This post was authored by Boisey O. Barnes, MD, FACC, founding member and trustee of the Association of Black Cardiologists and Andre Williams, CEO of the Association of Black Cardiologists.

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Racial and ethnic minorities continue to lag behind in many health outcome measures and patients are less likely to get preventative care, translating into more instances of heart disease, stroke and cancer.

During a recent Capitol Hill briefing, several groups, including the Association of Black Cardiologists (ABC) gathered to discuss ways to create awareness and help eliminate health disparities among minorities. ABC is dedicated to eliminating the disparities related to cardiovascular disease in all people of color and to no longer have cardiovascular disease as the leading cause of death.

The National Institutes of Health (NIH) has identified three contributors to continued health disparities -- gaps in minority health research, minority participation in clinical trials and lack of cultural competence and investments in the health care workforce, including clinical investigators.

While these contributors are indeed true, and should be addressed, we as physicians – as cardiologists – must also reach out to our minority communities and talk to our patients face-to-face about the simple changes they can make at home to lead healthier lives. As we observe National Minority Health Month in the U.S., there needs to be a new understanding of race and health not just this month, but every month. Why do African Americans live sicker and die younger than other races? There is still a lot of racial segregation in the U.S. – something many African-American cardiologists see each day in their practices. Many patients are living in different environments and have different exposure to health risk. Where you live and what your risk factors are determine your health.

We have what has been called the “deadly quartet” in the African American population – hypertension, high cholesterol, diabetes and tobacco – and we need to redirect our forces to where the needs are and focus and push for prevention.  First Lady Michelle Obama said “We can make a commitment to promote vegetables and fruits and whole grains on every part of every menu. We can make portion sizes smaller and emphasize quality over quantity. And we can help create a culture - imagine this - where our kids ask for healthy options instead of resisting them.”  But before that can happen, for children and for adults, we have to address prohibitive factors such as the “food deserts” in many of our poor and more often than not, minority neighborhoods where no grocery stores exist and there is an abundance of fast food restaurants.

The conversation continues as we look to help people of all races live longer, healthier lives. Together with the ACC’s Coalition to Reduce Disparities in Cardiovascular Outcomes (credo) we hope to make a difference sooner, rather than later.

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Please note that statements or opinions expressed herein reflect the views of the contributor, and do not reflect the official views of the ACCF, unless otherwise noted.

According to the Centers for Disease Control and Prevention, it has been estimated that at least 280 infants with unrecognized critical congenital heart defects (CCHD) are discharged each year from newborn nurseries in the U.S. Pulse oximetry newborn screening, a simple bedside test to determine the amount of oxygen in a newborn’s blood and the pulse rate, can identify some infants with a CCHD before they show any signs.

The ACC has long advocated for the universal coverage of CCHD screenings for newborns. Studies have shown that this approach to early detection of more subtle forms of congenital heart disease can prevent related complications and promote early diagnosis and treatment.

In September 2011, HHS Secretary Sebelius approved adding screening for CCHDs to the Recommended Uniform Screening Panel, which has been invaluable information as states pursue this policy. Members of the ACC’s Adult Congenital and Pediatric Cardiology Section including Gerard Martin, MD, FACC, worked with HHS to develop recommendations for the implementation of the screenings.

At the state level, there has been a push by several of ACC’s chapters working with other pediatric and cardiovascular societies to introduce policies for the newborn screenings.

Just last week Virginia Gov. Bob McDonnell originally vetoed a bill supporting legislation that would establish a public-private work group to develop a program for screening newborns for critical congenital cyanotic heart disease using pulse oximetry monitoring and providing appropriate early intervention services to infants identified as having the disease. But upon further review and discussions with key stakeholders led by ACC Staff including Delegate Patrick Hope, the ACC Virginia Chapter and others including Mended Little Hearts and AHA, McDonnell decided to implement an executive order that would put the congenital heart disease screening policy in place and officially signed the order today. This is a great example of how a strong grassroots push can be effective and instrumental.

