Special Issue of JACC: Cardiovascular Imaging Highlights Value of CV Imaging in Women

LESLEE_SHAW_HEADSHOTThis post was authored by Leslee J. Shaw, PhD, FACC, associate editor of JACC: Cardiovascular Imaging and a member of ACC’s Cardiovascular Disease in Women Committee.

For decades, we have heard all of the statistics that more women are dying of coronary heart disease than men. This early finding from the mid-1980s has continued to unfurl with additional data on unique biologic differences coupled with quality of care differences between women and men. All of these factors disadvantage women and illustrate the sizeable gap in knowledge relating to heart disease for females.

If the goals of our health care system are to provide high-quality care for all, then for half the population, we have truly failed! Is this too much of a nihilist’s perspective? Maybe, as gains have been made. We have gained tremendous insight into sex-specific differences over the past decade based on evidence from research using cardiovascular imaging.

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Exciting News on TAVR; Tempered by Unanswered Questions

Svensson_LarsThis post was authored by Lars G. Svensson, MBBCH, PhD, FACC, chair of the Sydell and Arnold Miller Family Heart and Vascular Institute at Cleveland Clinic in Cleveland, OH.

There are few procedures that show a benefit for patients relieving symptoms, saving lives, and improving long-term survival as aortic valve replacement (AVR). Indeed, the advent of transcatheter aortic valve replacement (TAVR) hailed a new era for valve replacement.

In 2001, Alain Cribier, MD, FACC, pioneered human implantation of percutaneous aortic valve replacement via the femoral vein, however this proved to be too high risk. The transapical approach was then implemented with a moderate risk, but shortly thereafter the transfemoral arterial approach was developed with considerably lower mortality although with complications. For example, there was about a 20 percent failure rate from failure to implant, embolization and severe perivalvular regurgitation. Nevertheless, studies in high-risk patients (PARTNER cohort A and PARTNER cohort B) showed excellent outcomes for TAVR with equivalence to open surgery.

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Taking a Closer Look at Centralized Systems of Care

Kovacs headshotThis post is authored by Richard J. Kovacs, MD, FACC, chair of the ACC’s Clinical Quality Committee.

As a result of continued hospital and practice integration, as well as an ongoing evolution to a health care system focused on value, not volume, a trend towards more highly centralized and organized systems of care is emerging as a means of meeting the triple aim of improved outcomes, better care and lower costs.

As a concept, centralized care allows for common standards and goals across a system, making identifying problems or gaps in care, monitoring progress and achieving results more streamlined and arguably easier. However, moving from concept to reality does have its challenges given the need for alignment among a diverse group of stakeholders across the care continuum, as well as the need to overcome clinical, administrative and macroeconomic factors that differ from system to system.

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Congenital Heart Disease Awareness: Transitioning ACHD Patients Into Specialty Care

Marion Rae headshotThis article was authored by Marion McRae, ACNP-BC, a nurse practitioner in the Guerin Family Congenital Heart Program at Cedars-Sinai Medical Center in Los Angeles, CA.

Congenital heart disease (CHD) occurs in close to 1 percent of births with over 90 percent living to adulthood. There are now more adults living with CHD than children due to successful surgical and medical treatment over the last six decades. Unfortunately, many adults with CHD have fallen out of congenital heart care either because they were told they were surgically “fixed” or because they were never referred to adult congenital heart disease (AHCD) providers upon reaching adulthood.

It is now known from decades of follow-up that there can be life-long consequences of even the simplest congenital heart surgeries. In addition, we now know that many individuals with complex CHD repairs that have a single ventricle or a systemic right ventricle will experience early heart failure, arrhythmias, and far-reaching manifestations of surgical procedures, such as the Fontan operation, that subject the body to systemic venous hypertension leading to liver cirrhosis, pulmonary hypertension, esophageal varices, protein-losing enteropathy, plastic bronchitis, etc. Many of these individuals will go on to need a heart transplant or multi-organ transplantation in their second to fourth decade of life.  Continue reading

The Stethoscope Lives

Williams HeadshotThis post was authored by Kim Allan Williams Sr., MD, FACC, president of the ACC.

A recently published Washington Post article, “Heart doctors are listening for clues to the future of their stethoscopes,” highlights important issues in cardiology, claiming that the stethoscope “is having a crossroads moment.”

The stethoscope is certainly not dead. Recent digital technology has upgraded the functionality of stethoscopes.  They now allow volume accentuation and frequency selection, as well as digital file transfer for teaching on rounds, competence testing, or audio file archival for comparison with prior or future recordings. Continue reading

Stakeholder Collaboration Key to Evolving Valve Management Strategies

Ogara_PatThis post was authored by ACC Immediate Past President Patrick T. O’Gara, MD, MACC.

The epidemiology of valvular heart disease (VHD) has changed dramatically over the past 50 years. In the U.S. alone, up to 1.5 million people have moderate or severe aortic stenosis (AS) and approximately 4 million people have significant mitral regurgitation (MR). Clinicians face several challenges in identifying and treating patients with valvular heart disease, particularly AS and MR.

To help better address these challenges, the College recently hosted a two-day Evolving Heart Valve Management Strategies Roundtable that brought together experts from 28 organizations representing a wide variety of medical specialties, industry, patients, integrated health systems and other stakeholder groups, as well as representatives from the U.S. Food and Drug Administration and the Centers for Medicare and Medicaid Services. Continue reading

Wednesday Video Highlights From AHA 2015

Watch Peter Block, MD, FACC, and Deepak L. Bhatt, MD, MPH, FACC, give a recap of Wednesday’s PRADA trial and AUGMENT HF trial. Also watch video interviews with investigators and experts on the NITRIC trial, ANNEXA-R trial, and more. View complete ACC video coverage on YouTube.com. Also check out videos from the FITs on the GO, at YouTube.com/FITsontheGO.

View full AHA 2015 meeting coverage at ACC.org/AHA2015.

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Tuesday Video Highlights From AHA 2015

Watch Peter Block, MD, FACC, and Deepak L. Bhatt, MD, MPH, FACC, give a recap of Tuesday’s PROACT-4 trial and PEGASUS-TIMI 54 trial. Also watch video interviews with investigators and experts on the RIVER PCI trial, ACCORDION study, and more. View complete ACC video coverage on YouTube.com. Also check out videos from the FITs on the GO, at YouTube.com/FITsontheGO.

View full AHA 2015 meeting coverage at ACC.org/AHA2015.

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Monday Video Highlights From AHA 2015

Watch Peter Block, MD, FACC, and Deepak L. Bhatt, MD, MPH, FACC, give a recap of Monday’s SPRINT trial from AHA 2015. Check out ACC’s SPRINT Trial Hub on ACC.org for all of the available ACC resources, expert commentary, a poll and more. Join the conversations on Twitter using the hashtag #SprintTrial.

Also watch video interviews with investigators and experts on the Fifty-Fifty trial, NCDR study on appropriate use, and more. View complete ACC video coverage on YouTube.com. Also check out videos from the FITs on the GO, at YouTube.com/FITsontheGO.

View full AHA 2015 meeting coverage at ACC.org/AHA2015.

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