This post was authored by Christine Lawless, MD, FACC, co-chair of the Sports and Exercise Cardiology Council & Section.

This year leaders from the ACC’s Sports and Exercise Cardiology Council were invited to lead sessions at the International Convention on Science, Education and Medicine in Sport (ICSEMIS) in Glasgow from July 19 – 24. The conference is a collaboration among the International Olympic Committee, International Paralympic Committee, International Federation of Sports Medicine and the International Council of Sport Science and Physical Education. Also known as the “Knowledge Olympics,” the convention occurs ever four years in conjunction with the Olympic Games, and some may joke that is the more important Olympics as there is always much to learn from one another.

Although Glasgow was cold (about 60 degrees) the topics were hot and we had a jam-packed program. Our session, “Return-to-Play (RTP) in Athletes with Cardiac Conditions,” covered innovation in RTP for athletes with cardiac conditions in the U.S., which I led; cardiomyopathy RTP, led by Barry Maron, MD, FACC; RTP with aortopathy and valvular heart disease, led by Paul Thompson, MD, FACC; and sports electrophysiology: RTP with Long QT and implanted devices, led by Michael Ackerman, MD, FACC.

There were also several heavy hitters that presented including Paolo Angelini, MD, from Houston, TX, where he runs a center for coronary anomalies, and gave a talk on the subject. He has a novel method of limited MRI to assess for this condition in middle school children (athlete and nonathlete), and has enrolled over 2500 children in this project. Sanjay Sharma, MD, from the UK, who spoke at ACC.12, gave a presentation on ECGs in black athletes. After his talk he left for London where he is providing medical coverage for endurance events.  Antonio Pelliccia, MD, from Italy, who also spoke at ACC.12, gave a presentation on SCD in athletes and the Italian screening program. Soon after, he also left for London, where he will provide service as Chief Medical Officer for the Italian Olympic team.

We also had the opportunity to network with Stewart Hillis, MD, who was the Scottish football team doctor for many years and received the Order of the British Empire for his work creating the sports medicine curriculum at the university in Glasgow. He shared some wonderful insights with us about cardiovascular screening for young people in the UK and Scotland. Surprisingly, high school athletes are not mandated to undergo preparticipation screening in the UK, thus here in the U.S. we are doing more for our high school athletes by requiring at least a history and physical. He also informed us that Italy was one of the few – if not only- European countries performing mandatory screenings.

Overall it was a great experience and I enjoyed the culture and hospitality of our hosts (I discovered a great goats’ cheese parcels recipe for anyone interested)!  Although the international audience may have different guidelines and opinions on the topic of screening of athletes, we still have much to learn from one another.

View photos from the Knowledge Olympics on ACC’s Facebook page and stay tuned to the ACC in Touch blog for the latest cv news from the Olympic Games. Also be sure to check out my interview in an American Medical News article about the Olympic games.

A bill that would de-fund the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ), an agency ACC has long supported, has passed through the House Labor, Health and Human Services and Education (Labor-HHS) Appropriations Subcommittee.

Although it is thought that the bill will progress no further in the House, it is a startling message, and urges us to emphasize the importance of patient-centered outcomes research and health services research. Earlier this year, the ACC testified before the House Labor-HHS Appropriations Subcommittee about the importance of AHRQ and health services research among other federal programs, and recently the College signed a Friends of AHRQ joint letter to the House urging them to reject the bill that de-funds AHRQ.

As you probably know, AHRQ’s funding goes towards research related to health care costs, quality, and access. These topics are crucial as we navigate health care reform and emphasize quality, value, and outcome in a new and more sustainable health care system. One of the ways the ACC and AHRQ have been working together is through the AHRQ’s National Partnership Network. As mentioned in a previous blog post by AHRQ Director Carolyn Clancy, MD, the College recently joined the AHRQ Effective Health Care Program to provide our members with free research and educational tools. The Agency also provides comparative effectiveness research (CER), which is important since it compares drugs, therapies, medical devices, tests, surgeries, or ways to deliver health care in the search for a more value driven system. Research summaries are available through AHRQ and are designed to help clinicians and patients compare a variety of health care interventions and treatments, and to understand the benefits, harms, and side effects of these various approaches. Members can also participate in the research development process, and there is a plethora of tools available for physicians and their patients on AHRQ’s website.

