Advocating for Cardiology in the Nation’s Capital

The ACC’s 2015 Legislative Conference is in full swing in Washington, DC. The conference kicked off on Sunday night with a special ACC Political Action Committee-sponsored reception and dinner featuring remarks from Pulitzer Prize-winning syndicated columnist, political commentator and psychiatrist Charles Krauthammer, MD. In the midst of a unique congressional climate, Krauthammer shared an insider’s perspective into the state of politics in Washington and the 2016 presidential election.

Today, a full lineup of sessions armed more than 400 attendees with the information needed to effect change in their states and on Capitol Hill. While it’s important for attendees to understand the health policy landscape every year, it’s more important than ever in 2015. Recent developments, including repeal of the Sustainable Growth Rate (SGR) by enactment of the Medicare Access and CHIP Authorization Act of 2015, release of new Meaningful Use regulations and ICD-10 implementation, have significantly shifted how health care is delivered, resulting in novel challenges and opportunities. Continue reading

Innovative Ways to Know Your Numbers

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

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Baseball legend Dwight “Doc” Gooden was a special guest at the free health screening community event.

Last week the College’s CardioSmart program, based on the Association of Black Cardiologist’s (ABC) Spirit of the Heart program model, held a Community Leaders Forum in South Bronx, New York. This program brought together panelists from across the patient spectrum to discuss patient and community engagement when it comes to health outcomes, the importance of knowing your numbers, women and metabolic syndrome, LGBTQ youth, the importance of leading by example, and more. Continue reading

Cardiometabolic Syndrome: A Problem Whose Time Has Come

This post was authored by William J. Oetgen, MD, MBA, FACC, ACC executive vice president of Science, Education and Quality.

A diverse group of stakeholders came together for the Cardiometabolic Think Tank.

A diverse group of stakeholders came together for the Cardiometabolic Think Tank.

“It’s a problem whose time has come,” said Scott Grundy, MD, PhD, in kicking off a special Cardiometabolic Think Tank focused on addressing cardiometabolic disease and its interdependencies and identifying a new care model that takes an integrated approach to treating risk factors across diverse populations.

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Cardiometabolic Disease: An Unprecedented Opportunity For an Interdisciplinary Approach to CV Care

Cardiometabolic disease is a serious and growing public health problem made up of an increasingly complex constellation of diseases that physicians must navigate. Cardiometabolic risk factors can entail everything from metabolic syndromes such as dyslipidemia, hypertension, obesity, insulin resistance and hyperglycemia, to behavioral factors such as physical inactivity, smoking and unhealthy diet, and even more genetic causes such as family history, age and gender. Cardiorenal metabolic syndromes, including microalbuminuria and reduced renal function, have recently been adopted into this greater defined sphere. Continue reading

Cardiovascular Disease is a Major Focus of PCORI’s Comparative Research

This post was authored by Joe Selby, MD, MPH, executive director of the Patient-Centered Outcomes Research Institute.

Dedicated to improving decision making around common, burdensome health care issues, the Patient-Centered Outcomes Research Institute (PCORI) views cardiovascular disease (CVD), including heart disease and stroke, as a critically important topic for research. CVD is the leading cause of deaths in the US, accounting for approximately one third of all deaths. Not surprisingly, it is the single most commonly studied topic in PCORI’s research portfolio. Continue reading

Creating a Broader Mission for the ACC Prevention Committee

This post was authored by Vera Bittner, MD, MSPH, FACC, chair of ACC’s Prevention Committee.

Cardiovascular disease prevention is central to the mission of the ACC, and many entities within the College, including the ACC’s Prevention Committee, have contributed to this important mission through advocacy, education, and patient-centered care initiatives. However, previous coordination between these efforts was limited, and in May 2012, the Prevention Committee was challenged by the ACC’s Clinical Quality Committee (CQC) to rethink its role and mission within the College. Through tireless ACC staff efforts and discussions with multiple internal and external stakeholders, a new committee charter was developed and subsequently approved by both the CQC and the ACC Executive Committee.