To date Indiana, Maryland, New Jersey, Tennessee, and West Virginia have approved plans that will assure universal testing of newborns for congenital heart disease. The New Hampshire legislature recently passed a CCHD screening bill, which will be reviewed by an oversight committee prior to the Governor’s evaluation and signature, and the Connecticut Senate recently passed a bill to require CCHD screening. The health departments of Michigan, Ohio and Alabama are also currently crafting regulations to require the screening.

The ACC’s State Government Relations team is currently strategizing with stakeholders to advance the screening requirement in several other states. We’ve come a long way over the past few years as the implementation of policies for CCHD screening becomes more widespread.

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The good news in the 2011 National Healthcare Quality Report and National Healthcare Disparities Report released Friday, April 20, by the Agency for Healthcare Research and Quality (AHRQ) is that there have been significant improvements in cardiac care, in areas including reduced hospital admissions for congestive heart failure and fewer hospital deaths due to heart attack.

Unfortunately, the less good news in the reports is that overall improvements in the quality of health care continue to progress at a slow rate – only 2.5 percent a year, and the majority of disparities based on race and ethnicity, socioeconomic status and other factors are either not improving or are heading in the wrong direction.

Working together we can overcome the challenges to future successes and improve the quality rates overall. Chief among the challenges is that health care providers are increasingly being asked to do more – and do it better – all while trying to make sure we guide our patients to the latest credible, evidence-based information and encouraging them to become more engaged with us in their own health and health care.

In our work to improve quality and access to care, AHRQ is building a much-needed resource of comparative clinical information on a variety of priority health conditions, such as cardiovascular disease. The work is being conducted by the Agency’s Effective Health Care Program, the first Federally mandated initiative to support patient-centered outcomes research. As part of this effort, AHRQ is establishing a national network of partners including ACC.

Patient-centered outcomes research, also known as comparative effectiveness research, takes a comprehensive look at the evidence, comparing the effectiveness and risks of various treatment options, and presenting bottom-line results to help you work with patients to answer the question, “What is the best treatment for this individual?”

Data in the quality and disparities reports show strides have been made in answering some of these questions in cardiac care. Along with advances involving congestive heart failure and hospital deaths, racial and ethnic disparities in cardiovascular care were less common than those in other conditions and, in fact, minorities often received better quality care than whites.

Through the Effective Health Care Program, AHRQ conducts systematic reviews of available research to compare the effectiveness, benefits, and potential risks of different treatment options: drugs, medical devices, tests, surgeries, or delivery methods. These evidence-based findings are synthesized into comprehensive reports and translated into plain-language clinician and patient summaries on topics such as effectiveness of self-monitored high blood pressure, combination therapy for high cholesterol, and ACEIs, ARBs, or DRI for high blood pressure. Continuing education credits and slide libraries on cardiovascular patient-centered outcomes research are also available. These resources are designed to encourage and support shared decision making between the patient and clinician, resulting in better care.

As an advocate for evidence-based research and informed decision-making, ACC has joined AHRQ’s national network of partners to share the Agency’s growing inventory of free research reports and tools to help clinicians educate patients about cardiovascular disease, and work with patients to make informed decisions about care. You can view these tools on the AHRQ Effective Health Care Program website, or order free copies of the summary guides, including the consumer guide AHRQ recently cobranded with ACC titled “Measuring Your Blood Pressure at Home: A Review of the Research for Adults” by calling 800–358–9295 and using code C-01.

Together we will increase awareness of patient-centered outcomes research and encourage patients to use this kind of research to help them make the best treatment decisions.

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Please note that statements or opinions expressed herein reflect the views of the contributor, and do not reflect the official views of the ACCF, unless otherwise noted.

This post was authored by Dick Kovacs, MD, FACC, former chair of the ACC Board of Governors and chair of the Best Practices and Quality Improvement Subcommittee, part of the College’s Clinical Quality Committee.

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The ACC, the American Heart Association, and the American Medical Association–Physician Consortium for Performance Improvement have released updated performance measures for adults with heart failure (HF) in order to provide further guidance to clinicians on the provision of optimal patient care.

