This Saturday, Sept. 29 is World Heart Day, a global initiative created by the World Heart Federation to inform people around the globe that heart disease and stroke are the world’s leading cause of death, claiming 17.3 million lives each year.

Complementing the health policy statement released last week from the Global Cardiovascular Disease Taskforce which urged timely global action to save preventable death from cardiovascular disease (CVD), this year’s theme will focus on CVD prevention among women and children, and will emphasize the following:

• Women/children and CVD are not synonymous:
  • CVD is commonly considered an “older persons” and a “man’s” disease
  • Women underestimate their CVD risk; even though almost half of the 17.3 million annual deaths occur in women
    
• Children are particularly at risk, since they have little control over their environment and can be limited in choices to living heart-healthy lives
• Unless action is taken to enable heart-healthy activity, the children of today are at increased CVD risk later in life 
• Women/mothers are often the “gate keeper” to their family’s health hence a key influencer in keeping their hearts healthy

The College is proud to be a partner of the World Heart Federation, and is doing its part to promote awareness of women, children and heart disease by engaging members and patients worldwide.

At Heart House, ACC staff will practice what they preach by participating in a number of wellness activities leading up to World Heart Day. ACC member Allen Taylor, MD, FACC, will be giving a special preventive heart talk to staff, and the ACC’s Helping Hearts Community Service team will be speaking at a local elementary school about preventive actions towards CV health.

On the social media front, ACC’s CardioSmart initiative has teamed up with the National Heart, Lung, and Blood Institute’s The Heart Truth® Campaign, healthfinder.gov, and the U.S. Department of Health and Human Services’ Million Hearts™ initiative for a special women’s heart health Twitter Chat which will take place this Friday, Sept. 29 from 1 – 2 p.m. ET. During the chat, experts including CardioSmart Editor Joanne Foody, MD, FACC, will be on hand to discuss heart health, dispel myths and answer questions from participants joining the conversation from around the world. To participate, follow @CardioSmart on Twitter and use the hashtag #HeartChat. (View the archived tweets here).

The ACC and CardioSmart have also built awareness through their Facebook pages, reaching a collective audience of nearly 15,000 individuals.  I encourage you to check out both ACC and CardioSmart’s Facebook pages and share the heart health facts, videos, patient tools and more.  (Oh, and “like” them while you’re there!)

In addition, this Saturday the ACC and the Association of Black Cardiologists (ABC) will be kicking off a series of health events targeted at the nation’s minority and underserved communities. The events, called Spirit of the Heart, provide a variety of activities over a three day span, including a panel discussion and a health fair open to the public where the ACC will conduct free health screenings and risk assessments. The kick off 2012 Spirit of the Heart event will be held in my hometown of Houston, Texas, where Keith Ferdinand, MD, FACC, and I will participate in the panel discussion. Future events will also be held in Dallas and Austin in October; Harlem, NY, in December; and Oakland, CA, to coincide with ACC.13 in San Francisco, so stay tuned!

With a day dedicated to the awareness of preventative steps for women and children, and with the collaborative help from all of our members, partners, and patients, it is my hope that we will be one step closer to dispelling CVD in this population.

This post is authored by Silvana M. Lawrence, MD, FACC, member of the ACC’s Sports and Exercise Section.

Although summer has come and gone, fall brings with it the excitement of the start of school and American-loving competitive sports like football. However, with the start of competitive sports also comes the fear of the unexpected event of a young athlete collapsing on the field.

Towards the beginning of fall, cardiologist’s offices become overwhelmed with young athletes needing sports clearance, and many questions surface that were not taught during training nor were considered in the daily practice of pediatric cardiology. Fortunately, parents pay more attention to complaints reported at the time of physical exams at the primary care physician’s office prior to sports participation. However, there is an undulating comfort level to clear young athletes with any positive answers to history questions or unusual findings on a cardiac exam.

To participate in sports in the US, a young athlete must first complete a screening, which includes a history and physical exam currently based on the AHA recommendations. However, those who undergo a screening at their cardiologist’s office will, undoubtedly, receive at least one test, i.e., an ECG, and not infrequently, additional testing that might include an echocardiogram, Holter and/or a stress exercise test.

