The benefits of statin therapy in reducing the morbidity and mortality associated with atherosclerotic cardiovascular disease (ASCVD) are well documented; however, statins remain underutilized for both primary and secondary prevention. Two years ago the ACC launched its LDL: Address the Risk Initiative with the goal of closing this disparity in care and improving patient outcomes by increasing awareness of the gaps in lipid management, including the importance of managing LDL-related risks. Continue reading
This post was authored by Kim Allan Williams, Sr., MD, FACC, president-elect of the ACC.
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
This post was authored by William J. Oetgen, MD, MBA, FACC, ACC executive vice president of Science, Education and Quality.
“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.
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
This post was authored by Nathan Wong, PhD, FACC, and Michael Blaha, MD, MPH, editor-in-chief and associate editor of the Cardiometabolic Disease CardioSource Clinical Community.
With the upsurge in prevalence of obesity and diabetes in the U.S. and beyond, and the fact that some three fourths of deaths in persons with diabetes and due to cardiovascular disease, the ACC and other groups have recognized the importance of understanding and communicating the importance of cardiometabolic issues in preventive cardiology. The convergence of diabetes and cardiovascular disease has been the basis for many such educational activities.
A new ACC community on cardiometabolic health will help to further educate clinicians on important connections between diabetes and other cardiometabolic conditions such as hypertension and dyslipidemia and cardiovascular disease. The community will highlight new strategies aimed to screen for these problems, detect those at highest risk to prioritize treatment, and newer and emerging therapies that have the potential for significant future benefit. Continue reading
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.
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.