Heart failure is a condition that occurs when the heart can no longer pump enough blood to meet the needs of the body. Because heart failure is often chronic, heart failure patients must work closely with their cardiovascular care team to not only slow the progression of the disease but also control symptoms and improve quality of life.

The newly released performance measures include care provided in both the outpatient and inpatient setting, emphasizing the need to measure care quality over time and across providers, while also focusing on functional outcomes.

The release of these performance measures are a timely reminder about the varied ACC resources to help manage heart failure patients, chief among them the new Heart Failure Practice Solutions “toolkit,” which provides easy access to nine tools (one for patients and eight for clinicians). This toolkit is intended to help cardiovascular professionals and others brush up on guideline recommendations for HF care; understand what to report for HF performance measures; prescribe appropriate drug therapies for HF patients; provide quality education and self-management strategies to patients; and assess performance improvement.

The Hospital to Home (H2H) Initiative led by the ACC and the Institute for Healthcare Improvement is another important resource for hospitals and cardiovascular care providers interested in improving heart failure patient transitions from hospital to “home.” Implementation of the H2H principles may help institutions avoid federal penalties associated with high readmissions rates. The H2H initiative challenges communities to better understand and tackle readmission problems through use of recommended tools and improvement strategies in three core concept areas: Early Follow-up, Post Discharge Medication Management, and Patient Recognition of Signs and Symptoms.

Beyond heart failure, the College has identified several other areas where the quality of care could be improved using recommended guidelines, appropriate use criteria and/or performance measures. I, working along with other ACC leaders and staff, am currently working to identify best practices for both atrial fibrillation and coronary revascularization. Similar to the Heart Failure toolkit, tools for each will range from web-based forms and check lists to pocket guidelines. It is our hope these tools will introduce real-time, easy-to-use solutions that cross the spectrum of quality, advocacy, and education and bring about real change.

For more details on the new Heart Failure Performance Measures as well as ACC resources, click here.

I’ve had the pleasure of spending the last few days at the World Congress of Cardiology in Dubai. The schedule was packed, but it’s truly been an honor to represent the College along with my colleagues President-Elect John Harold, MD, MACC, former Presidents Drs Bove, Beller, Conti, King, and Board member Eric Bates, MD, FACC, among others. The global reach of the College is tangible here. Among several presentations was an ACC symposium on achieving the Triple Aim in cardiovascular healthcare, a topic that I also address in this week's President Page in JACC.

Since Wednesday I’ve met with the ACC Saudi Heart Association, the Emirates Cardiac Society and the Lebanese Cardiology Society, gone on rounds at the American Hospital Dubai and visited The Health Care City, an amazing health care facility. I also joined other society leaders on Thursday morning at a joint leadership meeting on cardiovascular disease – at topic that Dr. Harold expanded upon in terms of prevention at a session later in the day.

Friday provided a very important opportunity for World Heart Federation members, of which the ACC is a part, to discuss where we currently are with developing a global framework for combating non-communicable diseases (NCDs). Nearly a year after the special UN Summit on the topic, it’s important that we continue to make progress and move the ball forward in addressing this global issue. A important achievement was that the Global Cardiovascular Disease Taskforce, made up of leadership from the world’s largest cardiovascular disease organizations including the American Heart Association, American College of Cardiology, European Heart Network, European Society of Cardiology and the World Heart Federation called on the 12,000 World Congress of Cardiology delegates in Dubai, and the CV disease community at large, to support the adoption of a global goal to reduce premature non-communicable disease mortality by 25 percent by 2025, one of the most important goals targeted by the NCD alliance.

In other exciting news for the College, in Dubai we officially launched the Thailand ACC Chapter and the United Arab Emirates ACC Chapter, bringing the total number of ACC Chapters to 20. Just three weeks ago at ACC.12 in Chicago we spoke about reaching this milestone before the end of the year – little did we dream we would reach our goal in two weeks!  We look forward to working with all of our international chapters and members globally in enhancing education, quality of care and bidirectional exchange of knowledge.

