This post was authored by Michael Wolk, MD, MACC, past president of the ACC.

We’ve come a long way over the past eight years with the development of Appropriate Use Criteria (AUC). To understand why these criteria are important to our daily practice, we must remember why the concept was first developed. More than a decade ago, usage statistics for diagnostic imaging was shown to have the fastest growth among all medical services covered by Medicare. At the same time, health plans in California were starting to review and question PCI and CABG cases based on RAND appropriateness criteria developed during the 1990s. The ACC’s Medical Directors' Institute, as well as leaders from our Board of Governors, saw this as both a challenge and an opportunity to look at both over- and under- use of procedures.

Upon approval by the Board of Trustees, we accepted the challenge of providing guidance regarding appropriate use of cardiovascular procedures, and ran with it. We created an Appropriateness Criteria Working Group involving several ACC leaders and published the document, ACCF Proposed Method for Evaluating the Appropriateness of Cardiovascular Imaging. Soon after, in October 2005, the first AUC document was published for SPECT MPI, ACCF/ASNC Appropriateness Criteria for Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT MPI). Upon completion, we held a summit to receive feedback on the process and how it might be improved. This information was used to refine the process including introducing early review of proposed clinical scenarios, larger expert panels, more comprehensive lists of clinical scenarios and ongoing coordination with clinical guidelines and other ACC policy documents. To date, the ACC has developed AUC for echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, cardiac radionuclide imaging, coronary revascularization and diagnostic catheterization. Currently under development are documents on implantable defibrillators and cardiac resynchronization, peripheral arterial and venous ultrasound, ultrasound use in pediatric patients, and multi-modality imaging use in heart failure, chest pain, and stable ischemic heart disease.

AUC define “when to do” and “how often to do” a given procedure in the context of scientific evidence, the health care environment, the patient’s profile and a physician’s judgment. The criteria can help inform individual patient care decisions but are best used to evaluate patterns of care by physicians over time.  All of the criteria are developed by panels of clinical experts from the ACC Foundation and its partner organizations based on evidence and when necessary expert opinion. The panels assess the benefits and risks of a procedure for different indications or patient scenarios and then determine whether the indication is appropriate, uncertain, or inappropriate. It is important to note that AUC ratings often contain more detailed scenarios than the recommendations covered in practice guidelines and thus subtle differences are possible. The criteria are also based on current understandings of technical capabilities and potential patient benefits of the procedures examined, and future evidence development will require these ratings to be updated on a regular basis.  In general, the documents have been updated every one to two years with all except the CMR AUC having been revised at least once since their original ratings.

I wrote in a 2004 President’s Page that "some may not see the importance of the College's efforts to address appropriateness. Some might argue that explicit guideline performance indicators can be divisive and prefer we not enter this arena. However, if we do not lead in this effort, others may set criteria that may not be wise either for us as physicians or for our patients.”

Eight years later, I believe the same scenario rings true. (Although looking at today’s use of radiology benefit management companies, I would change the last part of the sentence to “others WILL set criteria …”) It is our duty as a profession to work together with policymakers, payers and other medical societies to ensure patients are receiving the most appropriate care, while also reducing unnecessary health care costs and limiting wide variations in care delivery. This is about “doing the right thing” and is best done by our own standards based on the latest science.

For more information about AUC visit CardioSource.org/AppropriateUse.

This post is from a special AUC series on the blog focusing on the “basics” of what the AUC are, how to use them now, how the AUC can/will be used in the future, as well as the various ACC resources and tools available. Click here to read more.

As I’ve mentioned in several previous posts, my thematic focus for this year is patient-centered care – a style of care that emphasizes education and involvement of patients in medical decision making; integration of medical care, and application of principles of disease prevention and behavioral change. At the end of the day, I want to be able to say that the College has indeed improved patient access to the best cardiovascular health information, as well as provided new tools for health care providers to strengthen patient communication and ultimately improve outcomes.

Today’s release of our health policy statement focused on patient-centered care, is just one more way we are moving closer to achieving these goals. The document – an outgrowth of the commitment by the ACCF beginning in 2009 to develop a patient-centered approach to cardiovascular care – was developed by a writing committee made up of a wide range of representatives from general medicine, the cardiac care team, consumers, and advocacy.

In particular, the paper highlights several key elements to PCC care, including enhanced clinician/patient communications; health literacy; clinician-directed patient education; assessment of patient-centered outcomes; shared decision-making, and patient empowerment and self-management. The statement provides detailed recommendations related to each of these topics and stresses the importance of health policies that facilitate these recommendations and move the concept of patient-centered care from a much-discussed principle to actual reality.

