This post was authored by Richard A. Chazal, MD, FACC.

Medical liability has and continues to be a hot topic for cardiology and physicians in general. A study published in the January 2013 issue of Health Affairs found that the average physician spends 50.7 months, or 11 percent, of their career with an unresolved, open malpractice claim, an allegation of malpractice against a physician and a request for compensation.

On a more granular level, an analysis of 345 closed cardiology claims by The Doctors Company found the most frequent allegation was the failure or delay in diagnosis, followed by improper performance of surgery or a procedure such as cardiac catheterization, cardiac ablation or insertion of permanent pacemakers.

Tips on how to limit medical liability risk and avoid claims are always helpful, particularly given that real medical liability reforms have yet to be implemented by Congress as part of health reform.  Speaking at a special session at ACC.13, Robin Diamond, JD, MSN, RN, chief patient safety officer for The Doctors Company, provided several good tips for avoiding lawsuits. Diamond said she prefers to talk about medical liability in terms of decreasing chance of error, which in turn will decrease chance of injury or harm and ultimately will decrease chance of being sued. The most important thing, she said, is that “no matter how technically skilled, if the patient becomes angry or unhappy about something, chances of a lawsuit increase.”

Some specific tips:

• Practice good communication skills with medical colleagues, as well as patients and their families
• Effectively document
• Be aware of literacy issues
• Ensure medical assistants are functioning within their scope of practice and that allied professionals (ie. NPs and Pas) are practicing within their licensure
  

David Troxel, MD, medical director for The Doctors Company, also noted that risk evaluation and mitigation strategies (REMS) may be one way moving forward to reduce liability risks. Programs like the PDR Network, of which the ACC is a part, is an example of a REMS program, said Troxel.  He noted that participation in the PDR Network provides automated delivery of FDA-approved drug information and reminders and disease-specific educational information direct to patients via an EHR patient portal. It also provides drug safety and efficacy messaging direct to patients and enhances patient compliance by tracking fill rates and adherence.

Meanwhile, the ACC is partnering with The Doctor's Company on the first ever national program tailored to cardiologists and targeted at reducing risk and premiums specifically for cardiovascular teams. Members participating in the program benefit in a number of ways, including a claims free credit (with rates based on jurisdiction), and 5 percent program discounts for a favorable claims history, MOC participation and participation in the PINNACLE Registry.

This morning I had the honor of kicking off the College’s 62nd Annual Scientific Session in San Francisco. The meeting marks the first time in 40 years that the College has held its annual meeting in this iconic city. In fact, the last time we were here was in 1973 when Dr. Jeremy Swann was President. At that time, we had a total 9,500 in attendance at the conference.

Today, as I looked out over the standing-room-only Showcase session, it was clear we have grown a lot since then. We have also seen countless exciting changes in medicine. However, despite these changes, our guiding mission remains the same as it was four decades ago – to transform cardiovascular care and improve heart health.

I can’t think of a better person to talk about some of the transformations and improvements in cardiovascular care than Dr. Valentine Fuster. A true legend in the cardiovascular field, it was truly a privilege to introduce him as this year’s Simon Dack Lecturer. He took us on a “journey of the high risk plaque” and the path from cardiovascular disease to health, and was definitely a tough act to follow.

I chose to focus my presidential address on some of the exciting efforts the College has taken on over the past year, as well as a look ahead at some of the challenges we face as a global cardiovascular community. Among our top achievements, an expanding role for data registries like NCDR, both in the U.S. and internationally, and an increasing focus on appropriate use of diagnostic modalities and interventions. The power of data reporting is impressive and can change clinical practice, and improve quality of care.

The College’s CardioSmart initiative, is another exciting effort that is very dear to my heart and key to my presidential theme of patient-centered care.  We have made great strides this past year in expanding and enhancing the CardioSmart ecosystem to include a newly revamped web portal; mobile applications aimed at facilitating greater physician/patient interaction at the point of care; and partnerships with other medical specialty societies, public-facing public and private campaigns, and industry on local community events designed to educate patients and consumers about heart-healthy lifestyle choices. Beyond facilitating the engagement of patients in the clinic and in between visits, CardioSmart is helping us get our message to the population at large. This is where we truly need to be, spreading the word about healthy living and healthy choices in the community.

