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

The Economic Impact of AUC Implementation at a Large Community Hospital

Pranav Puri headshotThis post was authored by Pranav Puri, a first year undergraduate student at The University of Chicago.

Approximately 600,000 percutaneous coronary interventions (PCIs) are performed in the U.S. each year at a cost that exceeds $12 billion. In recent years, the emphasis of the national health care system has shifted towards providing higher quality care at lower costs, and payment models are shifting away from fee-for-service towards population-based health management and bundled payments. In an effort to assist both physicians and patients in choosing the best procedure for patient outcomes, the ACC developed appropriate use criteria (AUC) for coronary revascularization in 2009 and released a focused update in January 2012.

In February 2012, UnityPoint Trinity in Rock Island, IL initiated a process involving the education and participation of physicians and nurses towards the implementation of the ACC’s AUC. Since the economic impact of AUC has been of interest to me for quite some time (read my previous blog on my poster presentation at ACC.13 here), my colleagues and I put together a study to assess the long-term effects of implementation of AUC on volumes of both interventions and diagnostics. We also studied the distribution of acute vs. elective interventions, and aimed to quantify the economic impact of implementation of the AUC. Continue reading

Will DAPT Change My Practice?

This post was authored by Valentin Fuster, PhD, MD, MACC, editor of Journal of the American College of Cardiology.

First, I want to compliment Laura Mauri, MD, and her colleagues for conducting the landmark Dual Antiplatelet Therapy (DAPT) trial, which was presented yesterday at the American Heart Association’s Scientific Sessions in Chicago.

Recent guidelines have recommend that patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) discontinue dual-antiplatelet therapy – a combination of aspirin and another platelet inhibitor (e.g., clopidogrel) – within six months to one year. Nevertheless, the U.S. Food and Drug Administration and some clinicians have been concerned about the long-term impact of stents and dual-antiplatelet therapy duration on the adverse outcome of stent thrombosis. Continue reading

Guidelines Go Mobile

This post was authored by Richard J. Kovacs, MD, FACC, chair-elect of the Clinical Quality Committee, and Andrea M. Russo, MD, FACC, chair of the Best Practice and Quality Improvement Subcommittee of the ACC Clinical Quality Committee.

For over 20 years, the ACC and American Heart Association (AHA) have jointly been producing clinical practice guidelines that serve as the foundation of care. During this time, the ACC has also produced many programs and derivative products to facilitate implementation of the guidelines, often with limited impact and sustainability. Recently, the College began looking at ways to better leverage technology to meet the demand for quick access to up-to-date information. It is with recognition of the importance of and need for mobile-friendly tools that facilitate optimal guideline use and dissemination that the ACC has developed its new Guideline Clinical App. Continue reading

Perspectives on Hypertension

This post was authored by Patrick T. O’Gara, MD, FACC, president of the ACC, and William J. Oetgen, MD, MBA, FACC, executive vice president of Science, Education and Quality of the ACC.

A State-of-the-Art paper published this week in the Journal of the American College of Cardiology (JACC) provides three perspectives on the recommendations for treatment of hypertension published in the Journal of the American Medical Association (JAMA) late last year by panel members appointed to the Eighth Joint National Committee. The recommendations garnered much attention in the lay press and physician community for several major changes from the previous guideline (JNC 7). In particular, the recommendations raised the systolic blood pressure threshold for treatment of hypertensive persons aged 60 years or older to 150 mm Hg. A target of 140/90 was maintained for other age groups and for patients with diabetes or chronic kidney disease. Continue reading

Sudden Death in Athletes: A Wake-Up Call to Follow Pre-Participation Screening Guidelines

This post was authored by Michelle A. Grenier, MD, FACC, member of the ACC’s Sports and Exercise Cardiology Section Leadership Council.

There is little that sparks more controversy amongst physicians caring for young athletes than the pre-participating screening physical. There are factions amongst some of the most intelligent, well-read, elite practitioners. On one end of the spectrum, there is the belief: “What use is the screening physical if the end result is the final common pathway (unstable ventricular arrhythmia)?” On the other end, there is the belief that “All young athletes, regardless of sport and level of participation require history, physical, EKG and echo… and if necessary, MRI and stress!” In reality, the majority fall somewhere in between, and vacillate somewhat in real-world practice. Continue reading

Cholesterol Guideline Updates: New Tables and Figures

By Michael Mansour, MD, FACC, chair of ACC’s Board of Governors

Last November, the ACC and the American Heart Association (AHA), in collaboration with the National Heart, Lung, and Blood Institute (NHLBI) and other specialty societies, released four prevention guidelines that focused on obesity, the assessment of cardiovascular risk, lifestyle modifications to reduce cardiovascular risk and management of elevated blood cholesterol and body weight in adults. Continue reading

Reaction to Public Citizen’s Criticism of Cardiac Screening Programs

Public Citizen, a consumer advocacy group, called on 20 hospitals today to stop marketing health screening programs directly to the public, saying such screenings do “a great disservice to the community … and to public health more broadly.”

In letters sent directly to the hospitals sponsoring screenings by HealthFair, based in Winter Park, FL, Public Citizen called on the hospitals to stop “fearmongering — scaring healthy individuals about their future health.” The letters note that for “many people, false-positive test results from this screening lead to unfounded anxiety and additional unnecessary, risky, and costly diagnostic procedures and treatment interventions.” They also point out that false positives can also lead to overdiagnosis.

Continue reading

Choosing Wisely: “Low Hanging Fruit?”

The following post authored by William A. Zoghbi, MD, MACC, Joseph P. Drozda, Jr., MD, FACC, Joseph M. Allen, MA, and William J. Oetgen, MD, MBA, is in response to a recent New England Journal of Medicine perspective piece on the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaigna groundbreaking initiative that addresses unnecessary tests and procedures by promoting conversations between physicians and patients about what care is appropriate for their condition. In April 2012, the College joined eight other medical specialty societies in releasing specialty-specific lists of “Five Things Physicians and Patients Should Question” based on current evidence about management and treatment options. Since then the number of participating societies has grown exponentially and an increasing number of related tools have been developed.

In a recent perspective piece in the New England Journal of Medicine, Morden and colleagues offer their assessment of the ABIM Foundation’s Choosing Wisely campaign. In their analysis, they note that there are at least three factors to be admired in the Choosing Wisely concept. Continue reading