Moving forward this new health policy statement will serve as the cornerstone of the College’s efforts to 1) transform the delivery of cardiovascular care to empower patients across the care continuum; 2) enhance the patient–cardiovascular specialist relationship through the recognized voice of the ACC; and, 3) develop clear recommendations for content to the ACC patient-centered portfolio of tools, campaigns, resources and projects.  The ACC’s Patient-Centered Care Committee under the capable guidance of Mary Norine Walsh, MD, FACC, continues to make headway on a number of other efforts, including enhancing our CardioSmart web portal so that it is the go-to source for patient education and engagement. We are also continuing to build strategic business partnerships with consumer companies interested in health and wellness and fostering community engagement at local and national levels through health fairs and other health-related events. Finally, a dedicated group of ACC members is analyzing the role of cardiovascular specialists in the patient-centered medical home, while other ACC leaders are taking the lead in incorporating patient-centered care elements into their work. (For a personal perspective on patient-centered care, I invite you read my upcoming "President's Page" in JACC on "Restoring the Patient-Physician Relationship." It will post online on May 28. )

All of this work is invigorating! Ultimately, medicine is about a healing connection between human beings. We need to re-establish the ideal of medicine as an art as well as a science, and restore the patient-physician relationship. Patient-centered care is the right thing to do, both in principle and in practice.

That great, growling engine of change – technology – Alvin Toffler, Future Shock, 1970. (Harper, S&S)

The ACC this week submitted its comments to the Centers for Medicare and Medicaid Services (CMS) on its proposal for the second stage of the Electronic Health Record (EHR) Incentive Program. EHR adoption and meaningful use of these technologies is not an easy feat given the constant development of new technologies and the many challenges associated with true interoperability across different platforms. CMS and the Office of the National Coordinator (ONC) for Health IT have definitely undertaken a herculean task. The College’s comments outline the concerns with moving forward with Stage 2 without a careful analysis of Stage 1 – including the challenges associated with participation, as well as the positive results. To quote our comment letter: “We are concerned that the sum total of the requirements contained within this proposal seek to change behavior too rapidly without enough appreciation for the potential consequences.” We will be continuing to work closely with both CMS and ONC to refine requirements in a way that helps, rather than hinders, participation by cardiovascular specialists. (Read the ACC’s summary of Stage 2 requirements).

Meanwhile we are still in the first stage of the EHR Incentive Program, which is good news. However, this year marks the last year for physicians interested in participating to receive the maximum benefit of program participation. Physicians can earn up to $44,000 over five years if they meet the program requirements and begin participating in 2011 or 2012. First-year participants must only comply with the program’s requirements for 90 days, which means interested parties (not already participating) have until Oct. 1 to comply. (Check out this helpful guide from CMS).

We have also partnered with the Managed Care Advisory Group (MCAG) to help members receive incentive payments under program. MCAG uses a dashboard to track physician progress in meeting the Meaningful Use requirements and help identify problem areas. Once requirements are met, MCAG completes and sends the application for the incentive bonus to CMS. MCAG will be hosting a free webinar for ACC members from 1-2 p.m. on May 24, so stay tuned for more information on how to register. CMS also offers a number of resources, accessible via the College’s Health IT page, to help providers through the process themselves. The College is working with CMS to co-host a webinar later in June.

Today’s release of the 2012 Appropriate Use Criteria (AUC) for Diagnostic Catheterization aims to provide guidance on the performance of diagnostic cardiac catheterization. In the series of AUC documents put forth by the ACC and collaborating professional societies, this is the first AUC document addressing diagnostic cardiac catheterization. The criteria were released by the ACC and the Society for Cardiovascular Angiography and Interventions (SCAI) in collaboration with a dozen other professional societies.

Cardiac catheterization is an invasive diagnostic procedure that allows physicians to see the vessels and arteries leading to the heart and its chambers, and measure their pressure. The technical panel identified 166 possible clinical scenarios when referral for diagnostic catheterization might be considered – drawn from the medical literature and current clinical applications – and then assessed the appropriateness for each indication based on accepted methodology.