Several screening programs exist in different parts of the country aiming at early detection of conditions associated with sudden cardiac death. Presently, an ongoing large screening program of high school athletes is occurring in the state of Texas: The Texas Adolescent Athlete Heart Screening Registry – TAAHSRTM. This program has screened over 6,000 athletes to date, ages 14-18 years and utilizing history, 12 lead ECG and limited echocardiogram. Initial analyses of data have demonstrated a referral rate of about 9 percent for abnormalities detected either by ECG or an echocardiogram. We are currently putting together a paper on our findings, which I think will be a good piece of information. I also want to follow these kids longitudinally and see what happens with their natural history.

There is also a multifaceted group of young adults with congenital heart disease, repaired and palliated, that poses challenges. The present Bethesda guidelines have provided guidance for many years. However, many in the field agree it might be time to revise our data and perhaps dare to cautiously, but yet firmly, expand the type of physical activities these patients can (and ought to) engage in.

Challenges are posed daily by the growing population of inactive children that in addition to underlying heart disease, have added risk factors such as obesity, hypertension and abnormal lipid levels. Our inability, to some extent, to better define the level of physical inactivity necessary in order to protect the diseased heart, is hurting us by not promoting physical activity perhaps in the most needed segment of our pediatric population.

Exciting times are ahead of us and I truly believe we are making a difference in kids’ lives. We may not have the perfect model and, in fact, I think we do need to improve our understanding of the process and results/data to reassess the best mode of screening. Regardless, the face of sports and exercise cardiology continues to reach new horizons and, undoubtedly, will contribute to change the world of athletes with a healthy or a diseased heart.  

This post is authored by Gregory F. Michaud, MD, FACC, and Roy M. John, MD, FACC.

Most patients with atrial fibrillation (AFib) are elderly and symptoms are effectively managed with medications that control the ventricular rate. Anticoagulation should be administered in patients who are at significant risk of stroke (CHADS-VASC ≥ 2-3). Rhythm control, however, may be preferable in some patients. Here are five reasons to choose rhythm control over rate control in treating patients with atrial fibrillation, regardless of whether AFib episodes are paroxysmal or persistent:

1. Symptoms despite reasonable attempts at rate control. A word of caution when evaluating a patient for symptoms – patients with exertional dyspnea, poor exercise tolerance or fatigue may be incorrectly labeled “asymptomatic” in the absence of palpitations.
2. Intolerance to effective rate control medications.
3. Significant diastolic dysfunction. Often these patients do not tolerate AV dysynchrony even when the ventricular rate is well controlled. A classic example is a patient with hypertrophic cardiomyopathy. 
4. Tachycardia-related cardiomyopathy and poor response to AV nodal blocking agents.
5. Young patients with persistent or frequent paroxysmal atrial fibrillation.

Don’t miss the free web-based symposium, Rhythm Control:  What Therapy for What Patient? on Thurs., Sept. 27 at 12:00 pm ET. Case examples to illustrate clinical decision pathways and the pros and cons of various therapeutic options will be presented. Visit the joint ACC/Heart Rhythm Society AFib CardioSource Clinical Community for more information.

This blog post is part of a series of blog posts during AFib Awareness Month. Visit ACC’s Facebook page for additional information. The joint ACC/HRS AFib CardioSource Clinical Community is an online community that addresses atrial fibrillation topics that are relevant to routine and advanced practice. The community offers a collaborative space that facilitates interaction between clinical disciplines by offering an article of the month series, videos, case challenges, hot topics and more.

This post was authored by Scott Lilly, MD, PhD, chair of the FIT Committee and an Interventional Cardiology fellow at the University of Pennsylvania.

