escalation and hospitalizations in patients with heart failure with mildly reduced or preserved ejection fraction. As one of the largest heart failure trials presented at the Congress, FINEARTS-HF highlighted the additive benefits of finerenone alongside SGLT2 inhibitors, suggesting that these two therapies may become central to treating heart failure with preserved ejection fraction.
• Transcatheter Edge-to-Edge Mitral Valve Repair Trials: Another major focus was on two trials evaluating the effectiveness of transcatheter edge-to-edge mitral valve repair in patients with secondary mitral regurgitation. Both trials showed that the transcatheter approach is at least as effective as traditional surgical methods, offering a less invasive option with comparable outcomes.
• Hypertension Treatment Trials: Reflecting the emphasis of the new hypertension guidelines, trials exploring the efficacy of quadruple and triple antihypertensive therapies in single pills demonstrated their effectiveness in reducing blood pressure safely and potentially improving medication adherence.

Emerging Therapies and Future Directions

Among the many presentations, the FINEARTS-HF trial stood out for its implications for heart failure treatment. McMurray, the coprincial investigator, and Javed Butler, MD, president of the Baylor Scott and White Research Institute in Dallas, and distinguished professor of medicine at the University of Mississippi, discussed how their trial’s findings align with earlier data from the TOPCAT trial involving spironolactone, which, although not uniformly positive, hinted at potential benefits for certain patients.

However, the trial investigators weren’t the only key leaders focused on the late-breaking finerenone data. The findings from the FINEARTS-HF trial may mark the beginning of a new era for heart failure management, according to Deepak Bhatt, MD, MPH, MBA, the director of Mount Sinai Heart. This perspective was echoed by Butler and Christopher Kramer, MD, vice president of the American College of Cardiology (ACC), with more trials and new compounds expected to emerge in the near future. The integration of these therapies could redefine the standard of care, offering more personalized and effective treatment options for patients.

Redefining Cardiovascular Risk Assessment

A key takeaway from the Congress was the recognition that current methods for cardiovascular risk assessment may be inadequate. Lead investigator Amir Ahmadi, MD, a cardiologist at Mount Sinai Foster Heart Hospital Morningside and assistant professor at Icahn School of Medicine, and presenting author Anna Mueller, MD, an internal medicine resident at Icahn School of Medicine, recapped their study’s findings.

“What we think is a solution is the shift of mindset from treating the risk or the surrogates of disease—the risk being the risk factor, the surrogates of the disease being the chest pain, which is a subjective feeling that the patient reports to you—to actually looking at the disease,” Ahmadi said. “And with the current technology, we think it's possible to do that.”

The study found that current methods of predicting acute coronary syndrome (ACS) events using ASCVD risk scores and symptom-based screening are inadequate. In a retrospective analysis of 166 patients aged 65 or younger who experienced their first ACS event, 51% were classified as low or borderline risk and would not have been candidates for preventive statin therapy a week before the event. Moreover, over half of the patients did not show symptoms until less than 48 hours before their ACS, and 8% had no symptoms at all.

“As a resident physician who's practicing mostly in internal medicine at the moment, I feel like there's a lot of actual responsibility on internal medicine physicians and primary care physicians in treating and assessing patients for cardiovascular disease,” Muller said. “...I'm just excited to better help my patients with accurately predicting if they are at risk or not, and not just providing reassurance when I really shouldn't be.”

Looking to the Future of Cardiology

The Congress demonstrated that there’s much to be excited about in the future of cardiology—from new drugs and therapies to innovative approaches to risk assessment and disease management. Real progress, however, will happen when these new revelations are implemented into practice.

“Things are moving in the right direction—very exciting times,” Butler concluded. “but it's up to the clinicians now to implement these therapies as well.”