All “A-Twitter” at ACC.13

As cardiovascular science marches forward, certainly demonstrated at the ACC.13 Annual Scientific Session, so too does the way technology is used to expand communication. Innovation has changed the way we practice medicine—witness TAVR, the use of LVAD and the emergence of new pharmacology for the betterment of our patient care—and similarly, innovation has forever altered the way we locate and  consume the latest science and education reports as well as how we share education information with patients. This weekend, smart phones and tablets dominated the hallways of the convention center at ACC.13. While many attendees were using their devices to browse sessions and plan their schedules using the ACC.13 eMeeting Planner app, thousands of others, myself included, were using them to soak up as much knowledge as possible. With hundreds of events taking place in three separate buildings, it was impossible to be at every session that sounded interesting. The ACC’s meeting Twitter account (@ACC_2013) was my go-to source for everything that was happening in San Francisco, allowing me to follow thought leaders from across the spectrum of cardiology, each reporting, in real time, updates from a variety of venues including late breaking clinical trials, esoteric sessions on orphan diseases and impromptu FIT meetings with giants of cardiology. I wasn’t alone. The hashtag #ACC13 has been used more than 4,500 times by nearly 1,200 people and still counting. That makes ACC.13 the most “connected” meeting to date with more than 5 million impressions worldwide. 

On Saturday, I shared my personal experience with the use of social media in medicine during a presentation in ACC Central. In my hectic daily life, I take advantage of Twitter to get the most up-to-date information —from clinical to health policy to world news—delivered to the palm of my hand, enabling me to be the most informed physician I can be. It’s also helped me discover and innovate, adapting other cutting-edge tools and resources to my benefit.  This in turn helps me better serve my patients and run a more successful practice. 

Just because ACC.13 is a wrap, doesn’t mean social media will fade into the background. One out of every seven minutes spent online is on Facebook and there are 340 million tweets sent each day. Surprisingly, while only 19 percent of cardiologists believe social media channels are very or extremely effective for sharing insight on medical news, research, developments and treatments, there has been a rapid uptick in engagement across ACC’s suite of social media channels. At this stage in the game, it’s clear that social media is here to stay and I encourage all of you to get on board to become more informed, well-rounded clinicians.

 If you would like to experiment with knowledge acquisition via social media, it’s safe and easy. Simply log on to twitter, make an account and look me up at @DavidMayMD. Click the “follow” button and all my tweets will be delivered to your account. I tweet articles and commentary on a wide array of topics, essentially functioning as a sort of organic Google search engine. You will immediately sense the potential of thousands of us, linked together in cyberspace, each day searching our own interests, finding nuggets of value, then communicating about those interests in real time. And besides, your kids will think you’re cool.


My Path to ACC Presidency on the Shoulders of Giants

This post was authored by John Gordon Harold, MD, MACC, president of the American College of Cardiology.

Yesterday evening marked the College’s 62nd annual Convocation – a ceremony of celebration, tradition, transition, and renewal. It served as formal recognition of the many accomplishments of new Fellows and Associates and was just the beginning of their lifelong relationship with the College. For me, it was also a new beginning, as well as time of reflection on those who have come before me – for my mentors, for the College’s past presidents. I am grateful to William Zoghbi, MD, MACC for his service to the ACC and I look forward to carrying the torch that he passed to me last evening.

Forty years ago in San Francisco, Jeremy Swan, MD, MACC was inaugurated as President of the College – and four decades later, I stand in his footsteps. He set an example of personal and professional integrity, was brilliant in research, built a world-class division of cardiology, and involved me in patient-care, clinical research and in the greater cardiovascular community. From him, I learned about the need to focus on building for the future, the importance of philanthropy, and the importance of supporting the College.

Most importantly, Dr. Swan modeled for me how to be a mentor. The French philosopher, Bernard of Chartres, said that “we are like dwarfs on the shoulders of giants, so that we can see more than they, and things at a great distance, not by virtue of any sight on our part, or any physical distinction, but because we are carried high and raised up by their giant size.”