In general, the technical panel advises that cardiac catheterization is appropriate in patients:

• Without prior stress testing but who report symptoms and have a high pretest probability, or high likelihood of disease in the physician’s judgment
• With definite or suspected acute coronary syndrome
• With typical symptoms and intermediate- or high-risk findings on prior diagnostic testing

The panel noted certain situations in which individuals should not be referred directly to cardiac catheterization. Among others, these include diagnostic workups for:

• Asymptomatic patients at low risk for coronary artery disease or without significant symptoms suggestive of heart disease
• As part of a preoperative work up for non-cardiac surgery in patients with good functional or exercise capacity and/or
• Those undergoing low-risk surgeries (with few exceptions like in patients with significant risk factors, or undergoing transplantation or heart valve surgery)

These criteria are important for physicians to consider as they make clinical judgments and discuss medical decisions with their patients. Ultimately, medical decisions are individualized depending on the clinical situations and with shared decision making with patients. Moving forward, these criteria will be translated into decision support tools, and linked with the previously published coronary revascularization AUC for optimal patient care.

In general, given the continued focus on achieving the triple aim in health care, more and more attention is being given to AUC as a means of reducing variations in care and ensuring appropriate use of technologies and therapies.

On Wednesdays here on the blog over the next two months, we’ll be featuring a special AUC series focusing on the “basics” of what the AUC are, how to use them now, how the AUC can/will be used in the future, as well as the various ACC resources and tools available.

We’re looking forward to the discussions and your feedback, so stay tuned!

Also, in case you missed it, yesterday the ACC and SCAI, in collaboration with the Society of Thoracic Surgeons and the Society for Vascular Medicine, released an updated consensus statement for cardiac cath labs. Read the article on CardioSource.org here.

Obesity rates have reached epidemic proportions in the United States and in my home state of California. The ACC’s Governor of Northern California William Bommer, MD, FACC, co-authored a study that was recently published in the American Heart Journal. The study evaluated serial changes in obesity and fitness in California school children following implementation of prevention measures in all California public schools and found that following these measures has stabilized or improved obesity and fitness levels in 5th through 9th grade students. This is an important study as we all look for ways to improve the heart health of children and adults.

Dr. Bommer describes his study for ACC in Touch blog readers below:

It’s easy to give advice on losing excess weight, “Just eat less and exercise more.” It works on TV, where contestants often lose 100 pounds. However it’s very hard in the real world to follow that advice and lose weight and keep it off for ourselves, our patients and our community. Thus, the prevalence of obesity in many countries has been increasing for the last four decades. Since childhood obesity leads to adult obesity and both carry a significant risk for cardiovascular and other major diseases, it behooves us to develop effective programs to prevent these increases in obesity.

How do we do this? Multiple programs and trials have attempted to prevent obesity. A 2009 Cochrane review identified and screened 14,000 publications and selected 29 papers on interventions for preventing obesity in children. Although the evidence showed that prior diet and exercise programs had been effective in promoting healthy diets and increased physical activity levels, they were not effective in preventing weight gain and obesity.

This obesity problem was recently addressed in California with a more comprehensive diet, exercise, and education program mandated for all school children. At the request of the California Department of Education, ACC member Barry Coughlin, MD, FACC, chaired a Task Force to study and develop an obesity prevention program for all California school children. A comprehensive set of recommendations were made and incorporated into school policy and procedures.

The program was unique in that it made major changes at every school facility and followed the progress with extensive testing in all 6.3 million students.

Our recent analysis of the test results revealed that obesity rates no longer increased in students once they entered into testing at 5th, 7th, and 9th grades. In fact, physical fitness metrics actually improved while body composition remained stable. For once, obesity within the school classes was no longer increasing. This is a big step but there is still more work that needs to be done.

Despite controlling obesity within the school classes, we found that new students entering school testing each year continued to show increasing obesity. Therefore we need to also focus our efforts on preventing obesity in preschool and early primary years. Since preschool years, are outside of the Public School jurisdiction, we will have to focus on community programs for families, day care centers, and preschools to reduce obesity in these younger children.

Early, comprehensive, prevention programs can be effective. Once children or adults are obese, it is still very hard to get long-term weight reduction. Further research on afterschool programs, diet modified gut flora, and novel pharmaceuticals may offer promise. But until then, early and effective prevention is our best medicine.

The ACC at the national level is working to combat obesity, and has partnered with the Obesity Action Coalition (OAC) and 45+ other organizations in a nationwide effort to encourage individuals to contact their legislators and raise awareness of obesity as a serious medical condition.