The ACC’s leadership in the development of guidelines, performance measures and registries, as well as our innovation in terms of educational programs and products, allows us to play an important role abroad. Quality patient-centered care knows no borders…

Look for more details on ACC’s activities in Dubai in the May/June issue of Cardiology, hitting mailboxes later next month. Photos will also be posted on the ACC’s Facebook page.

It is customary at the ACC that the first trip of the newly installed ACC President is to visit Heart House in Washington, DC to meet with College staff. So on Monday April 9, I met with the entire staff of the ACC, of more than 300, to discuss my upcoming presidential year. I shared with them the details of my pathway to becoming president of the ACC along with some photos of earlier years in Lebanon, my hometown, my team at the Methodist DeBakey Heart & Vascular Center in Houston, TX and of my loving family.

I was encouraged by the energy in the room and the open interaction and discussions. I am confident that this next year will be a great one under the current guidance of Tom Arend, the ACC’s General Counsel and Chief Operating Officer, who will serve as the interim Chief Staff Officer, alongside the team of Senior Vice Presidents and dedicated staff while we search for a new Chief Executive Officer of the ACC. This process has already started. Changes can be bittersweet but in the words of Winston Churchill: “there is nothing wrong with change, if it is in the right direction.”  The ACC continues to be a vibrant organization with strong member and staff leadership. I look forward to many exciting achievements this year working with all of you.

Over the past two weeks ACC leaders have been globetrotting in the U.S. and all over the world to attend the Florida Chapter meeting, the German Society of Cardiology’s Annual Meeting, the Malaysia Heart Association’s Annual Meeting, the World Heart Federation’s World Congress of Cardiology Scientific Sessions, and the ARCA Italian Clinical Cardiology Society Meeting. I’m glad we have these opportunities to share with other international leaders how the ACC is working to combat cardiovascular disease and to promote patient-centered care this coming year.

Finally, I look forward to communicating with you, our members, through the Blog and exchanging important developments or thoughts. I invite you to leave any questions you may have in the comment section below.

This post was authored by David May, MD, FACC, BOG Chair-Elect.

There was an interesting article published in Sunday’s Washington Post by Jordan Rau titled, “Medicare moves to tie doctors pay to quality and cost of care,” which offered a glimpse into the public view of physician payment and pay for performance.

The article was about resource use reports and outlines the complexity of attempting to characterize how much each of us actually costs the Medicare system, the huge problem of bundled payment system implementation, and all this on top of not having clear outcomes data on most of what we do.

Imagine for a moment the inverse of your first reaction to this concept. Imagine you are a primary care provider and receive a report that says your favorite cardiologist, Dr. X, spent an enormous amount of money working up your patients, and it cost you pay for performance money! How will that change your referrals?

Further, as a private practice cardiologist, I own the costs of my care. What is the cost of an employed cardiologist who uses the outpatient department of the employer hospital on the HOPPS payment scale? Is the cardiologist saddled with the "cost" or is the cardiologist "hidden" from exposure even though they cost the Medicare system twice as much? Quite a conundrum.

The ACC Advocacy team is currently assembling a group of physicians to review the resource use reports and have a meeting with CMS in the coming weeks.  They’re also interested in the feedback on the nature of these reports and suggestions on how they can be improved.  Leave your comments below or email advocate[at]acc.org.

It is both an honor and a privilege to be a member of the cardiovascular community. But there is a responsibility that comes with the designation. The ACC and its members are committed to quality cardiovascular care in an effort to do the right thing for our patients.

Over the past two years, the Maryland Chapter of the ACC under the leadership of Sam Goldberg, MD, FACC, past president of the chapter, and several others at the chapter and national level have been working to develop an oversight system for all state hospitals performing PCIs. (Read previous blog posts on the topic here and here). The bill was introduced over a year ago, and just this past week the Maryland Legislature passed the bill which for the first time requires a state agency to develop requirements for peer or independent review, consistent with the ACCF/AHA/SCAI Guidelines for PCI, of difficult or complicated cases and for randomly selected cases for Maryland hospitals.