The new federal fiscal year begins on Oct. 1, 2012, so Congress must act on appropriations by then to continue funding federal agencies. With the election looming, every indication is that Congress will once again resort to enacting a continuing resolution this fall to fund programs into the new year. Regardless, we must continue to educate members of Congress on the importance of federal programs such as these, in order to prevent future bills that defund these programs from passing.

To learn more on the topic, read an article on CardioSource.org.

This post was authored by Dick Kovacs, MD, FACC, former chair of the ACC Board of Governors and co-chair of the Sports and Exercise Cardiology Council and Section.

The 2012 Olympic Games in London kick-off today, and as we all prepare to root for our respective teams, this is a time where the field of Sports and Exercise Cardiology will inevitably be in the spotlight.

TheHeart.org reported, “at least four elite athletes have been felled by sudden cardiac death in recent months ... the media attention these events have garnered has inflamed the controversy over whether better preparticipation screening would have prevented any of the deaths or whether the time has come for nations and health organizations to agree on a universal approach. And although cardiac events at past Olympic Games have been rare, they're not unheard of.”

The International Olympic Committee (IOC) has recommended that all countries screen their athletes to minimize the risk of sudden death. However, as Dr. Bove stated in a previous blog post, 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 U.S., as well as the concern for false positive results.

The next few weeks will be exciting nonetheless watching some of the most talented athletes of our time competing for the gold.

A recently published perspective in the New England Journal of Medicine by David S. Jones, MD, PhD, notes, “One thing is certain: the Olympics will remain an object of medical fascination."

Stay tuned to the ACC in Touch Blog and ACC’s Facebook page for the latest cv news from the Olympic Games! Also next week on the blog Dr. Christine Lawless will be giving an update from the Knowledge Olympics which just wrapped up this week.

This post was authored by Joseph P. Drozda Jr., MD, FACC, chair of the Clinical Quality Committee of the ACC.

One of the many ways the ACC can let its voice be heard on issues related to cardiovascular care is through Health Policy Statements (HPS). These documents are intended to promote or advocate a position, be informational in nature, and may offer guidance to the stakeholder community regarding the College’s stance on healthcare policies and programs.

HPS are overseen by the ACC’s Clinical Quality Committee (CQC), the group responsible for developing and implementing all health policy statement policies and procedures related to topic selection, commissioning writing committees, and defining document development methodologies. The CQC, in partnership with the Advocacy Committee, brings together various areas of the College to create these statements. This could include the National Cardiovascular Data, the ACCF/American Heart Association Task Forces on Guidelines and Performance Measures, and the Appropriate Use Criteria Steering Committee.

Once the CQC has selected a topic for HPS development, a writing committee is formed, including other participating organizations if applicable.  After the work group has completed the document, a peer review process is conducted before the document is submitted to the CQC for review.  The last phase is review by the ACC’s Board of Trustees. These statements then become official ACCF policy and may be published in the Journal of the American College of Cardiology (JACC) or other journals.

Most recently, a HPS on Patient-Centered Care (PCC) was developed as the cornerstone for 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. Other previous HPS topics have included generic substitution, principles for public reporting and pay for performance. (View all of the College’s HPS here).

HPS are of critical importance because their intent is to influence policy in a way that will benefit our members, but more importantly will lead to better care for our patients. HPS are not intended to offer clinical guidance for treating patients, though they may focus on clinical topics. They are aimed at public and private policy makers, including Congress, staffers, managed care organizations and the general public as our audience.

The CQC is currently identifying the next few topics on which to develop a HPS in the coming year. If you are interested in proposing an idea for a HPS, please provide a few sentences describing the topic and the policy message the ACCF should deliver, and send an email with your ideas to Laura Ritzenthaler at lritzent[at]acc.org.