Dr. Swan was my giant – a blend of a scientific cardiologist, compassionate physician and human being. We connected over our passion for cardiology, as well as our common Irish heritage. He taught me that a mentor must be a good listener, honest, trustworthy, knowledgeable, respected, willing to devote time to others and able to connect on both professional and personal levels.

Great mentors like Dr. Swan are essential to our collective future. If we are to be successful as a profession, it is our responsibility to act now to grow and foster the cardiovascular workforce to meet future demands. If we fail to do this, we will be unable to both meet the needs of patients and stem the growth of cardiovascular disease. And while mentoring requires a great deal of effort and collaboration, the benefits are priceless.

Who was your mentor?

ACC.13 Poster Presentations – Better than Ever

This post was authored by Payal Kohli, MD, fellow-in-training at the University of California, San Francisco (UCSF).

With the abundance of science at every meeting, I’ve often wondered why they even have poster sessions, which end up being heavily neglected and sparsely attended, sometimes even by the authors themselves. This year, something about the way the poster session was organized seems to have changed that completely and it was packed.

Maybe it was a theme of the meeting itself. Every room seemed to be overflowing, people lining up to see the science this year. Maybe it’s the gorgeous city of San Francisco, which has drawn people from all over the world. Maybe it was because the posters were centrally located near the free coffee from sponsors. Who knows? All I know is that the well-organized, cozy poster session was a real treat this year.

I spent my time in the prevention track, since my interests are rapidly evolving towards that direction.  I think what struck me the most about the posters that I saw in the prevention track was the sheer number—there were dozens! This was a good sign as the promotion of health is becoming the focus of the science of tomorrow, as Dr. Fuster noted in his opening lecture.

The second thing that really stood out was the formation of Prevention groups across the country, such as the Ciccarone Center at Johns Hopkins University, which is under the supervision of Dr. Roger Blumenthal. These types of groups may be trailblazing the way for groups focused on optimal research and clinical delivery of prevention. And many of my co-fellows who belong to this group are lucky to be in a rich collaborative environment such as this, where their name appears on not just one, not just two but sometimes three or four posters, allowing them to be involved in multiple projects at the same time and delve into their research from many different angles.

What struck you most about the poster sessions?

Poster Presentation Shows Economic Impact of AUC

This post was authored by Pranav Puri, winner of the best CCA poster award.

Early last summer, as the presidential campaigns began to heat up and national dialogue once again shifted to healthcare policy, I decided to leave the rhetoric of the campaigns aside and take a look at the raw figures of healthcare spending for myself.

After sifting through a couple pages of Google search results, I found myself on the website of the Organization for Economic Cooperation and Development (OECD), an organization of developed economies, and the numbers I found there were truly staggering. The U.S. spends $2.6 trillion on healthcare which is approximately 18% of GDP; to put that figure in perspective, the OECD average is 9.5% of GDP.

More importantly, however, the quality of healthcare in the U.S. ranks far closer to the OECD average than to the top of the list. Further research showed that roughly 3,700 percutaneous coronary interventions (PCIs) per million were performed in the U.S. while the OECD average was close to 1,250. Around that time, Trinity Regional Health System in Rock Island, IL, my hometown, had implemented the ACC’s appropriate use criteria (AUC) for coronary revascularization.

With the OECD data fresh in my mind, I approached the cardiology department at Trinity to study the effect of implementation of AUC for coronary revascularization on volume of PCIs and cost savings. Data from six months after implementation of AUC was compared to that of corresponding six months in 2010 and 2011. The number of interventional cardiologists did not change over that time period while the number of patients seen by the cardiologists during the time period increased. The number of diagnostics decreased by 9 percent after implementation of the AUC, and the number of interventions decreased by 27 percent.

Due to a decrease in interventions and diagnostics, total hospital reimbursement over the six month time period decreased by 35 percent from the previous year. If the AUC for coronary revascularization were to be further implemented and similar trends were to be observed nationally, we calculated that $2.3 billion would be saved. The maximum decline, I hypothesize, was in interventions that would be labeled as “uncertain.” The AUC’s greatest impact, therefore, was on influencing physician behavior rather than cutting back on “inappropriate” cases. By adding an element of oversight and better informing staff and patients, the AUC influenced the physician’s thought process and reinforced doubts about prospective procedures.

