The Future of Graduating ACHD Fellows

ACC_10_05_13_0001This post was authored by Curt J. Daniels, MD, FACC, a member of the ACC’s Adult Congenital and Pediatric Cardiology (ACPC) Section, and a professor of Internal Medicine & Pediatrics at The Ohio State University and Nationwide Children’s Hospital in Columbus, OH.

Congenital heart disease (CHD) is the most common birth defect occurring in about one in 100 live births. Incredible advancements in the care of children with CHD have led to improved quality of life and survival, and more patients today reach adulthood than ever before. Because of this, the proportion of children vs. adults with CHD has shifted over the last decade and there are now more adults than children living with CHD by a 2/3rd margin. This is fantastic news for the more than 40,000 infants born with CHD each year in the U.S.

However, this is only half of the story. The success of pediatric cardiology and CHD surgery has created new challenges for the medical community, patients and families. The care of the adult CHD (ACHD) population is complicated and complex; not only because of their specific CHD anatomy and physiology, but also from a care model standpoint. ACHD patients fall between pediatric cardiology and adult general cardiology. Historically, training programs did not mandate any specific time dedicated to ACHD patient care, and therefore, cardiologists were ill prepared to understand how to evaluate and care for ACHD patients. Plus, compared to other care models in adult and pediatric cardiology, such as heart failure and electrophysiology programs, nursing and advanced care practitioners were either not developed or supported for ACHD, leading to systematic flaws in who and how patients are cared for within medical centers. Except for a few select areas in the country where ACHD was developed from a programmatic standpoint, most of the 1.5 million patients were lost to specialized CHD care.

The tide has now changed. Over the past decade, the ACC along with many other societies and organizations, developed several initiatives that advocated for and worked toward solving these issues for ACHD patients.  In 2007, a petition to the American Board of Internal Medicine (ABIM) and American Board of Pediatrics (ABP) initiated a process, which eventually led to approval in 2012 for ABIM ACHD Board Certification. Qualifying and eligible ACHD cardiologists will be able to take an exam and be certified in ACHD. Initially, most cardiologists who qualify will do so by “grandfathering” into eligibility based upon their current practice and competencies in ACHD. However, this will change over the next several years. Grandfathering will phase out as the Accreditation Council for Graduate Medical Education (ACGME) – the certifying organization for all medical training programs – approved ACHD fellowship training phases in, and by 2021, all who qualify for the certifying exam will do so only after completing a 24-month ACHD fellowship following pediatric or general cardiology. ACGME has created a standardized curriculum with two pathways for the pediatric or general cardiologist. ACHD subspecialty training is consistent with other post-cardiology fellowships in heart failure/transplant, electrophysiology and interventional cardiology, and will generate specialized ACHD cardiologists who then are eligible to be board certified to care for ACHD patients. The first certifying exam for ACHD is Oct. 20, 2015.

Although the ABIM ACHD board certification and ACGME-approved training programs provide a remarkable base for the care of ACHD patients, and provide a clear path for the future, it does not fully address the issue of how we care for patients within a hospital system or medical center. Imaging standards, interventional procedures, inpatient and outpatient care, are a part of the care model that must be developed with a high standard to provide quality care. To this end, the Adult Congenital Heart Association (ACHA) as a patient advocacy society has created an ACHD Program Accreditation process to provide criteria to improve the quality of care delivered in the U.S. A committee of ACHD specialists and patients developed specific criteria under several major categories of care. The process has been endorsed by several health care and patient advocacy societies and cardiovascular organizations including the ACC.

The future is bright for CHD patients as we begin to build a model to provide and deliver high-quality ACHD care. The ACC along with and through the ACPC Section has been a major influence providing leadership and shepherding the initiatives that will lead to improved access to life-long specialized care for all CHD patients.

Visit the Congenital Heart Disease and Pediatric Cardiology Clinical Topic Collection on ACC.org and learn more about the ACC’s ACPC Section here.

ACC on Capitol Hill: Health Information Blocking is a Threat to Patients and Practices

MIrroThis post was authored by Michael J. Mirro, MD, FACC, a member of the ACC’s Informatics and Health Information Technology Task Force.

Today, I had the opportunity to testify on Capitol Hill about the important issue of health information blocking, unforeseen problems that have been created by electronic health records (EHRs), and possible solutions to help improve care during a Senate Health, Education, Labor, and Pensions (HELP) Committee hearing titled “Achieving the Promise of Health Information Technology: Information Blocking and Potential Solutions.”

This spring, Senate HELP Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) announced their aim to accomplish five items related to interoperability of EHRs, including health information blocking, by the end of the year—whether through legislative means or an administrative fix. To accomplish this goal, the Senate HELP Committee has been hard at work soliciting feedback from stakeholder organizations, including the ACC, to help them pave a path forward. Continue reading

Advancing Health IT and Improving Patient Care

The ACC Informatics and Health Information Technology Task Force is charged with the infusion, coordination and harmonization of informatics and health information technology (HIT) into the activities and policies of the College. While Task Force members hail from across the U.S., they are united in their dedication to facilitating, promoting and accelerating the transformation of quality cardiovascular care. These members are hard at work addressing data interoperability, promoting electronic health record (EHR) adoption, coordinating EHR vendor engagement, developing tools and strategies to improve the operational efficiencies and effectiveness of ACC registries, and providing leadership and outreach to internal and external organizations. Continue reading

Remembering a Mentor: William C. Little, MD, FACC

This post was authored by ACC President Kim Allan Williams Sr., MD, FACC.

