A Good Reminder Not to Lose Sight of Patient Value When Looking at Costs of Care

This post was authored by William A. Zoghbi, MD, MACC, past president of the ACC, in response to the New York Times article on echocardiography charges.

The New York Times this week ran a feature article in its “Health” section on the variations in charges associated with echocardiography (The Odd Math of Medical Tests: One Scan, Two Prices, Both High). In addition to raising concerns about charges, the piece suggested not only an increase in the use of echocardiography, but also inappropriate use of the technology by physicians.

Discussions about variations in cost are important across the health care spectrum – charges for all health services, not just echocardiography, vary significantly from one institution to another in the US. However, as Dr. David Wiener of the American Society of Echocardiography (ASE) noted in the article, it’s important that these discussions take into account the multiple factors responsible for the variation, including our decentralized health care system, state regulations and the need to subsidize poorly reimbursed services. Furthermore, the actual charges have little to do with actual payment for services by private or governmental payers, as charges have become an index of overall health care costs and inflation for each institution over the years, and do not mirror actual payments – a mere fraction. Unfortunately, the uninsured in the US are burdened with negotiating these high charges to a more acceptable and realistic level, highlighting the need for reform and transparency in prices of rendered services.   Continue reading

A Viewpoint From the Front Lines of Heart Screenings

This post was authored by James Beckerman, MD, FACC, member of the ACC’s Sports and Exercise Cardiology Section.

For the past several years, I have had the honor of volunteering with Play Smart Youth Heart Screenings in Portland, OR, providing free blood pressure and electrocardiogram screenings for nearly 5,000 young people ages 12 through 18 in our cardiology clinics and in their schools. We have identified nearly 200 with hypertension, and approximately one out of every 100 children screened is diagnosed with a cardiac condition, including structural abnormalities like hypertrophic cardiomyopathy, coarctation of the aorta, and bicuspid aortic valves, as well as electrical anomalies like long QT syndrome and Wolff-Parkinson-White syndrome. Along with over 50 screening programs nationwide, from family-run foundations like Simon’s Fund and the Nick of Time Foundation to academic centers like Johns Hopkins, University of Washington and Stanford, we screen kids because we believe that there is value in identifying young people with cardiac conditions before they might become symptomatic or dangerous. We actively fundraise to support our efforts and provide our screenings for free. Continue reading

Congenital Heart Disease Research: An Expanding Frontier

This post was authored by Ami Bhatt, MD, FACC, member of the Adult Congenital and Pediatric Cardiology Section.

In 1949, the National Institutes of Health began funding research in congenital heart disease (CHD). Since then, not only has the field grown, but the patients have aged successfully, introducing new frontiers for CHD research. As the field of cardiology has advanced impressively in the past four decades, the field of CHD has steadily grown and research efforts are now abundant. In addition to single center and multicenter academic efforts, collaboration with patient advocacy organizations and privately funded foundations has helped move research and registries forward. However, the time for an increase in the advancement of scientific inquiry is beginning now. Continue reading

The Physical Exam in Fellowship

This post was authored by Akhil Narang, MD, a fellow-in-training at the University of Chicago.

Over lunch, Jafar Al-Sadir, MD, FACC, a master clinician and often described by trainees as a “human echo,” introduced us to his long time patient, Mr. Jones. For years, Mr. Jones has been driving more than an hour to join fellows-in-training (FITs) at the monthly Bedside Physical Exam Rounds. At each of these sessions, Al-Sadir carefully selects a patient with excellent physical exam findings and then spends the entire hour helping us hone our skills, appreciating pericardial knocks, describing jugular venous pulsations, or ensuring we all hear the posteriorly radiated murmur of mitral regurgitation due to a flail posterior leaflet. Continue reading

U.S. vs. Canada: The Emerging World of Sports Cardiology

This post was authored by John Vyselaar, MD, member of the ACC’s Sports and Exercise Cardiology Section.

Sports cardiology is an emerging area of cardiovascular care. It is an exciting time to be involved in this developing field. This is true not only in the U.S., but also internationally.

As a Canadian cardiologist and international member of the ACC, I have been surprised by how similar some aspects of medical practice can be regardless of jurisdiction, whereas others can be quite different. The clinical practice of medically treating patients seems pretty much the same everywhere. Certain things like access to medications or the units you use to measure your lab values (mg/dl vs. mmol/L) may differ slightly, but physicians everywhere still care about using the right anticoagulant or accurately determining a glomerular filtration rate. On the other hand, the practical and financial aspects of actually getting patient care done can vary widely. The impact of single vs. multi-payer insurance, socioeconomic factors, and litigation risk make some aspects of practicing medicine in Canada very different from the U.S. and other jurisdictions. Continue reading

Hot Topics from AHA 2014 – Day 4

Check out ACC video coverage of the latest hot topics from AHA 2014. Watch Peter Block, MD, FACC, and Deepak L. Bhatt, MD, MPH, FACC, give a recap of Wednesday’s trials. Also watch a video interview with the FITs on the GO and Laura Mauri, MD, MSc, FACC, regarding use of prolonged dual antiplatelet therapy as discussed in the DAPT Trial. Check out full coverage from the meeting at CardioSource.org.

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The Power of Social Media in Medicine

This post was authored by John Gordon Harold, MD, MACC, immediate past president of the ACC.

A study released today during AHA 2014 provided an interesting perspective on the ability of social media to effectively distribute findings of published articles. The trial, “Intention-to-Tweet,” randomized 243 articles published in Circulation to either receive social media or not and found no difference in median 30-day page views (409 [social media] versus 392 [control], P=0.80). There were also no differences observed by article type (clinical, population, or basic science; P=0.19), whether an article had an editorial (P=0.87), or whether the corresponding author was from the U.S. (P=0.73). Continue reading

Will DAPT Change My Practice?

This post was authored by Valentin Fuster, PhD, MD, MACC, editor of Journal of the American College of Cardiology.

First, I want to compliment Laura Mauri, MD, and her colleagues for conducting the landmark Dual Antiplatelet Therapy (DAPT) trial, which was presented yesterday at the American Heart Association’s Scientific Sessions in Chicago.

Recent guidelines have recommend that patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) discontinue dual-antiplatelet therapy – a combination of aspirin and another platelet inhibitor (e.g., clopidogrel) – within six months to one year. Nevertheless, the U.S. Food and Drug Administration and some clinicians have been concerned about the long-term impact of stents and dual-antiplatelet therapy duration on the adverse outcome of stent thrombosis. Continue reading