MUNICH, Germany — Philips Healthcare (Eindhoven, the Netherlands/Andover, Massachusetts) stood out among the dozens of manufacturers of cardiac imaging equipment for European markets jockeying for mind-share with the 24,000 cardiologists participating in the annual congress of the European Society of Cardiology (ESC; Sophia Antipolis, France) here last week.

Beyond the usual live demos of ultrasound scans, Philips worked a soft-sell campaign, handing out a prized CD loaded with abstracts from the scientific sessions to a continuous queue of cardiologists, capturing their e-mail addresses, and then for submitting to a five-minute survey contributing €5 ($7) to a team of doctors bicycling from Amsterdam to the ESC congress.

As sales of cardiac imaging equipment, primarily portable ultrasound units, moves increasingly from the hospital to private practices and community clinics, Philips' strategy is to gain a thought-leadership position in the sector with messages that resonate with cardiologists, rather than radiologists, who more than ever are becoming the direct customer.

On the heels of completing the successful MyHeart Program for the European Union (EU), Philips expanded its footprint in European cardiology, announcing in quick succession earlier this year that it would lead two further EU programs focused on cardiac care, HeartCycle and euHeart.

Where the EU provided €9 million ($12.7million) for MyHeart under its Sixth Framework program to encourage innovative cardiac care devices, HeartCycle and euHeart will each receive €14 million ($19.75 million) in EU funding under the Seventh Framework, extending through 2012.

Philips is leading consortiums for both projects that include a total of 34 research, academic, industrial and medical organizations across Europe.

A generous half of the $2 billion in imaging equipment sales generated by Philips each year comes from the North American market. Europe is a significant but smaller share of the international market that makes up the balance of the business.

"So you are wondering, 'Why Europe?'" asks Joris van den Huck, vice president for cardiology programs at Philips.

"Here at the ESC congress, we have heard both the past and incoming presidents of the society referring to their deep commitment to Europe becoming a hub for the study and research of cardiac disease," he said.

The ESC announced at the congress that its European Heart Research Foundation, launched last year is now officially operational, based in the UK.

"Meanwhile there is also a lot of attention at the EU on cardiac care, where Philips has secured a key position as a partner in this effort," he said, adding, "The EU member governments are in tune with these programs, in fact spending on these programs."

Van den Huck added, "At the end of the day this attention means the medical community will be giving it their attention as well, and that is going to drive demand."

In an interview with Medical Device Daily, van den Huck described Philips' strategy toward the cardiac imaging market, which may begin in Europe but has global ambitions for equipment sales:

"Our first theme is to take a different approach to product innovation by focusing on the care cycle, or patient pathways, which is a better way to say it.

"Care cycles are about how advanced technology is going to benefit workflow, and therefore patient outcomes. A focus on care providers brings us closer to some clear insights for unmet needs, especially for acute patient care.

"The new CX50, for example, responds to the need for highly portable ultrasound to reduce door-to-balloon time. For acute cardiac patients, there is a lot of the diagnostics that can be done in transit, transmitting to the hospital readings in transit.

"Portability also moves in the direction that everyone is working toward, to bring more intuitive imaging to clinics and private practices. It is a huge market.

"Philips' second theme addresses another area of great interest to healthcare providers and their patient pathways, which is home health care.

"Healthcare is an ever-increasing economic burden on society and increasing healthcare productivity is the key to relieving that burden, which is felt acutely here in Europe where governments are the payers for health services.

"This theme connects with our work with the EU. In the HeartCycle program we will be taking care of the patient in the home and simplifying what is a seemingly complex process.

"For home care, people tend to think of complex solutions, when in fact, everyday technology can often be used. It does not take sophisticated technologies to do very basic monitoring of patients.

"In the MyHeart program, we learned one key is putting technology in people's beds to monitor disease progress, such as heart rate and respiratory. One of the devices coming out of that program was, indeed, sophisticated, the ferroelectric sheet capable of monitoring a patient's tiny motions while sleeping.

"This is known as ballistocardiography, the detection of heart activity from tiny changes in the weight and balance of the body that returns a vital sign reading noninvasively, even passively.

"The sheet is useful for big, macro movements as well, like a patient getting out of bed, which may be helpful to know in the case of geriatrics or perhaps an Alzheimer's patient.

"The third theme in Philips' strategy addresses minimally invasive interventions.

"Recognizing the ongoing trend for years of surgery moving to minimally invasive there is an obvious need for such things as the Hybrid OR, combining the cath lab with the surgical arena.

"The X-ray is no longer the only modality in surgery. Philips, for example, has introduced live 3-D transesophigal echocardiogram (TEE), which is selling like hotcakes.

"We announced this year our partnership with Skytron (Grand Rapids, Michigan) to deliver hybrid operating rooms combining Philips cardiovascular imaging with surgery room equipment to enable clinicians treat patients in the same room.

"When you start to think out of the box in this area, you begin to see the potential for imaging technologies to enable other, so far unseen, procedures in a fully enabled surgical theater.

"Our fourth theme is for timely triage. This is not primarily about acute patients and door-to-balloon time but about recognizing disease earlier, even identifying an asymptomatic patient, people with elevated risk factors that simply have not been diagnosed yet.

"This brings us to the euHeart Program with the EU and a separate program we initiated this year with other companies called the High-Risk Plaque Program.

"In the high-risk plaque program we are working with AstraZeneca (London), Merck (Whitehouse Station, New Jersey), BG Medicine (North Waltham, Massachusetts) and Humana (Louisville, Kentucky) to advance the recognition and management of what is the underlying cause of heart attacks.

"The portable imaging equipment and these EU programs all start to fit with Philips' definition of timely triage because the early recognition of heart disease is not something you do in a hospital. You want to do it as close as possible to the patient in primary care settings, such as a general practitioner's office.

"We want to help cardiologists provide referring GPs with the tools to diagnose earlier on. This requires several things, the means to visualize it, to measure it and then to determine the significance of these readings.

"From high-risk plaque, we will have 7,000 patients exposed to measures and compared to diagnostics of different imaging modalities to see what profile of these patients can be identified early on for a risk stratification.

"With euHeart, we will be capturing all cardiac characteristics of structure, morphology, physiology and pathologies trying to create a unified theory of everything cardiac, if you will. The EU wants to build one model, what they hope will one day be called the European Heart Model, that can be extended to personalized models of specific patients' hearts in three dimensions, regardless of the diagnostic means used.

"euHeart has 'Image Fusion' written all over it. We will work in cross-modalities and then, if we can translate images from different and diverse modalities into this one unified model of everything cardiac then we will have created a mathematical reflection of what the human heart looks like, how it works, how it develops diseases. This can become something very personal when you input you own data.

"The vision, the hope, is that if we can do this and create risk stratifications, you are talking about something that is applicable and relevant for millions of people across the world, not just Europe anymore.

"Now we will be able to go to the 5 million people with chest pain in the U.S. or another 5 million heart failure patients who are undiagnosed in Europe with an ability to understand and use this European model.

"The model will not belong to Philips, no more than devices from the MyHeart program we led belong to Philips. But serving in this leadership role brings us very close to the cardiologists and the emerging technologies, giving deeper insights into processes, needs andpossible solutions.

"As I said, at the end of the day, this leads to understanding demand."