Key goals of the ACC Prevention Committee include:

  • Act as a liaison to – and a voice for – preventive cardiovascular specialist members within and on behalf of the College
  • Mentor Fellows in Training, early career members, and CCA members interested in prevention
  • Serve as ACC’s “access point” for collaborations with other societies and government entities on projects related to prevention including but not limited to:
    • Assuming coordination of the ACC’s partnership with the Million Hearts Initiative
    • Coordinating the dissemination of the upcoming prevention guidelines within the College with the College’s representative to the National Institutes of Health-led National Program to Reduce Cardiovascular Risk
    • Maintain communications and collaborations with key professional societies active in the field of prevention (e.g. American Association of Cardiovascular and Pulmonary Rehabilitation, American Diabetes Association, American Heart Association, American Society of Hematology, and more)
  • Provide input on ACC guidelines and performance measures relating to cardiovascular disease prevention, as appropriate
  • Serve as a resource to the Advocacy department and other entities within the College
  • Serve as a resource to address disparities in cardiovascular risk factor incidence, prevalence, awareness and treatment
  • Serve as a resource to CardioSmart.org for patient-centered initiatives
  • Support dedicated resources for prevention specialists, including but not limited to, access to guidelines, point of care reference tools, and quality improvement tools
  • Create specific practical and clinical programming and content geared towards cardiovascular disease prevention at the ACC’s Annual Scientific Session and at Chapter meetings, as appropriate
  • Work toward recognition as a Council within the ACC

The ACC Prevention Committee will only be successful in fulfilling its goals with the help and input from a wide cross-section of ACC physician and non-physician members, including those who are still in training. For those interested in or focused on preventive cardiology, please let us know who you are and consider volunteering to participate in projects coordinated by the committee. Let us know what gaps need to be addressed and how the committee can assist you in prevention efforts, be it in your own practice and community or at the chapter or national level. We welcome suggestions for educational programming and development of toolkits to facilitate implementation of prevention into daily practice. Let us know what you would like to see on CardioSource.org and collaborate with your patients to develop new ideas for CardioSmart. Help us develop relationships with prevention-focused organizations to facilitate joint prevention initiatives. Please direct all questions, comments and ideas, to Eva Grace, ACC Prevention Committee staff, at egrace@acc.org.

Check out the new CardioSmart Community on CardioSource and stay up-to-date on the latest CardioSmart features that can improve your practice.

NCDR Study Shows Gaps in Care

This post was authored by William J Oetgen, MD, MBA, FACC, ACC’s senior vice president of Science and Quality.

A recent study using data from the NCDR’s® ICD Registry™ found that the likelihood of receiving cardiac-resynchronization therapy with defibrillation (CRT-D) is mediated by community wealth and hospital resources. The study looked at 22,205 patient stays and found in the full hierarchical model, average median household income (P<0.001) and implantable cardioverter-defibrillator implantable volume (P<0.001) remained significant predictors of CRT-D receipt. Further, patients treated at hospitals in affluent communities were more likely to receive CRT-D than patients treated in poor communities, despite accounting for other patient and hospital characteristics, including insurance status.

Since health care disparities are complex issues, and it has been shown that “variations by race and ethnicity exist in the use of medical devices for the treatment of advanced heart failure,” the study attempted to address the “relative impact of patient-, hospital-, and community-level factors on the likelihood of CRT-D receipt.”

The lead author noted that the analysis demonstrates that the wealth of the community in which patients live impacts the care they receive, and the relationship between median household income and receipt of CRT-D persisted regardless of the patient’s insurance status. The authors also note that their findings have important implications for efforts to address healthcare disparities and that health policy targeting insurance coverage alone will be ineffective in resolving inequities in care.

The ACC has been working on several initiatives to address gaps in care like the example above. ACC’s credo initiative seeks to help clinicians better serve all of their patients, regardless of race, ethnicity, gender, primary language, or other factors that may impact care. The ACC has also been working with groups like the National Minority Quality Forum on the CardioMetabolic Health Alliance, to improve cardiometabolic risk factor control in diverse populations.