Our first-ever CardioSmart Patient Advocate Award winner Larry King, whom we also honored during the Showcase Session, understands the power behind spreading the message. His voice and efforts have had a profound and positive impact on awareness about heart disease and the importance of patient-centered cardiovascular care. As a person with cardiovascular disease and a long history of exemplary personal advocacy for cardiovascular patients, I can’t think of a better first-time recipient of this award.

Meanwhile, when it comes to challenges, arguably the biggest one in my mind is the growing rate of non-communicable diseases (NCDs) and (until recently) limited global efforts to tackle this problem. As I mentioned in my presidential address, NCDs currently account for 60 percent of global death, and yet receive less than 3 percent global funding.  That being said, we have made amazing strides over the last year and a half, working with international agencies, our new international chapters, and other international cardiovascular societies to rectify this – and these efforts continue.  I have no doubt that we can protect population health by taking a global perspective and strengthening international collaborations – but the time is now.

I very much enjoy the first hours of the Annual Scientific Session because I’m reminded each time that this is our meeting! Being surrounded by thousands of physicians, nurses, practice administrators and other vital members of the cardiovascular care team at varying stages in careers and from hundreds of countries is invigorating. This is our time to share ideas, hear from the best minds of our time, and get caught up on the latest and greatest clinical research. Seize this opportunity! Learn from the legends, thank our heroes, and become a leader. Together, united, we can take down the #1 global cause of death!

This post is authored by John S. Rumsfeld, MD, PhD, FACC, chief science officer of the NCDR.

The NCDR’s annual conference (NCDR.13) started today and is already off to a great start. Over 950 registry professionals, cardiovascular physicians and administrators are in attendance, and the meeting opened with a great keynote presentation about excellence in cardiovascular care and the role of the NCDR given by Martha Radford, MD, FACC, director of clinical quality and safety at NYU Hospital Center.

In response to physician and health care administrator’s growing interest in the NCDR, we've added a MD/Administrator track to NCDR.13, which includes a series of workshops specifically designed for their needs. Health care in the U.S. is changing dramatically and cardiovascular professionals face a future that will include more public reporting of quality measures, increased needs to demonstrate performance improvement, and an increased focus on outcomes. The NCDR can directly help physicians and administrators with these, so this is a major focus for the NCDR programs going forward, starting with the NCDR.13 meeting.

Meanwhile, NCDR research will be featured throughout ACC.13. Twenty-two abstracts, including oral and poster presentations will feature NCDR research. Several of the topics discussed at the NCDR.13 will be further fleshed out in educational sessions as well, including sessions focused on the use of registry data for MOC purposes, international registry lessons learned, TAVR research and more.

Congratulation to Jonathan Hsu, MD author of the poster “Inappropriate Oral Anticoagulant Use in Atrial Fibrillation Patients with a Low Risk of Thromboembolism: Insights from the NCDR® PINNACLE Program,” which is being recognized as a Best of Poster and Best FIT Poster at ACC.13. The poster will be on display Monday, March 11th from 9:45-10:30 a.m. in Poster Sessions, Expo North.

For the complete guide to NCDR abstracts at ACC.13, visit NCDR.com/ACC13 or stop by ACC Central during Expo hours.

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

Despite a rather recalcitrant Congress, last year saw very significant changes for health care and cardiology. After the swirling uncertainty surrounding the Affordable Care Act (ACA), the U.S. Supreme Court ruled the ACA, including its individual mandate, was constitutional. With the federal debate laid to rest, the action shifts to the states where for political and policy reasons a patchwork quilt of variability still leaves physicians, hospitals and patients perplexed on how to adapt to Medicaid expansion, the Exchanges and other insurance changes. Yet hidden in the rancor over the ACA were many challenges and changes effecting cardiology that the ACC tackled with a large degree of success.

For more than a decade, the sustainable growth rate (SGR) and the nearly 30 percent cuts associated with the flawed formula have threatened to impede improvements to the health care system and weaken the sustainability of practices nationwide. While a fight for permanent repeal of the SGR was unsuccessful, the last-minute “fiscal cliff” legislation delayed “the cliff” and its 27 percent cuts until 2014, at least restore a degree of financial security to physicians and ensure patients have continued access to quality care for 2013.