This topic is also timely as the CDC is currently holding a “Weight of the Nation” Conference and next week a HBO Documentary series, The Weight of the Nation, on May 14 and 15 will feature the Institute of Medicine's extensive work on obesity. The four documentary films examine pressing issues of obesity as they relate to children, communities, policies and systemic challenges.  Click here to find a viewing party near you and learn about what’s driving the nationwide obesity epidemic.

Last year it was decided that the annual ACC Executive Committee (EC) retreat – usually held around this time of the year at the ACC’s “Heart House” headquarters in Washington, DC — be held in the city where the current ACC president resides. The rationale behind this move was so that the College’s senior leadership team, including staff leaders, could meet and interact in a different setting and engage, while also getting a pulse on local issues and topics.

With this in mind, last week the EC travelled to Houston, TX. We had a great meeting and I had the opportunity to host everyone in my home for some delicious Lebanese food, thanks to my wife Huda! The second day we visited the Methodist Hospital and the Methodist Hospital Research Institute where the team interacted with the hospital leadership. We toured the Methodist Institution of Technology, Innovation and Education (MITIE), fully dedicated to education and simulation. Importantly, we had a town hall meeting with more than 250 professionals, practitioners and trainees from around the Texas Medical Center regarding the future of health care and cardiovascular medicine. The panelists were the leaders of institutions from around the Texas Medical Center — which is the largest in the world and employs about 100,000 individuals – and included Marc Boom, MD, president and CEO of the Methodist Hospital System; David Fine, president and CEO of St. Luke’s Episcopal Health Care System; Ralph Brindis, MD, MPH, MACC, past president of the ACC and senior advisor for Cardiovascular Disease, Northern California Kaiser Permanente; Vivian Ho, PhD, the James Baker III Institute Chair in Health Economics at Rice University; and David Lopez, president and CEO of Harris County Hospital District. I had the opportunity to moderate the discussion of this extraordinary panel of experts. You will be interested in this very open discussion that transcends the Houston market and addresses important issues of our health care system, opportunities and challenges.

On another note, the ACC leadership team will be in touch throughout the year with our sister societies and specialty cardiology societies to listen and collaborate on cardiovascular health care issues of mutual interest. We plan to visit with them at their meetings or at Heart House. This week, John Harold, MD, FACC, president elect of the ACC, Tom Arend, interim chief staff officer and I will be at the HRS meeting in Boston and at the SCAI meeting in Las Vegas.

Moving forward, communication, collaboration and engagement are key to our effectiveness in the health care arena. We will be in touch…Keep in touch!

Look for more photos of the EC retreat and the town hall meeting on the ACC's Facebook page.

This post was authored by former ACC President Alfred Bove, MD, PhD, MACC.

In the news this week, Alexander Dale Oen, a world champion swimmer from Norway died during training camp in Flagstaff, AZ, after suffering a cardiac arrest. He was 26. Oen won the 100 breaststroke at the worlds in Shanghai last July and took silver at the 2008 Beijing Olympics. He was expected to compete in the Olympics in London this summer.

Oen is not the first, nor unfortunately last, young athlete to suffer from sudden cardiac death. A recent policy statement published in March by the American Academy of Pediatrics estimates that 2,000 people under the age of 25 die from sudden cardiac arrest in the U.S. every year.

As we head into Spring training seasons for high schools, colleges and major-league teams, as well as look ahead to the summer Olympics, this latest death will likely add continued fuel to the debate about whether to require EKGs in addition to physical exams for younger athletes participating in high-intensity sports. Both the American College of Cardiology and the American Heart Association agree that the mandatory screening of all young athletes with an ECG is not warranted based on cost (due to the large number of tests that would be required), the low incidence of sudden death among athletes in the United States, as well as the concern for false positive results. However overseas, both the European College of Cardiology and the International Olympic Committee (IOC) recommend resting electrocardiograms for all young athletes before they are allowed to compete.

The Journal of American College of Cardiology last year featured an article titled “Mandatory Electrocardiographic Screening of Athletes to Reduce Their Risk for Sudden Death: Proven Fact or Wishful Thinking?” that suggests the latter. The study analyzed the incidence of sudden death among competitive athletes following the enactment of the 1997 National Sport Law, which mandates screening of all athletes with resting ECG and exercise testing. The study found that there were 24 documented events of sudden death or cardiac arrest events among competitive athletes during the years 1985 through 2009, with 11 occurring before the 1997 legislation and 13 occurring after it. According to the study, the average yearly incidence of sudden death or cardiac arrest events was 2.6 events per 100,000 athlete-years. The study concluded that mandatory ECG screening of athletes had no apparent effect on their risk for cardiac arrest.  The authors suggested that the higher incidence of sudden death found in the Italian studies was not representative of the sudden death risk in the athlete population of most other countries [including the United States] which have a much lower incidence.