Upon entering Moscone West late Friday evening to complete my registration and pick up my ACC.13 badge, I was taken aback by the frenzy and sheer excitement surrounding the meeting. Coming from a small town of 40,000, it was hard for me to fathom the magnitude of ACC.13. The next day during my poster presentation, I was greeted by attendees that showed great interest in my poster and posed incisive questions. Overall, the attendees were extremely supportive and made ACC.13 a welcoming place for a 16 year old high school student amongst well tenured physicians and researchers. As I get ready to board my last flight home, I can’t help but reminisce on the past few days and look forward to ACC.14 in Washington, DC.

FIT Mix ‘n’ Mingle Event: Hollywood for Cardiology

This post was authored by Payal Kohli, MD, fellow-in-training at the University of California, San Francisco (UCSF).

I don’t even know where to begin about how great yesterday’s Fellows in Training (FIT) Mix ‘n’ Mingle event was.  It started off with me spotting Dr. Deepak Bhatt, one of my all-time favorite mentors who I was hoping to catch a glimpse of to congratulate him on the presentation of the CHAMPION-PHOENIX trial.  I then saw Dr. Michael Landzberg, the most beloved adult congenital cardiologist of Boston, who taught me what a Fontaine was during my third week of my internship.

On my way to get a refill of my soda, I spotted Dr. Robert Harrington, who I am convinced will change the landscape of clinical trials on the west coast and who graciously invited me and my colleague Dr. Fatima Rodriguez to a Stanford Alumni event later that evening.  I’m only just getting started!  There were so many other amazing mentors in attendance, including Dr. Valentin Fuster, Dr. Lynne Stevenson, Dr. Pat O’Gara, Dr. Jeff Popma to name a few. The list was truly endless and I felt like I was in Hollywood with the stars, not knowing who to see next.

Next, I ran into Dr. Phil Green, who was my resident when I was an intern, and we recounted stories about practical jokes we used to play on each other, along with Dr. Tariq Ahmad and Dr. Nihar Desai.  I saw at least five generations of residents from my Brigham and Women’s/Massachusetts General Hospital family, including Dr. Ehrin Armstrong who was my resident when I was a scared third-year medical student.

I think everything about academic medicine was perfectly crystallized into this one single event — research, ideas, collaborations, networking, mentoring and education. This was truly a microcosm of the ACC meeting.

My only complaint?  I wish it was longer!

A Closer Look at Medical Liability Risk Reductions

This post was authored by Richard A. Chazal, MD, FACC.

Medical liability has and continues to be a hot topic for cardiology and physicians in general. A study published in the January 2013 issue of Health Affairs found that the average physician spends 50.7 months, or 11 percent, of their career with an unresolved, open malpractice claim, an allegation of malpractice against a physician and a request for compensation.

On a more granular level, an analysis of 345 closed cardiology claims by The Doctors Company found the most frequent allegation was the failure or delay in diagnosis, followed by improper performance of surgery or a procedure such as cardiac catheterization, cardiac ablation or insertion of permanent pacemakers.

Tips on how to limit medical liability risk and avoid claims are always helpful, particularly given that real medical liability reforms have yet to be implemented by Congress as part of health reform.  Speaking at a special session at ACC.13, Robin Diamond, JD, MSN, RN, chief patient safety officer for The Doctors Company, provided several good tips for avoiding lawsuits. Diamond said she prefers to talk about medical liability in terms of decreasing chance of error, which in turn will decrease chance of injury or harm and ultimately will decrease chance of being sued. The most important thing, she said, is that “no matter how technically skilled, if the patient becomes angry or unhappy about something, chances of a lawsuit increase.”

Some specific tips:

  • Practice good communication skills with medical colleagues, as well as patients and their families
  • Effectively document
  • Be aware of literacy issues
  • Ensure medical assistants are functioning within their scope of practice and that allied professionals (ie. NPs and Pas) are practicing within their licensure

David Troxel, MD, medical director for The Doctors Company, also noted that risk evaluation and mitigation strategies (REMS) may be one way moving forward to reduce liability risks. Programs like the PDR Network, of which the ACC is a part, is an example of a REMS program, said Troxel.  He noted that participation in the PDR Network provides automated delivery of FDA-approved drug information and reminders and disease-specific educational information direct to patients via an EHR patient portal. It also provides drug safety and efficacy messaging direct to patients and enhances patient compliance by tracking fill rates and adherence.

