The Dwindling Relevance of Annual Meetings


The annual meetings of the American College of Cardiology and the American Heart Association have been the centerpiece for the international exchange of ideas in clinical and basic cardiology for the last half century. They have attracted research scientists from around the world as a result of their preeminence as a platform for the presentation of new concepts.

They provided the setting for Mason Sones to show the first direct angiographic imaging of the coronary artery, for Andreis Grunzig to demonstrate the first percutaneous dilatation of the coronary artery, and for Michel Mirowski to present the first demonstration of the automatic implanted defibrillator. Those events caused gasps in the audience as we all saw, for the first time, a major breakthrough in cardiovascular medicine.

The scramble to get onto that platform or to be in that audience when the newest discovery was presented drew large audiences. The decrease in attendance in the past few years can be viewed as an index of the decrease in the importance of that platform.

The decreased attendance in the AHA and ACC annual scientific sessions provides ample evidence of the reduced role of American leadership and the ascendancy of European leadership in the world of cardiology. As the attendance at American meetings has ebbed, the European Society of Cardiology has seen a progressive increase in attendance of its annual meeting.

The AHA reached its highest attendance in the later part of the last century when its professional attendance in 1999 topped just over 20,000. It gradually slipped to 19,169 in 2010, and was 15,553 in Orlando in 2011. The ACC professional attendance has also fallen, from 18,542 in 2008 to 12,980 in 2011. At the same time, the attendance at the European Society of Cardiology has increased from 18,413 in 2002 in Berlin to almost 27,080 professional attendees in 2011 in Paris.

This decrease has not been observed in all American medical specialties. The Radiological Society of North America has had approximately 27,000 professional attendees for the last 5 years, and it advertises nearly eight football fields of exhibits.

One factor limiting attendance at some meetings is the expense, including the increase in admission fees, which now have gotten well into the four-figure level even if you are a member.

One of the most striking changes at the recent AHA and ACC meetings was the stark decrease in exhibitors. Exhibits that seemed to go on for miles in previous years, requiring rest stops at coffee stands along the way, have now became accessible with a casual walk. Many of the high-tech exhibitors either shrank their exhibit space or were entirely absent. Attendance and the number of exhibitors at the recent AHA meeting were impacted by the annual meeting of Transcatheter Cardiovascular Therapeutics, which had more than 12,000 attendees and was being held almost simultaneously a continent away. In order to fill the exhibition space at the recent AHA meeting, booth space was given over to displays of costume jewelry and pashmina scarves.

It is estimated by representatives of the ACC that international attendance at American meetings has decreased by at least one-third. This decrease is open to different interpretations. It has become increasingly difficult, for example, for many Asian and Eastern European cardiologists to obtain U.S. visas. But the fact that the Europeans do have an excellent meeting on their own soil has made that meeting more accessible to them. It is also clear that more Asian and American cardiologists are attending the European meeting. Part of this attraction has been related to a friendlier environment for the performance and consequent presentation of clinical trials in Europe.

The decrease in attendance at the American meetings is, in large part, a result of the balkanization of the "big tent" of cardiology. The creation of specialty associations by electrophysiologists, interventionalists, and heart failure specialists, to name but a few, has impacted on the appeal of – and need to engage in – the large annual meeting in order to satisfy professional requirements. Specialty cardiologists now have not only their own meeting platforms, but also their own specialty journals, which are in direct competition with JACC and Circulation.

What is lost, however, is the integrated educational experience that the practicing cardiologist needs in order to bring the entirety of cardiovascular science to the individual patient. When the field of cardiology was smaller and its scientific and clinical horizons were nearer at hand, this could be accomplished at one meeting.

We have, unfortunately, outgrown our "tent," but the Internet is now there to help us. Access to the meeting’s scientific presentations is now readily available through a variety of electronic media sites, including Cardiology News.

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