What does this mean? Johann von Goethe, a German poet, playwright, novelist, and natural philosopher, said: “Knowing is not enough; we must apply.” As the latest cardiac-related death of an athlete makes headlines, it is our job to take our knowledge and make sure we continue to educate not only each other, but our primary care colleagues as well, about what to look for and the questions to ask when screening young athletes. Most importantly we need to make sure primary care providers know when to refer for EKGs.  Patient education is also key. It’s critical that young athletes understand the warning signs and know when to seek help. Promoting the availability of AED’s at athletic events is also key, serving as a less costly alternative to mandatory ECGs that is proven to save lives if used immediately.

Moving forward, the College’s Sports and Exercise Cardiology Council and Section is an important resource for cardiovascular professionals who work with and or treat athletes. The goal of the section and council is to serve as a conduit for information and action regarding the cardiovascular care of athletes, and support constructive and enhanced interactions with all interested stakeholders. We are also participating in the dialogue regarding public policy around issues specific to the cardiovascular care of athletes and exercising individuals and are looking at enhancing opportunities for multidisciplinary training to improve interpretation cardiac testing in athletes and exercising individuals.

Also earlier this week the Sports and Exercise Cardiology Council worked with The New York Times to get a correction to an article “Should Young Athletes Be Screened for Heart Risk?” Read the article including a comment by Christine Lawless, MD, FACC and Richard Kovacs, MD, FACC here.

Share your thoughts on mandatory testing of athletes below.

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

The implementation and use of health information technology (IT) is a crucial component to the systematic practice of quality cardiovascular medicine. Not only is health IT at the crux of ensuring appropriate and continuous patient care across different care settings, it also is vital to practice and hospital quality improvement efforts. Health IT also allows for improved data collection and reporting that can aide in identifying gaps in care and/or areas for further research. At the end of the day, health IT adoption and meaningful use also provides opportunities for increased reimbursement through several federal programs, including the E-Prescribing Incentive Program, the Electronic Health Record (EHR) Incentive Program and the Physician Quality Reporting System. Meanwhile, those not currently participating in these efforts are at risk of penalties.

Over the last several years the growth in health IT has been unprecedented. Speaking at ACC.12 in Chicago this past March, Farzad Mostashari, MD, SCM, deputy national coordinator for programs and policy at the Office of the National Coordinator for Health IT, noted that 34 percent of all physicians and 35 percent of all hospitals have adopted EHRs. In terms of cardiovascular professionals, a recent survey of the ACC’s CardioSurve panel indicates that 43 percent of cardiologists and 50 percent of practice administrators participated in the federal EHR Incentive Program in 2011. The latest numbers released by the Centers for Medicare and Medicaid Services (CMS) in February 2012 indicate that 2,538 physicians identified as cardiologists successfully participated in the program.  Fifty-eight percent of cardiologists responding to the 2012 survey indicated that they are participating or plan to participate in 2012.

Given the integral role of health IT in patient care, quality improvement and now physician reimbursement, it’s important that cardiovascular professionals understand how best to use health IT; the pros and cons of using health IT vs. waiting; and the fundamentals of the federal incentive programs in order to gauge eligibility and avoid looming financial penalties. Over the course of the next month, the ACC in Touch Blog will feature a series of blog posts on Thursdays detailing the federal incentive programs; providing overviews of ACC health IT resources and tools; and highlighting cases studies/lessons learned from members “in the trenches.” Webinars are also being planned with the Centers for Medicare and Medicaid Services, as well as some of our partners involved in providing health IT services to members.

We also invite you to share your own questions, challenges, lessons learned and EHR tips below. These will be compiled and featured in the July/August issue of Cardiology, as well as help guide us in the development of future tools and communications to aide in the ongoing transition to a digital world.

Yesterday was a big day for Transcatheter Aortic Valve Replacement (TAVR) therapy in the U.S. The Centers for Medicare and Medicaid Services (CMS) announced approval of a National Coverage Determination (NCD) of TAVR. The announcement follows an analysis based on an NCD request from the ACC and The Society of Thoracic Surgeons (STS) in late 2011.

The NCD covers TAVR when performed with a FDA-approved device consistent with labeled indications and any other FDA requirements. In addition, it permits Medicare coverage only in facilities meeting certain requirements. The NCD also requires all patients to be included in a national TAVR registry. Medicare coverage will be available for non-FDA-approved indications when performed in a CMS-approved clinical study.