The cardiovascular community lost a master clinician, educator, advocate, researcher and mentor last week with the unexpected passing of William C. Little, MD, FACC.

Bill was an internationally renowned cardiologist with research interest in ventricular function. He is credited for research leading to a shift in thinking about atherosclerosis as a systemic process and the ensuing use of aspirin or statins. One of his major research accomplishments was the finding that acute cardiac events often occurred at sites of minimal stenosis. Continue reading

ACTION Registry-GWTG Exceeds 1,000 Participating Sites

Bhatt_HeadshotjollisThis post was authored by Deepak L. Bhatt, MD, MPH, FACC, and James G. Jollis, MD, FACC, co-chairs of the ACC’s ACTION Registry-GWTG steering committee.

ACC’s ACTION Registry-GWTG recently welcomed its 1,000th participating hospital – Florida Hospital Celebration Health. This marks an important milestone for the registry and for the larger cardiovascular community because it serves as evidence that the registry is and will continue to contribute to improved care and outcomes for ST-segment elevation myocardial infarction (STEMI) and non-STEMI patients. With a history of evolving to meet the demands of changing science and definitions of quality care, the registry has brought real, life-saving changes for this patient population. Continue reading

5 Tips For Integrating Sports Cardiology Into Your Practice

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

Many of us have multiple roles in our work, and are very busy. I am privileged to consult for professional soccer and football teams, snowboarding and skiing organizations, and professional athletes from other sports. I also have been involved with high-level amateur athletes. However, I am a practicing full-time general cardiologist. I carry a heavy patient load, instruct medical students, residents and fellows, participate in clinical trials, and have become a co-leader of my division at my local hospital.

I hear a common refrain from many practicing cardiologists – they love sports and find sports cardiology fascinating, but are not sure how they could get involved or incorporate this into their busy lives. Here are five tips, from my own experience, that may be helpful: Continue reading

Mentorship in Fellowship

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

As the new academic year commences, there is a palpable energy on the wards. Fresh-faced first year cardiology fellows, subspecialty fellows, and newly minted junior attendings excitedly (and nervously) begin a new chapter in their academic career. As I reflect back upon my first year in general cardiology training, beyond the incredible amount of clinical cardiology knowledge I’ve gained, the most satisfying aspect of my fellowship thus far has been the mentorship I’ve been fortunate to experience. Continue reading

Is Your Electronic Health Record Working For You and Your Patients?

Shor HeadshotA recent New York Times article titled “Tech Rivalries Impede Digital Medical Record Sharing” addresses a critical issue for medicine – data blocking. In addition to high fees charged by some vendors for access to records, a lack of consistency in file formats among vendors prevents electronic medical records from meeting their potential to improve patient care.

Different electronic medical record vendors collect data in varying formats, making it difficult to share information without additional data entry and creating gaps that reduce the value of the health records to doctors and patients. If the issues of exorbitant fees and consistency across platforms are not addressed, electronic medical records will unfortunately be an added burden that does not meet its huge potential for advancing the quality of medical care in this nation.     Continue reading

The Opportunity of Cardiac Rehab

Melissa Tracy headshotThis post was authored by Melissa Tracy, MD, FACC, section chief, non-invasive cardiology, Division of Cardiology at RUSH University Medical Center in Chicago, IL, and a member of the ACC’s Prevention of Cardiovascular Disease Section Leadership Council.

We are a country of opportunity. We are a society of diversity. We should all be treated with the best care possible. A recent update on the regional referral to cardiac rehabilitation (rehab) after angioplasty published in the Journal of the American College of Cardiology shows that we are not doing just that.  We must change from a SICK care model to a HEALTH care model. Continue reading

Transparency and Truly Informed Consent: A Modest Proposal

Robert Beekman HeadshotThis post was authored by Robert H. Beekman, III, MD, FACC, chair of the ACC’s Adult Congenital and Pediatric Cardiology Section and Leadership Council.

A fundamental principle of patient-centered care is patient autonomy.  Essentially, this means that patients are respected as independent agents who make informed decisions about their health care. Of course, informed decisions are evidence-based and therefore require data. No data = no informed decisions. Clinicians have an ethical obligation to respect and to promote patient autonomy.

Transparent sharing of medical data is a hot topic in 2015. Patients are pleading for it. But the concept of transparently sharing outcomes data with patients has elicited concerns from many outstanding, well-meaning clinicians: transparency may be misleading if the data aren’t perfect (complete and accurate); the data must be risk-adjusted; the data must be context-adjusted; there is uncertainty regarding exactly what data should be shared. These concerns are reasonable of course, and must be addressed before the system can become fully transparent. However, “waiting for perfect” will lead to paralysis. Continue reading