Besides helping achieve the SGR patch in the American Taxpayer Relief Act of 2012 (ATRA), the ACC team succeeded in helping cardiology in two other important ways.  First, last year saw an aggressive campaign waged to close the in-office ancillary services exception (IOASE), also known as the Stark exception that allows us to perform tests and imaging in our offices, mounted by radiology and others. Its inclusion in the ATRA was successfully prevented. In addition, the team’s work with the Senate Finance, Ways and Means and Energy and Commerce Committees, following the stellar testimony of ACC Past President Douglas Weaver, MD, MACC in July, resulted in the law providing that participation in qualified clinical data registries, such as the NCDR®, will count as PQRS participation in 2014. While many details still need to be worked out, this will allow greater ease of avoiding the cuts that now occur for non-participation in PQRS.

Despite our successes, 2013 has many risks. The 2 percent across-the-board sequestration cut to Medicare and the even greater cuts to public health remain a threat when the two month delay in the ATRA expires on March 1. The ACC adamantly opposes the 2 percent Medicare sequester and the approximately 8 percent sequester cut to NIH, CDC, AHRQ and other crucial agencies, and the College will continue to urge Congress to prevent the cuts from going into effect. While successfully prevented in 2012, the forces working to close the IOASE have already marshaled an even stronger campaign this year. In response, we are working with a broad coalition to demonstrate to Congress and the Administration that closure of the exception would cause great disruption to patient care and would effectively end the viability of private practice and actually result in greater expenses for Medicare and insurers. Similarly, the College remains opposed to enactment of prior authorization for imaging services under Medicare.

On the medical liability reform front for this year, the U.S. House of Representatives is expected to take action on the HEALTH Act once again, which includes MICRA-type liability reforms. The College will continue to work with other stakeholders to support this act and advance supplemental medical liability reforms. Often missed in the College’s activities is its work for public health and science.  Again this year, the College will work to support federal funding for NIH; AHRQ; the NHLBI; the Health Resources and Services Administration’s AED program; the Prevention and Public Health Fund; the Million Hearts™ initiative; CDC’s Heart Disease and Stroke Prevention Program; and congenital heart disease research and surveillance.  As Congress struggles to find spending cuts, Graduate Medical Education (GME) finds itself targeted.  Advocacy with the help of the Academic Council is working with the AAMC to prevent any disruption to fellowship training.

As you can see 2013 holds many risks to cardiovascular care.  There are many opportunities for U.S. members to get involved in ACC's advocacy efforts, including learning more about ACCPAC, and participating in legislator practice visits and Legislative Conference.

Stay tuned to CardioSource.org/Advocacy throughout the year for health policy updates. To get involved in ACCPAC, visit accpacweb.org.

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

A recent study using data from the NCDR’s® ICD Registry™ found that the likelihood of receiving cardiac-resynchronization therapy with defibrillation (CRT-D) is mediated by community wealth and hospital resources. The study looked at 22,205 patient stays and found in the full hierarchical model, average median household income (P<0.001) and implantable cardioverter-defibrillator implantable volume (P<0.001) remained significant predictors of CRT-D receipt. Further, patients treated at hospitals in affluent communities were more likely to receive CRT-D than patients treated in poor communities, despite accounting for other patient and hospital characteristics, including insurance status.

Since health care disparities are complex issues, and it has been shown that “variations by race and ethnicity exist in the use of medical devices for the treatment of advanced heart failure,” the study attempted to address the “relative impact of patient-, hospital-, and community-level factors on the likelihood of CRT-D receipt.”

The lead author noted that the analysis demonstrates that the wealth of the community in which patients live impacts the care they receive, and the relationship between median household income and receipt of CRT-D persisted regardless of the patient’s insurance status. The authors also note that their findings have important implications for efforts to address healthcare disparities and that health policy targeting insurance coverage alone will be ineffective in resolving inequities in care.

The ACC has been working on several initiatives to address gaps in care like the example above. ACC’s credo initiative seeks to help clinicians better serve all of their patients, regardless of race, ethnicity, gender, primary language, or other factors that may impact care. The ACC has also been working with groups like the National Minority Quality Forum on the CardioMetabolic Health Alliance, to improve cardiometabolic risk factor control in diverse populations.