This year over 70 fellows-in training (FITs) from across the nation attended the 2012 Legislative Conference in Washington, DC where they met with ACC and congressional leaders to discuss current issues affecting practice of cardiology in both academic and private practice settings. Although it may be difficult to remain apprised of proposed and impending legislation during fellowship years – the conference format addresses this.  On Monday, there was an array of speakers that discussed specific issues for collaborative lobbying. These short (and often entertaining) presentations were interactive and reliably followed by practical questions from the nearly 500 physicians, cardiac care associates or FITs in attendance. In between the discussions, there were a number of breaks that allowed FITs to interact and introduce each other, have smaller group conversations regarding a particular issue, or meet with ACC leadership. Fully debriefed, we received our congressional visit schedules and prepared to “storm the hill” with our fellow state ACC members.

Among the issues we addressed this year was a proposed cut to ACGME spending – something that could directly affect on our training.  Whether these cuts would have a direct affect on the number of fellowship positions, or result in variations in educational infrastructure or national meeting subsidies is unclear. Regardless, these changes are clearly occurring at a time when there is a greater need for cardiovascular physicians – driven both by the aging population and the availability of new and effective therapies that mandate specialized training. The ACC has responded to this and other proposed cuts proactively by requesting a partnership with respect to health care reform. Through addressing overutilization via appropriate use criteria, and improving quality of care by advocating national registries, the hope is that we will be able to more effectively deliver care in a less costly manner.

While we as FITs may spend most of our professional time at the bedside or in the latest scientific journal, I was reminded this weekend of the world outside of the clinic. We have cardiologist advocacy leaders – individuals that, despite busy practices devote a significant amount of time to preserving our ability to learn, care for our patients and help to secure our future. When FITs participate now, it strengthens the delivery of these messages to congress, broadens our perspective, and will hopefully cultivate the next generation of these cardiologist advocacy leaders.

For the many FITs that visited the Capitol last week, I hope you arrived home safely; to the rest, I hope to see you next year.

I am honored and thrilled to announce that the ACC has been named one of Greater Washington’s Healthiest Employers by Washington Business Journal. Fifty Washington, DC-area employers were identified as the area’s healthiest employers within five categories based on organization size. The College was honored with 8th place in the 250 to 500 employee category.

The award makes public the news that the ACC truly practices what they preach. ACC’s Ready, Set, Go: Taking Care of You Wellness Program focuses on overall well-being of its more than 330 ACC staff. The program highlights the importance of mental, physical, emotional, nutritional and financial wellness. The Wellness Program was introduced in 2009 to proactively tackle increasing health care costs, changes to the health care landscape and industry competition by focusing on wellness education, employee education and lifestyle modification at Heart House.

The program has blossomed in 2012 with more participants than ever before and a growing culture of wellness within Heart House walls. Staff participate throughout the year in education sessions, fitness classes, fairs, partner challenges, screenings and more – all aimed at increasing morale, strengthening professional relationships, and resulting in healthier, happier employees. To date, 40 percent of employees completed biometric wellness screenings in both 2010 and 2011, 30 percent of staff participated in a pedometer-based step challenge and more than 40 employees consistently participate in ACC fitness classes. One of the newer offerings of the wellness program is a staff-specific version ACC’s CardioSmartTXT program to keep employees up to date on upcoming events or provide a quick wellness tip or resource. A short video (watch below) highlights the program offerings and was shown at the Healthiest Employers awards ceremony at the Grand Hyatt Washington.

We are days from the World Heart Federation’s World Heart Day celebration. Their theme last year was workplace wellness – a theme that ACC staff clearly embrace. This year, the College will celebrate World Heart Day’s women and children’s heart health theme in a big way with engaging, educational on-site events for staff. ACC members and the public can engage with ACC during the week prior to World Heart Day through social media channels including a #HeartChat Twitter Chat next Friday, Sept. 28 at 1 p.m. ET, led by the ACC, the National Heart, Lung, and Blood Institute’s The Heart Truth® Campaign, healthfinder.gov, and the U.S. Department of Health and Human Services’ Million Hearts™ initiative. Stay tuned for more details.

Congratulations to the College and its staff for being awarded this prestigious title and for making wellness a priority.  

Today a very important health policy statement was released from the Global Cardiovascular Disease Taskforce, a group of experts representing the ACCF, World Heart Federation, American Heart Association, European Heart Network and European Society of Cardiology, and include ACC Past President David Holmes, MD, MACC, and myself. The jointly released health policy statement urges timely global action to save preventable death from cardiovascular disease (CVD).