Meanwhile, the ACC is partnering with The Doctor’s Company on the first ever national program tailored to cardiologists and targeted at reducing risk and premiums specifically for cardiovascular teams. Members participating in the program benefit in a number of ways, including a claims free credit (with rates based on jurisdiction), and 5 percent program discounts for a favorable claims history, MOC participation and participation in the PINNACLE Registry.

CCAs: Celebrating 10 Years as Part of the ACC Team

The ACC’s Cardiac Care Associate (CCA) designation and membership group began in 2003 in response to ACC’s focus on team-based cardiovascular care, a decade later this group has grown to include more than 5,000 members of the cardiac care team, including nurse practitioners, registered nurses, clinical nurse specialists, physician assistants and clinical pharmacists.

Among the group’s biggest accomplishments over the last decade:

  • National and state-level committee positions for CCA members, including on the ACC’s Board of Trustees
  • Certificate of Accreditation as a provider of continuing nursing education from the ANCC
  • CCA-specific educational track, and dedicated pharmacology program, at Annual Scientific Sessions
  • Ability to vote in ACC chapter elections
  • Creation of the Associate of the American College of Cardiology (AACC) designation to recognize advanced professional achievement by CCA members. (Ten CCAs will receive this designation at Convocation during ACC.13.)
  • Launch of the Cardiovascular Team Section

New this year, the first Distinguished Associate Award will be given at ACC.13 Convocation to Brenda Garrett. “I am humbly honored and proudly accept this award on behalf of all nurses, PA’s and all those that compose the ‘Cardio Team,’” said Brenda.

Check out the following video from Eileen M. Handberg, PhD, ARNP-BC, FACC, Margo B. Minissian, RN, ACNP-BC, CLS, AACC, and Michael Clark, PA-C, PhD, AACC, for more on the CCA Anniversary. You can also share your thoughts on role of the cardiovascular care team below.

Answers to Atherosclerosis ‘Wrapped Up’ in Mummies?

This post was authored by ACC President-Elect John Gordon Harold, MD, MACC.

Commonly, we think of atherosclerosis as a consequence of modern lifestyles, mainly because it has increased in developing countries as they become more westernized. However, data released today from the Horus Study of four ancient populations suggests a missing link in our understanding of heart disease, and suggests that we may not be so different from these ancient civilizations.

As physicians we have typically blamed fast food, lack of exercise, smoking and lifestyle factors of modern life for our predisposition to heart disease. But remains from the Unangan (Aleut) Indians of the Aleutian Islands, Peruvian mummies, the ancestral Puebloans of southwest America and mummies from Egypt show atherosclerosis to be a condition that has spanned thousands of years, including a wide variety of geographic locations, genetic backgrounds and lifestyles.

The Horus team performed CT scans of 137 mummies from these four different geographical regions spanning over four thousand years and found signs of atherosclerosis in 35 percent of the mummies and across all populations in the study. Specifically, the team found evidence of atherosclerosis among all groups, including 39 percent of the 77 Egyptians studied, 26 percent of 51 Peruvians, 40 percent of the five Hisatsinom examined, and 60 percent of the five Unangan.

The presence of atherosclerosis, which was regarded as being present if calcified plaque was seen in the wall of an artery or expected course of an artery, suggests the possibility of a more basic predisposition to the disease and that atherosclerosis is an inherent component of human aging with other causes or risk factors that need to be further elucidated.

At the end of the day, while the Horus researchers could not determine the exact cause of death in the bodies examined, symptoms consistent with cardiac chest pain have been described in ancient Egyptian papyrus scrolls. If nothing else, Horus is a wake-up call that we need to look beyond modern risk factors to fully unravel the mysteries of atherosclerotic heart disease.

Photo Caption: Dr. Harold with the Horus trial investigators.