In addition, this past year the ACC and its CardioSmart initiative has partnered with the Association of Black Cardiologists on a series of community events aimed at increasing awareness of heart disease and promoting better heart health, particularly in high-risk communities. The next event, called Spirit of the Heart, will take place this weekend in Harlem, NY (read more about Spirit of the Heart and view photos from the event in a previous blog post here).

We know the complex problems related to health care disparities cannot be solved overnight, but it is our hope that these initiatives will slowly but surely help close the gaps in care.

This post is authored by Gary Puckrein, PhD, president and chief executive officer of the National Minority Quality Forum.

Physicians and the medical community have reached a fork in the road: we need to document that quality and reduced costs are related. By doing so, we hope to offer policymakers a new framework in which to measure the value of medicine. The conjectures:

• An avoidable mortality index can be an indicator of unnecessary acute events (disease, hospitalizations, disability and death) in a population. Such an index may have utility in localizing the performance of our health care system, thus enabling the investigation of gaps in outcomes of care. 
• There are signals that avoidable acute events are non-random occurrences. There is a possibility that they manifest at predictable frequencies within clinical and geographic sub-populations, and are sentinels of health care and health status disparities.
• Unnecessary acute events have financial implications. At least one study found that 36% of diabetes-related hospitalizations were avoidable. If that percentage holds true for Medicare beneficiaries, the savings could well be over $10 billion per year.
• By reducing unnecessary acute events, we may be able to establish an association between improved quality and bending the cost curve, thereby offering a counterpoint to those who believe reducing provider reimbursements is a desirable cost savings device.
  

The American College of Cardiology, the National Minority Quality Forum (NMQF), and the American Association of Clinical Endocrinologists have joined forces to put our conjectures to the test and have formed the CardioMetabolic Health Alliance. The objective of the Alliance is to improve cardiometabolic risk factor control in diverse populations, including high blood pressure, elevated fasting blood sugar, dyslipidemia, abdominal obesity (waist circumference) and elevated triglycerides; and to provide more effective and coordinated care for people with established cardiometabolic disorders.

In pursuit of its mission, the Alliance will study the possibility that predictable patterns of unnecessary acute cardiac events occur in communities, and that these patterns are measurable and amenable within the context of current treatment modalities. By using the ACC’s PINNACLE Registry and CathPCI Registry, as well as NMQF’s Cardiovascular Disease Index and U.S. Diabetes Index, the Alliance will explore the possible correlation between cardiometabolic disease and unnecessary emergency room visits and hospitalizations; and how these findings can be used to design predictive models and quality improvement interventions targeted for providers and patients at high risk for an acute cardiovascular episode.

Members of the CardioMetabolic Health Alliance and ACC will be meeting at the 2012 Cardiometabolic Health Congress this week in Boston, Ma. Visit the Alliance’s website for more information www.cardiometabolicha.org. Also read more about CardioMetabolic Syndrome in an article in the July/August issue of Cardiology magazine.

This post was authored by Eric Stecker, MD, FACC, member of the ACC’s Clinical Quality Committee.

Last week I made the argument that value (efficient provision of quality care) is a critical but under-recognized component of successful health care reform. Today we’ll briefly address several potential elements of health care reform that cardiologists should be facile with.

How do you measure quality care?
It is no longer sufficient to say we provide high quality care; we must demonstrate it objectively. Quality metrics remain imperfect but will improve over time and provide important information for patients and policymakers. Patients who see cardiovascular physicians participating in programs like ACC’s Imaging in FOCUS, and using registries such as those that fall under the ACC’s NCDR^® umbrella, can be assured the appropriateness and quality of their inpatient and outpatient care is being monitored and in most cases continuously improved.  The ACC’s clinical publications, including practice guidelines, consensus documents, appropriate use criteria, data standards and health policy statements are also excellent resources when it comes to guiding the most appropriate, evidence-based care.