Medication non-adherence is a growing public health concern because there is evidence that this is prevalent problem which is associated with adverse outcomes and higher costs of care. Addressing the problem is especially critical as the number of Americans affected by a chronic condition requiring medication therapy is expected to grow from 133 to 157 million by 2020. Nearly three out of four Americans admit that they do not always take their medication as directed, a problem that causes more than one-third of medicine-related hospitalizations, nearly 125,000 deaths in the U.S. each year, and adds $290 billion in avoidable costs to the health care system annually.

One of several ways the College is working to encourage medication adherence is through the Script Your Future campaign led by the National Consumers League (NCL), a 113-year-old Washington, DC-based consumer advocacy organization. The campaign addresses the need for tools and resources to support medication adherence across the country and opens dialogue between health care professionals and patients about the health consequences of non-adherence. Advocates have found that the messages about the importance of adherence need to come from a variety of places in order for patients to absorb them, and the campaign faces that challenge head-on by partnering with diverse groups, and working to reach patients in a variety of places, and via a variety of relationships – through open dialogue with doctors, pharmacists, nurses, caregivers, and other health care professionals.

This spring marked the first anniversary of the three-year campaign that targets those who suffer from three chronic conditions: cardiovascular, diabetes and respiratory. Script Your Future is operating at both the national level and in six regional target markets across the country – Baltimore, Birmingham, Cincinnati, Providence, Raleigh, and Sacramento – hosting local, grassroots efforts on the ground in these communities to educate patients and their loved ones about the importance of taking medication as directed and to initiate new conversations between patients and their healthcare professionals. 

Moving forward, Script Your Future offers several opportunities for Chapters, both in the target markets and nationally as part of the Million Hearts campaign, to increase patient education around the benefits of medication adherence as it relates to the treatment and prevention of heart disease. It also affords opportunities to promote CardioSmart tools, such as the new CardioSmart Med Reminder app. This app is free to iPhone and iPad users and is intended to serve as a medication and prescription refill reminder, as well as a personal medication record, to help patients communicate with health care providers about the medications they are taking.

This summer the ACC and CardioSmart are promoting a “Don’t Take a Vacation from Your Medication” campaign on our social media channels to curb the trend of medication non-adherence and to encourage patients to not forget about taking their medication. Get all of the tips and tools on ACC and CardioSmart’s Facebook pages. Also be sure to follow @ACCinTouch and @CardioSmart on Twitter. You can also learn more about medication adherence in the July/August issue of Cardiology magazine, hitting newsstands later this month, and in the July issue of CardioSource WorldNews. The College’s Hospital to Home (H2H) campaign also has medication adherence as a key component of reducing unwarranted hospital readmissions. You can learn more and take part in the H2H “Mind Your Meds” Challenge at h2hquality.org.

I am excited to share some updates about the ACC’s search for a new chief executive officer (CEO). The ACC has selected Korn/Ferry International, a leading global executive recruitment and talent management firm, to work with the search committee tasked with hiring a new CEO. The search committee, which consists of 15 ACC member leaders and staff, is currently soliciting input from an array of stakeholders, including members of the ACC’s Board of Trustees, the Board of Governors, past-presidents, council chairs, next generation leaders and staff. It is our hope to have a new CEO in place by next year’s annual meeting in San Francisco. Interested candidates should contact Lorraine Lavet, lorraine.lavet[at]kornferry.com.

Meanwhile, as I mentioned in a previous blog post, the College is operating under the current leadership of Interim Chief Staff Officer Tom Arend, who has done a phenomenal job.  In addition, College leaders continue to step up to the plate and have been busy representing the ACC on Capitol Hill and at cardiovascular meetings around the globe. Former ACC President Doug Weaver, MD, MACC, testified on physician payment last week and this week Jerry Kennett, MD, FACC, will be representing the College before the House Small Business Committee on the topic of “Health Care Realignment and Regulation: The Demise of Small and Solo Medical Practices?” We’ve also had representation by ACC members at recent FDA committee hearings on new drugs and devices.