In addition, this past year the ACC and its CardioSmart initiative has partnered with the Association of Black Cardiologists on a series of community events aimed at increasing awareness of heart disease and promoting better heart health, particularly in high-risk communities. The next event, called Spirit of the Heart, will take place this weekend in Harlem, NY (read more about Spirit of the Heart and view photos from the event in a previous blog post here).

We know the complex problems related to health care disparities cannot be solved overnight, but it is our hope that these initiatives will slowly but surely help close the gaps in care.

Racial and Ethnic Disparities in Diabetes and CV Disease

This post is authored by Keith C. Ferdinand, MD, FACC, chair of the Minority Cardiometabolic Disease Alliance.

Over the last several decades, the U.S. has made substantial progress in overall cardiovascular health and reducing health disparities, but ongoing racial/ethnic, economic, and other social disparities in health are both unacceptable and correctable. Combating diabetes is an example of one such issue.

Diabetes is an urgent public health issue, especially for African Americans, Hispanics, American Indians and Alaskan Natives, and certain other minority populations. National data from 2007-2009 revealed that the prevalence of type 2 diabetes mellitus in non-Hispanic black adults was the greatest at 12.6 percent, with Hispanics closely following at 11.8 percent, followed by Asian Americans at 11.1 percent and non-Hispanic whites at 8.4 percent, respectively. Other groups with high rates of diabetes include American Indians, South Asians and Americans of Middle Eastern descent.

Race and ethnicity are not anthropologic or scientifically based designations, but instead sociocultural constructs of our society. Therefore, disparities in diabetes prevalence observed in racially and ethnically distinct subgroups of the U.S. population may not only be based on attributable, intrinsic factors (e.g., genetics, metabolism), but more prominently extrinsic factors (e.g., diet, environmental exposure, sociocultural issues). These social determinants of health are clearly major considerations in preventing and controlling diabetes and the associated cardiovascular morbidity and mortality and are the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics. For instance, steps to improve communication for patients who have English as a second language, and positive means to assist with culturally competent communication and care, include utilizing bilingual staff, an on-site professional medical interpreter, a telephonic medical interpreters, or professional interpreters, either on-site, telephonic, video. Using a patient’s bilingual minor relative is not recommended.

The ACC has taken innovative approaches to culturally competent diabetes care and CVD risk reduction. The purpose of CardioSmart.org is to provide comprehensive, thorough, and authoritative informational and educational resources as well as interactive management and compliance tools for heart disease patients and their families. It includes a Diabetes Education Center, with culturally appropriate and literacy level correct language on understanding diabetes. Novel tools include text messaging for adherence reminders and Spanish-language educational materials. In addition, the College’s credo initiative is dedicated to reducing racial/ethnic and other disparities in cardiovascular outcomes, while the new CardioMetabolic Health Alliance includes a focus on diabetes as a way of stemming the outbreak of cardiometabolic disease.

The CardioMetabolic Health Alliance: Improving Quality, Bending the Cost Curve

This post is authored by Gary Puckrein, PhD, president and chief executive officer of the National Minority Quality Forum.

Physicians and the medical community have reached a fork in the road: we need to document that quality and reduced costs are related. By doing so, we hope to offer policymakers a new framework in which to measure the value of medicine. The conjectures:

  • An avoidable mortality index can be an indicator of unnecessary acute events (disease, hospitalizations, disability and death) in a population. Such an index may have utility in localizing the performance of our health care system, thus enabling the investigation of gaps in outcomes of care.
  • There are signals that avoidable acute events are non-random occurrences. There is a possibility that they manifest at predictable frequencies within clinical and geographic sub-populations, and are sentinels of health care and health status disparities.
  • Unnecessary acute events have financial implications. At least one study found that 36% of diabetes-related hospitalizations were avoidable. If that percentage holds true for Medicare beneficiaries, the savings could well be over $10 billion per year.
  • By reducing unnecessary acute events, we may be able to establish an association between improved quality and bending the cost curve, thereby offering a counterpoint to those who believe reducing provider reimbursements is a desirable cost savings device.