The statement is timely and was released on the one year anniversary of the United Nations High-level meeting on non-communicable diseases (read my blog post from last year’s meeting here).  We are calling on government and the cardiovascular community to accelerate the progress on the commitments made last year and support the ten evidence-based targets, including the top four exposure targets on physical activity, tobacco, dietary salt intake and hypertension/blood pressure. By focusing on these top four targets, the goal is to achieve the following by 2025:

• A 10 percent relative reduction in prevalence of insufficient physical activity in adults aged 18+ years;
• A 30 percent relative reduction in prevalence of current tobacco smoking;
• A 30 percent relative reduction in mean adult (aged 18+) population intake of salt, with aim of achieving recommended level of less than 5 grams per day; and
• A 25 percent relative reduction in prevalence of raised blood pressure.

We all agree that this first step is imperative if we are to achieve the overarching goal of a 25 percent reduction in mortality from non-communicable diseases by 2015, a goal that was determined this past May at the 65th World Health Assembly in Geneva.

The ACC is calling upon its members to take this statement to heart. With CVD costing governments nearly $863 billion globally, and the number of deaths related to CVD expected to grow to more than 23.6 million by 2030, the consequences will be astronomical if we are not successful at curbing these preventable deaths. Read more about the statement on CardioSource.org.

A spotlight will be on cardiovascular disease during World Heart Day on Sept. 29, and the College and other stakeholders worldwide are participating in activities focused on prevention for women and children. More information on ACC World Heart Day activities is posted on both the ACC and CardioSmart Facebook pages.

Over the past few weeks I’ve gotten a glimpse into the not-so-distant future of the ACC and Cardiology. Last week’s 21st Annual Legislative Conference was a huge success thanks to the efforts of 400 attendees, many of whom traveled to our nation’s capital and participated in the Hill visits. This was a record attendance! We were very pleased to have over 70 fellows-in-training (FITs) and over 60 Cardiac Care Associates (CCAs) in attendance during the briefings and Hill visits. I was inspired to see this growing support from the physicians and associates who are the future of cardiology. Their involvement was indeed palpable and inspiring. You can read about the perspective of different member types including an FIT, CCA, Cardiovascular Administrator and International member here on the blog in coming days.

After the conference, I had a chance to attend the “Teaching Skills Workshop for Emerging Faculty” at Heart House conducted by Drs. Pat O’Gara and Rick Nishimura and generously supported since its inception in 2005 by ACC Past President Dr. Michael Wolk. I also had dinner with these bright young cardiologists and CV surgeons, some of whom came all the way from Israel. The workshop promotes the development of skills (effective individual presentations, teaching, and communication) for those emerging faculty who are committed to contributing to the College’s mission of education and to facilitate this transfer of knowledge into their professional environment. It is invigorating to see such stellar and engaged professionals, a glimpse of our future educational and thought leaders.  I had a chance also to address them formally and tell them about the College and how they can get involved.  I even showed them an impromptu taped testimonial (that I did in my office on my iPhone!) of the effect of this intense workshop on a previous graduate who is among our faculty—Dr. Steve Little, who is now a young star.

This program has been phenomenal. Since 2005, we’ve had a total of 82 participants in 4 courses (given every other year); the skills and relationships developed at the workshop have led to their involvement in close to 600 activities or appointments at ACC to date. During my presentation I reiterated the fact that the ACC is always looking for involvement at every career stage. The College is accepting nominations and applications for committee and council membership through Oct. 31. All ACC Fellows (FACC/MACCs), FITs, CCAs, and Cardiovascular Administrators are invited to nominate a colleague or apply for membership online at https://services.acc.org/CommitteeNominations.

Looking ahead, the College is now accepting applications for the Chief Executive Officer of the ACC. As I mentioned in a previous blog post, the College selected Korn/Ferry International, a leading global executive recruitment and talent management firm, to work with the search committee tasked with hiring our new CEO. Our hope is to have the CEO named by next year’s Annual Scientific Sessions held March 9 – 11, 2013 in San Francisco, CA. You can read the job description, apply or refer someone for the position here.