On the international front, the ACC-Brazilian Society of Cardiology (SBC) Cardiovascular Symposium featuring Valentin Fuster, MD, MACC, in Sao Paulo was a phenomenal success with over 2,000 attendees. Thank you and many congratulations to SBC President Jadelson Pinheiro de Andrade, MD, and ACC Brazil Chapter Governor Antonio Chagas, MD, FACC, for such a phenomenal event. The ACC Mexico Chapter recently held a very successful annual meeting that BOG Chair Dipti Itchhaporia, MD, FACC, President-Elect John Harold, MD, MACC, and I attended. The meeting, hosted by ACC Mexico Governor Erick Alexanderson, MD, FACC, was held at the Mexican National Institute of Cardiology “Ignacio Chavez,” which was the first heart hospital when it opened in 1944. Erick is an inspirational leader and is big on FIT involvement in the chapter and will be bringing FITs to Legislative Conference this September. I’ve also had the pleasure of attending the Spanish Cardiology Society meeting, where I celebrated the Twinning of the ACC Florida Chapter and the Spanish Cardiology Society. Special thank you to Juan Aranda, MD, FACC, and Vicente Bertomeu, MD, FACC, president of the Spanish Cardiology Society. I also can’t leave out the once in a lifetime opportunity to represent the ACC and CardioSmart in the Olympic Torch Relay in England. Meeting many other torch bearers, each with a unique story of community service, entrepreneurship for charity or health, or personal courage was heartwarming and inspiring.

Speaking of carrying the torch, ACC’s amazing members and staff continues to carry the College’s flame. Planning is already well underway for ACC.13 in San Francisco, with registration slated to open next month. We are also making significant headway on our College-wide digital strategy and new lifelong learning platform – both of which will launch soon. Just this week we also launched an amazing new live case series on CardioSource.org. Working with Mt. Sinai hospital, we will be live streaming complex cardiovascular cases at 8 a.m. ET on the third Tuesday of each month.  Cases can be viewed by visiting CardioSource and will be archived for future viewing.

This summer has been a busy one thus far, with even more meetings and excitement to come. Be sure to follow me on Twitter @WilliamZoghbi and follow ACC @ACCinTouch for the latest cv updates.

(pictured top to bottom: ACC Mexico Chapter meeting; Twinning of the ACC Florida Chapter and the Spanish Cardiology Society.)

This post was authored by ACC Past President W. Douglas Weaver, MD, MACC.

Wednesday was an exciting day in Washington, DC, where I testified on behalf of the ACC before the Senate Finance Committee hearing regarding Medicare physician payments. The hearing addressed problems plaguing the current Medicare physician payment system and sought to identify new payment models and quality initiatives that incentivize high-quality and high-value care at reduced costs.

Following recent discussions with former Centers for Medicare and Medicaid (CMS) administrators and insurers, the ACC, along with the American Medical Association, American Academy of Family Physicians, American College of Surgeons and American Society of Clinical Oncology, was invited to share lessons learned on effective physician payment approaches. This was a vital opportunity to reiterate our long-term dedication to exploring innovative payment models in Medicare and share how our many quality programs and evidence-based measures are working to improve the delivery of high quality, affordable care.

I cannot stress enough how critical the discussion on Medicare physician payment is to the sustainability of our health care system. Congress must avert scheduled reimbursement cuts just released in the proposed 2013 Medicare Physician Fee Schedule, repeal the SGR, and provide stable payments for several years to allow the development of new delivery and payment models. They know this, but just don’t know how to do it. Although I was prepared to provide suggestions to improving value over the next several years; I was surprised to be asked about what we can do this year which will dramatically reduce Medicare costs beginning in January.

The SGR has been a problem for years and a key issue I faced during my tenure as ACC President in 2008. The current uncertainty in the future stifle both our practices and our hospitals in making real investments aimed at improving integration and reducing the current fragmentation of care and reducing waste. It is discouraging that Congress has yet to come up with a solution, but I am hopeful that we can develop a system that aligns compensation with performance of evidence-based medicine and higher value, appropriate health care.

During my testimony, I had the opportunity to discuss several of the College's exciting innovations currently underway, such as our clinical registries which can be used to increase quality far beyond the PQRS quality measures of CMS. We also have appropriate use criteria embedded into Cath PCI-which has begun to lower the number of patients getting unneeded revascularization.  I asked them to incent doctors to use these tools and incent EMR venders to incorporate them into their products which also need to be made interoperable among all of the suppliers.