In a statement issued by the Maryland Chapter, Marc Mugmon, MD, FACC, president of the Maryland chapter stated, “Peer review is a fundamental component of any comprehensive continuous quality improvement effort and will enhance patient safety by providing constructive, objective feedback to cardiologists in a collaborative environment. Independent, external review will be free of bias and politics, and by identifying individual operator strengths and weaknesses, it will help achieve the highest standard of performance. This process will complement robust internal programs and will rapidly identify and address potential deviations from accepted evidence-based guidelines for the use of stents.”

The Maryland Chapter, at the invitation of the Maryland Health Care Commission, will be an integral part of the regulatory process to implement regulations and ongoing performance measures as a member of the newly establish Clinical Advisory Group.

This is a great example of what we can accomplish at the state level though the hard work of our Board of Governor leaders. Earlier this year the Maryland Chapter was presented with the award for Advocacy at the Leadership Forum, and I am pleased to see all of their hard work and efforts have come to fruition. I hope their efforts can be a model for other states.

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

The Hospital to Home (H2H) initiative was launched in 2009 as a joint effort of the ACC and the Institute for Healthcare Improvement. Three years later, the goal of H2H continues to be a 20 percent reduction of hospital readmissions within 30 days for patients admitted with either acute myocardial infarction or heart failure. Three important activities that address core concepts have been identified as targets for improvement:

1. Medication Management Post-Discharge: Is the patient familiar and competent with his or her medications and is there access to them?
2. Early Follow-Up: Does the patient have a follow up visit scheduled within a week of discharge and is she or he able to get there?
3. Symptom Management: Does the patient fully comprehend the signs and symptoms that require medical attention and whom to contact if they occur?

In addition, H2H strives to create a learning community that shares expertise, experience and tools – and works together to improve the transition from hospital to home. The H2H community was developed to address these “challenges.” And, in a remarkable example of collegiality and cooperation, H2H members are collaborating and sharing information to help each other.

Over the past few years since H2H was established, individual and hospital participation in H2H has steadily increased. Currently, 2,294 individuals and 1,326 hospitals (39 percent of all U.S. hospitals) have united around the shared goal of lowering the risk of readmission.

Members of H2H have engaged in lively discussions of challenges and success strategies on the H2H listserv and on webinars designed to share experiences and best practices. We are continuously seeking ways to encourage participation and easier ways to access the tools and resources of the community.

During an ACC.12 session in Chicago, a panel of experts convened to discuss and identify tools and ideas to reduce hospital readmissions including a neighborhood watch solution that enlists trained volunteers from nearby universities to educate patients and make follow-up phone calls. We had several great ideas presented and the discussions underscored how the best way we can find the answer is by working together.

Reducing readmission rates is not straightforward and each institution must tailor its strategy to its particular setting and resources. Research in this area is still evolving, but with available knowledge it is now possible to make progress. In order to be successful and reach our goal, we must continue to learn from what we do – and from each other.

For more information on H2H visit www.H2Hquality.org.

Last week on the blog I talked about my presidential focus on furthering patient-centered care (read the blog post here). A big component of this focus will be education, one of the four pillars of the ACC. In an effort to provide the requisite breadth and depth of content to meet the needs of all our members across care teams, we have identified and are already hard at work on several endeavors:

• We will inaugurate our Lifelong Learning Portfolio on CardioSource.org along with point-of-care tools that provide the clinician a perspective on competency requirements and individual practice gaps using proven learning formats and experiences to drive continual practice improvements. We will also provide Maintenance of Certification tools for both Part II and Part IV to ensure all our members can maintain their competency.
• We will keep all our members abreast of competency requirements.
• We will launch, this year, our first annual curriculum planning process, based on newly published competencies, registry data, and aggregate educational outcomes.
• We are devising an innovative blended learning strategy to support knowledge transfer to practice by delivering a sequence of learning experiences across live and online learning channels.

I discuss this and more of my goals in my first President’s Page published in this month’s issue of the Journal of the American College of Cardiology (JACC).

I invite you all to leave your ideas, comments and suggestions below. I look forward to identifying the possibilities and shaping the future of cv care together.