The College’s future leaders and CEO will help guide the College in its continued pursuit of the singular mission to transform cardiovascular care and improve heart health. From what I can see, the future is very promising and exciting indeed!

(pictured above: Over 70 FITs attended Legislative Conference, view more photos here)

This post is authored by Cathie Biga, RN, MSN, president and chief executive officer of Cardiovascular Management of Illinois.

I just finished a remarkable two days at ACC’s Legislative Conference in our nation’s capital.  While I have been privileged to attend in the past, this was the first time I had the honor of being on the Hill with the ENTIRE cardiac team representing Illinois! Led by our current Governor Marc Shelton, MD, FACC, Past Governor Jerome Hines, MD, PhD, FACC, integrated and independent physicians, FITs, CCAs, and practice administrators, we were 11 strong and hit nine offices.

Sharing our message from the “trenches” was important to all of us, and explaining the vast landscape of cardiology care in Illinois was a challenge we tried to hit head on.  From patient access (explaining why imaging cannot be reduced any more or reductions for same day of service is problematic) to the administrative burdens and cost of running a practice, we relayed our message and asked for their help. 

While speaking with our Legislative aides, chiefs of staff, and a few members of Congress, we relayed that while payment reform will inevitably happen (and it really must), we MUST ensure accurate quality data is used to drive this process – which the College has. In addition, physicians and their team MUST be at the table when these decisions are made.

Change is inevitable and hopefully our trek to the Hill will remind us all how important this health care message is for cardiology and why EVERY member of the team needs to be involved. 

P.S., You don't have to fly all the way to Washington to get involved -- our Senate and Congressional representatives live in your neighborhood! Get to know them, call them, invite them to your practice and support them!

Hope to see you all next year!

For additional coverage of the 2012 Legislative Conference, visit CardioSource.org and check out the photos on ACC’s Facebook page.

This post is authored by Richard Kovacs, MD, FACC, chair of the Best Practices and Quality Improvement Subcommittee, a subcommittee of the College’s Clinical Quality Committee.

The ACC is leveraging AFib Awareness month to highlight the many ways the College has stayed on top of the clinical and practice needs and demands of CV professionals in what is truly an evolving landscape.

This month the ACC launched an Atrial Fibrillation (AFib) Toolkit to provide tools and strategies for the patient care team to support high-quality care for patients with AFib.  Rather than only defining high-quality AFib care as defined by clinical performance on National Quality Forum endorsed measures, the AFib Toolkit establishes clear goals for overall high-quality AFib care by identifying and filling gaps in the knowledge and behavior of the patient and the patient care team in meeting these goals.  

Included in the AFib Toolkit:

• Five tools focused on diagnosis and risk assessment
• Four tools, plus 23 individual drug monographs, for treatment and management of AFib
• Three tools focused on patient education

As noted in last week’s blog post, AFib is the most common arrhythmia in clinical practice, and is responsible for 15-20 percent of all strokes, which account for 1 in 17 deaths in the U.S. and rank third among all causes of death after heart disease and cancer. In addition to improving clinician adherence to National Quality Forum endorsed performance measures for AFib, the AFib Toolkit will increase patient awareness of the risks associated with AFib, and enhance patient engagement in their AFib care plan.  Provider understanding and inclusion of patient behavior, choices, and lifestyles in care planning is especially important with AFib because of the rapidly evolving landscape of AFib therapies.  The AFib Toolkit is an opportunity to identify approaches for supporting the patient-provider partnership in meeting care goals among considerable safety and efficacy concerns.

In addition to the AFib toolkit, the ACC provides innovative educational programs like A New ERA v 2.0, a free Performance Improvement-Continuing Medical Education activity designed to help physicians improve the care of their patients with atrial fibrillation. To track data of patients with AFib, last year the PINNACLE Registry launched a new platform, PINNACLE-AF, focusing on atrial fibrillation and including the next generation of anticoagulants. Currently a new national anticoagulation initiative, led by ACC, is under development to drive awareness of the efficacy and safety of new anticoagulation therapies.