The American College of Cardiology, the National Minority Quality Forum (NMQF), and the American Association of Clinical Endocrinologists have joined forces to put our conjectures to the test and have formed the CardioMetabolic Health Alliance. The objective of the Alliance is to improve cardiometabolic risk factor control in diverse populations, including high blood pressure, elevated fasting blood sugar, dyslipidemia, abdominal obesity (waist circumference) and elevated triglycerides; and to provide more effective and coordinated care for people with established cardiometabolic disorders.

In pursuit of its mission, the Alliance will study the possibility that predictable patterns of unnecessary acute cardiac events occur in communities, and that these patterns are measurable and amenable within the context of current treatment modalities. By using the ACC’s PINNACLE Registry and CathPCI Registry, as well as NMQF’s Cardiovascular Disease Index and U.S. Diabetes Index, the Alliance will explore the possible correlation between cardiometabolic disease and unnecessary emergency room visits and hospitalizations; and how these findings can be used to design predictive models and quality improvement interventions targeted for providers and patients at high risk for an acute cardiovascular episode.

Members of the CardioMetabolic Health Alliance and ACC will be meeting at the 2012 Cardiometabolic Health Congress this week in Boston, Ma. Visit the Alliance’s website for more information www.cardiometabolicha.org. Also read more about CardioMetabolic Syndrome in an article in the July/August issue of Cardiology magazine.

Gender and Salary Disparities in Cardiology

As a female cardiologist in a field of predominantly men I am aware of the challenges and opportunities faced by my female colleagues. An age-old issue has been potential gender salary disparities.

A study published this week in the Journal of the American Medical Association (JAMA) answered the gender salary disparity question and found that gender differences in salary exist among a group of physicians who perform similar work.

The disparity is still apparent after adjusting for a number of variables which authors hypothesized may be the cause for the difference. The variables include medical specialty, characteristics of the institution in which they work, work hours, and academic productivity and rank.

The findings show that if the salary disparity is constant over an entire 30-year career, a woman in the study group will earn $350,000 less than a man in the same group. Authors emphasize that the “cumulative difference” would be significantly larger if not controlled for the variables like specialty, rank and leadership.

The study authors suggest that additional research is needed to investigate why these gender differences in compensation develop and how to diminish their impact, due to their continued presence and “difficulty to justify.”

The ACC’s Women in Cardiology Member Section is also a great resource for women cardiologists with opportunities to strengthen their professional support system and skills through networking events, professional development and mentoring programs. These findings are sure to be a topic of discussion in the section.

In addition to gender salary disparities, there are also gender differences in cardiovascular outcomes. To look at this further, the College, in partnership with SCAI, has been participating in a Gender Data Forum series, which bring clinical trialists together from around the world to address these disparities.  The first forum, held this past December, focused on acute coronary syndromes (ACS) and acute myocardial infarction (AMI).  A white paper containing the findings and recommendations is expected later this year.  A second forum, which will address DES, revascularization and complex PCI is planned for September.

Awareness of women and heart disease also continues to be a major issue. I wrote in a previous blog post that according to WomenHeart, heart disease is the leading cause of death of women in the U.S. Nearly five times as many women will die from heart attacks alone this year than will die from breast cancer and women have a 28 percent increased risk of dying as compared to men to die within the first year after a heart attack. The statistics are staggering.

CardioSmart.org has a plethora of information for patients on women and heart disease, which was “once considered largely a man’s disease.” It has been said that once women place the same importance on preventing and detecting CHD as they do on their annual mammogram, we will be a much healthier nation.

I am proud to be a female cardiologist in a leadership position with the ACC. As these issues become increasingly important we must continue to support one another and encourage the up and coming female stars in the field.