I also told them they need to support care management in the out-patient setting, which is paying primary care docs and specialties such has ours in which the vast majority of our patients are billed under primary care diagnoses (eg, heart failure, coronary disease, hypertension). These extra dollars allow us to fund the needed physician infrastructure to keep these patients on a care plan, and to reduce emergency visits and hospitalization.

The bottom line is that ACC knows how to improve quality and efficiency use our registries and other specialty specific tools. If Medicare promotes these activities by incentivizing their use and helping pay for the efforts, I believe the current improvements that we are witnessing will accelerate.

Read more about the ACC's involvement in the Senate Finance Committee roundtable on Medicare Physician Payments on CardioSource.org including the submitted testimony. Also read a statement from ACC President William Zoghbi, MD, FACC on the hearing.

(pictured top: Dr. Weaver testifying before the Senate Finance Committee; pictured bottom: Senator Max Baucus (D-Mont.) and Dr. Weaver)

Today I had the distinct pleasure and honor of representing the ACC and CardioSmart and carrying the Olympic Torch through Bicester, England. My five minutes of “Olympic fame” were quite a whirlwind. The experience was unique, symbolic and memorable; cheering spectators, taking time to express an involvement in the very spirit that the Olympics embody: dedication, collaboration, and healthy competition in sports.  I was reminded of all the hard work and determination of the amazingly talented athletes who will be competing in a few short weeks. I was proud to carry the Olympic Torch in this symbolic run in the name of heart heath.

I was also reminded of why I was given this honor. As I wrote in a previous blog post, I am one of 22 participants chosen by the Coca-Cola Company to carry the Olympic Flame as part of its Live Positively campaign. Other participants running with me include leaders of national health organizations, former Olympians like Michelle Kwan and Summer Sanders, and young individuals representing charitable organizations. Participants were selected due to their commitment to live positively and make a difference in their communities.

Sports and exercise medicine is always a hot topic around the Olympics, and just last week The Lancet published a series of articles that discussed recognizing exercise as a “fifth vital sign”, one of the key indicators of health used by health professionals, and whether sports and exercise specifically contribute to the health of nations. Other papers addressed issues like the role of technology in improving sports performance; commentaries included training in sports and exercise medicine for medical undergraduates, Olympic winning, the art of medicine, drug cheating at the Olympics, and more. I invite you to peruse this interesting issue.

Be sure to check out more photos from my run on ACC’s Facebook page, and as we gear up for the 2012 Summer Olympics which will kick-off on July 27, stay tuned to ACC’s Facebook page for the latest cv news. I will also be Tweeting live from Bicester: you can follow me at @williamzoghbi.

On a related note, members from the ACC’s Sports and Exercise Cardiology Council will be leading sessions at the International Convention on Science, Education and Medicine in Sport (ICSEMIS) on July 19 – 24. Also known as the “Knowledge Olympics,” ICSEMIS is a global sports and science convention held every four years at the same location as the Olympics. Also, if sport and exercise cardiology is your area of interest, don’t miss ACC’s Sports Cardiology Summit: Protecting the Heart of the American Athlete, which will be held at Heart House in October. You can also join the Sports and Exercise Cardiology Section of the ACC.

Overall the Olympic Torch Relay was a unique, thrilling and memorable experience; a first for the ACC and cardiovascular organizations.

PS, Read more about my run in an article in CultureMap Houston.

A recent CardioSource WorldNews (CSWN) cover story looked at personalized medicine and raised the question of where we’re headed. Personalized medicine, as defined by the Personalized Medicine Coalition, refers to “the tailoring of medical treatment to the individual characteristics of each patient…to classify individuals into subpopulations that differ in their susceptibility to a particular disease or their response to a specific treatment.”

Personalized medicine is a relatively new term, but at this point there are endless possibilities in its implementation. According to National Institutes of Health’s National Human Genome Research Institute, personalized medicine “has the potential to transform healthcare through earlier diagnosis, more effective prevention and treatment of disease, and avoidance of drug side effects.”