In the end, whether we’re talking about AFib, or another area identified as ripe for improvement, ACC members need real-time, easy-to-use solutions that cross the spectrum of quality, advocacy and education and bring about real change. The efforts underway by a multi-disciplinary team of ACC members and staff are bringing these tools to life.

This blog post is part of a series of blog posts during AFib Awareness Month. Stay tuned in the coming weeks for more information from the College on AFib news, tools and initiatives. Also visit ACC’s Facebook page for additional information.

This post was authored by Jim Fasules, MD, FACC, senior vice president of Advocacy for the ACC.

This week more than 350 ACC members were in our nation’s capital for the College’s 21st Annual Legislative Conference. ACC’s leaders, FACCs, FITs, CCAs, Practice Administrators and even international members were all on hand to participate in briefings on the critical health policy issues facing medicine today.

The conference kicked-off on Sunday with a special reception and dinner celebrating the 10th Anniversary of ACC’s Political Action Committee. During the keynote speech, Pulitzer Prize winner and syndicated Washington Post columnist George Will shared his insider’s perspective of the current political climate and the impending presidential election. Filled with facts and baseball references, Will was able to engage a packed room full of attendees from both sides of the aisle.

On Monday members heard from ACC President William Zoghbi, MD, FACC, who presented results from the 2012 Practice Census, (read more about the results on CardioSource.org), as well as from a range of politicos including an election outlook from Ronald Brownstein.

Earlier today Rep. Michael Burgess, MD (R-TX) was presented with the President’s Award for his distinguished public service and support of the College’s health policies that promote high-quality patient-centered care.  Soon after, conference participants headed to Capitol Hill for a day full of pre-arranged meetings with their members of Congress. Given the current health care landscape, members stressed the importance of Congress avoiding further harmful spending cuts and reforming the Medicare payment system. With 295 separate legislator meetings scheduled, the ACC’s commitment to quality and patient-centered care was heard loud and clear on the Hill.

Our actions and advocacy efforts this week are important for many reasons. We are dependent on Congressional action to prevent upcoming cuts from the sustainable growth rate (SGR). In addition, the Centers for Medicare and Medicaid Services (CMS) has already proposed an array of new policies for the 2013 Medicare Physician Fee Schedule (read ACC’s comments on the proposed rule here) that include both threats and opportunities for cardiology. These proposed policies include:

• The final year of transition to new PE RVUs causes small reductions to most cardiology services.
• A proposed multiple procedure payment reduction for a wide range of diagnostic cardiology services (e.g., echocardiography, stress tests, vascular ultrasound) would reduce the technical component payment for the second and any subsequent service by 25 percent if performed on the same day.  ACC has vigorously opposed this proposal.
• Medicare has proposed for the first time to pay for transitional care services for patients discharged from hospitals or skilled nursing facilities. Physicians providing care coordination services within the first 30 days of discharge would have the opportunity to bill Medicare for these services. The ACC sees this as an important step forward for Medicare, but expressed some concerns about the specifics of the proposal. We’re hopeful that CMS will make some changes to ensure that patients with cardiovascular disease benefit from the new policy.
• If CMS goes forward with its proposed rules, physicians in groups with 25 or more practitioners will be the first to be subject to the value-based payment modifier established in the Affordable Care Act. Also, beginning in 2015, groups of 25 or more will be subject to a 1 percent penalty or may be eligible for bonus payments based on PQRS participation and performance on quality and cost measures in 2013, and practices with 25 or more physicians and other practitioners will need to take action in the first quarter of 2013 to avoid the penalty and ensure potential eligibility for bonus payments.

Not included in the proposed rule, but of great significance to cardiology, we also expect 2013 coding and valuation changes to result in cuts of 20 percent or more for EP/ablation services and some PCI services, but exact impacts will not be available until Medicare releases payment information on Nov. 1.

Although CMS will review comments and release final decisions on these proposals soon, our efforts on the Hill this week will inevitably help raise awareness of the issues facing cardiology today. Stay tuned to the ACC Advocate and CardioSource.org for updates this fall. Also stay tuned for individual perspectives from Legislative Conference here on the blog in the coming days.