In a statement, the ACC commended CMS on its decision and its comprehensive approach to the introduction of TAVR. This means that this transformative technology will be available to Medicare patients who do not have other options for treating severe, debilitating aortic stenosis. We also agree with CMS’s decision to structure the NCD in a manner that supports access to TAVR while ensuring that services are performed by the best qualified team of physicians and hospitals. We hope this NCD proves to be a successful model for providing rapid access to promising new technologies for Medicare beneficiaries while focusing on patient safety, quality care and outcome.

Earlier in the day, I also participated in an STS/ACC joint Town Hall meeting to discuss the ASCERT study which was presented at ACC.12 (read a previous blog post on the study here and listen to a recording of the town hall meeting here). Although the study has caused some controversy, all of the panelists, which included Dr. Jeff Rich, president of STS, Drs. William Weintraub and Fred Edwards (principal investigators) and others,  underscored the importance of the heart team approach to shared decision making with patients and transparent discussions to determine which revascularization procedure is best suited for a particular patient with multivessel coronary artery disease.

This same “heart team” approach has been apparent throughout the introduction of TAVR into the U.S. Over the past year, the ACC has worked with STS, SCAI and other professional societies on several clinical documents and recommendations in order to effectively and appropriately introduce this new therapy. In addition, the STS/ACC TVT Registry was developed as a collaboration between STS and ACC, also working with CMS, the Food and Drug Administration, Edwards Lifesciences and others.

It is gratifying to see this “heart team” approach starting to take hold. Congratulations to all involved in making this a reality; a victory for our patients.

For more TAVR news and updates and links to additional clinical documents, visit CardioSource.org/TVT.

Hypertension, or high blood pressure, is a major and growing public health problem in the United States.  Approximately 72 million people in the U.S., or about 1 in 3 adults suffer from the disease, which if left untreated can increase risks for heart attack, stroke, and/or other health complications. Blood pressure management has been identified as a key component of the Million Hearts initiative, led by CMS and CDC with a goal to prevent one million heart attacks and strokes over the next five years by focusing on the “ABCS” (aspirin for high-risk patients, blood-pressure control, cholesterol management, and smoking cessation).

As part of “National High Blood Pressure Education Month,” the ACC throughout May is focused on reminding cardiovascular professionals about the tools and resources available to help not only improve care for patients with/or at risk of  hypertension, but also help educate patients about the importance of controlling their blood pressure and minimizing their cardiovascular risks.

Just last year, the ACC Foundation, along with the American Heart Association and the American Medical Association – Physician Consortium for Performance Improvement, released truly ground-breaking performance measures designed to help clinicians treating adults with coronary artery disease (CAD) and hypertension (view the Performance Measures here). Unlike previous measures, these focused not just on treatment in the hospital setting, but on primary and secondary prevention as well. They also addressed whether important cardiac risk factors are being “controlled” to targeted goals vs. simply “treated” – a move that requires much greater patient involvement in treatment and care decisions. Finally, these performance measures emphasized patient-focused functional outcomes and stressed the need to not only assess patient angina and functional symptoms but also to develop treatment plans to improve these outcomes.

The ACC’s PINNACLE Registry takes these performance measures and puts them into action. Registry participants collect data on practice performance and then receive quarterly benchmark reports that can and should be used to identify areas for improvement. Participants in the registry also have access to the PINNACLE Network as a means of sharing best practices and encouraging quality improvement among registry users. PINNACLE is one of the primary ways the ACC is working on a national level with the Million Heart’s initiative.

The ACC’s CardioSmart^TM initiative is also a critical resource when it comes to hypertension. Cardiac care providers can download patient fact sheets in both English and Spanish, or send patients directly to CardioSmart.org to take advantage of the CardioSmart Health Tracker: Blood Pressure Tool. CardioSmart has set a goal of capturing 5,000 blood pressures through the month of May via the online tool and working with its partners at the grassroots level.

Sometimes the toughest problems have the easiest solutions. When it comes to taking down the number one cause of mortality worldwide, taking simple steps to manage conditions like blood pressure can go a long way.

In case you missed it, there’s only one day left to participate in the Office of the National Coordinator for Health Information Technology (ONC), Million Hearts and AHA “Beat Down Blood Pressure” video challenge: http://bloodpressure.challenge.gov/.

How are you helping your patients manage hypertension? Share your tips in the comment section below!