In the article, Chris Cannon, MD, FACC, editor-in-chief of CSWN, talks about how he envisions the future of personalized medicine saying how “unexpected drug-drug interactions will be minimalized, patients will receive better and more coordinated care, and healthcare costs will plummet.”

Along the lines of new technology and methods, Eric Topol, MD, FACC, explains that he “envisions people with hypertension continually monitoring and tracking their blood pressure though a nonintrusive wristband that sends readings directly to a smartphone.”

As technology and science continue to evolve, there’s really no limit to the impact technology will have on personalized medicine.

However, the field of cardiology may take time to adopt.  This past winter, ACC’s CardioSurve panel was asked several questions on the topic of personalized medicine in order to explore perceptions and its future. The research asked cardiologists to first define “personalized medicine.” Nearly three out of four (72 percent) cardiologists cited genetic testing as the key defining attribute while approximately half (53 percent) of the panel responded with molecular diagnostics.

In addition, the results showed that the light usage, or lack thereof, is largely due to the fact that the majority of cardiologists do not feel that personalized medicine is impacting the treatment of their patients suffering from cardiovascular disease. The primary instigator of the short-term skepticism is that 75 percent of these cardiologists believe that there is a lack of patient outcome data in regards to the implementation of personalized medicine technologies.

While I do agree that applications of genetics in cardiovascular disease to personalize the approach to treatment may take time as it has to be value and outcome driven, we do not have to wait to have a personalized approach to patient care. With my presidential year focused on patient-centered care, the College is working towards these steps as a model for care. Our CardioSmart patient initiative is already geared to empower health care professionals and patients to partner effectively to achieve better cardiovascular outcomes. This initiative brings about new tools and technologies. The College is also taking the steps towards a more comprehensive digital strategy (read more in a blog post here). It’s quite an exciting time as modern medicine continues to evolve.

What is your opinion of personalized medicine and where it is headed? Leave your comments below.

This post was authored by John Rumsfeld, MD, FACC, chief science officer and chair of the NCDR.

The ACC in Touch Blog has spent the last two months exploring Appropriate Use Criteria (AUC), including what the criteria are; how to implement AUC in practice; and what AUC might look like in the future. This week’s post is focused on the National Cardiovascular Data Registry (NCDR®) and its ties to AUC. What might those ties be, you ask?

Well, the NCDR began in 1997 as a quality improvement initiative of the ACC to help hospitals and clinicians measure and benchmark the quality of their care. Today, the NCDR has six national hospital-based programs and one ambulatory care program (PINNACLE).  While much of the data collected in NCDR maps to the ACC/AHA clinical practice guideline recommendations, NCDR is committed to capturing data for quality metrics from the suite of ACC science documents, including performance measures and AUC.

The NCDR is involved with AUC in several ways. The CathPCI Registry already has data mapped to the coronary revascularization AUC.  Hospital participants receive quarterly CathPCI Registry outcomes reports that now include AUC for coronary revascularization metrics. The new ‘point of care’ CathPCI tool supports assessment of individual cases with regard to AUC category. The CathPCI AUC metrics are intended to support local quality improvement efforts for use by hospitals to compare themselves to a national rate, evaluate individual cases with regard to appropriateness, and determine if a quality improvement process is needed. Importantly, by ‘operationalizing’ the collection of data to measure AUC through NCDR, important feedback has been provided by hospitals and ACC members toward improvement of the AUC. The NCDR data elements will be updated with each version of the AUC that is released.

Currently, AUC on implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are under development. Once finalized, AUC metrics will be created for the ICD Registry reports as well.

As additional AUC are created by ACC and partnering organizations, the NCDR will strive to capture relevant data – in the inpatient and ambulatory care settings – to support measurement and benchmarking for hospitals and practices. Moreover, the NCDR programs are evolving to integration with clinical workflow. As point of care tools become available to support clinical decisions, including appropriateness, NCDR will incorporate them into its programs. NCDR is committed to measuring and improving quality of care and patient outcomes, and as AUC are part of the Science and Quality documents of the ACC and its partnering organizations, NCDR is committed to the valid measurement and feedback of AUC.

For more information about NCDR, visit www.ncdr.com. For more information about AUC, visit www.CardioSource.org/AppropriateUse.