Financial incentives for providers and patients
Medicare has initiated “value-based purchasing” programs to incentivize health care systems to improve quality. These programs could expand considerably in the future if proven successful. Individual health systems and insurers have experimented for many years with various financial programs to incentivize physicians to improve quality metrics or outcomes. The impact of these pay-for-performance programs has been mixed, but as pointed out by Ryan and Blustein, appropriately targeted and scaled monetary incentives are likely to have an impact.  Programs to incentivize patients by lowering or eliminating copayments (“Value-Based Insurance Design”) have proven very effective and are critical to aligning both the “supply” and “demand” aspects of high value care.

Managing individuals versus managing populations
Physicians are accustomed to caring for individual patients who engage them in the clinic, emergency department or procedural suite. However, by necessity the measure of a population’s health is made at the population level, not the individual level. Federal, state and local governments as well as businesses and employers have become more sophisticated and motivated to track aggregate health measures.  As a result cardiologists will become increasingly responsible for reporting and improving the health of all of the patients in their practice as a whole.  It will be important for cardiologists to gain the familiarity and skill to manage populations, but also retain sensitivity to issues that could harm individual patients so that policies and metrics can be modified accordingly.

If health care reform efforts are appropriately structured, cardiologists can thrive by focusing on efficient provision of high quality care for individuals and populations.  This will be best achieved when cardiologists align with and achieve leadership roles in health systems that focus on and incentivize quality systems of care.

A recent New York Times article reported that a hospital system in Florida is being investigated for possible overuse of cardiac procedures and percutaneous coronary interventions (PCI). Although the facts currently available to the public are limited, the mere possibility of inappropriate procedures with little regard for patient well-being evokes feelings of incredulity, shock, and dismay. The kind of clinical practice depicted in the article flies in the face of all of our ACC core values and mission—values that are wholeheartedly embraced by the vast majority of cardiologists. Unfortunately, unprofessional behavior can arise anywhere in society, through myriad circumstances. In medicine, however, even a single occurrence that puts a patient at risk is one too many. Beyond the effect on the individual patient, unprofessional behavior betrays patient trust and, when portrayed at the national level, sends shock waves into good patient-physician relationships.

The College has always emphasized professionalism and quality of care. As new discoveries are applied to practice and our knowledge increases, the ACC updates an extensive array of educational and quality improvement tools to help guide appropriate care: educational programs, comprehensive guideline and quality standards, Appropriate Use Criteria (AUC), the National Cardiovascular Data Registry (NCDR^®) and more. These tools provide a source of information to the health care team on the latest science and evidence-based medicine as well as a means to evaluate and measure quality parameters of the care rendered. Ultimately, the best care is accomplished in the context of an enduring relationship between a patient and the physician/health care team.

In recent months I’ve highlighted the importance of involving patients in their care and rekindling the patient-physician relationship. The ACC’s desire to encourage patients to take an active role in their own care is evidenced by resources such as CardioSmart. We have also invested a great deal of time and effort developing tools for physicians, such as the College’s AUC. The criteria define “when to do” and “how often to do” a given procedure based on a patient’s profile and evolving scientific evidence, combined with a physician’s seasoned judgment (click here to view a recent blog series on AUC, and check out the current issue of Cardiology magazine for a story on the purpose behind AUC).  Over the past few years, these documents have tackled a variety of diagnostic procedures and therapeutic interventions. An AUC document on coronary revascularization was published in 2009 and more recently, one on cardiac catheterization.

An independent program, Accreditation for Cardiovascular Excellence (ACE), sponsored by the ACC and Society of Cardiovascular Angiography and Interventions (SCAI), was started a few years ago to provide accreditation and continuing quality improvement services for cardiac catheterization, PCI and carotid artery stenting, as well as external peer review for coronary angiography and appropriate use. Through its external cath lab evaluation, the program can assess cath lab quality, appropriateness and angiogram film reviews to evaluate accuracy of coronary assessments.

As ACC Past President Ralph Brindis, MD, MACC, said in an ACC in Touch Blog post on the overutilization issue in 2011, “how we react to this overutilization storm will determine our future.”   The ACC’s Maryland Chapter, who at that time was faced with a similar situation, was exemplary in the way they tackled their own crisis and worked tirelessly with SCAI and state officials to advocate effectively for oversight and guidelines for cath labs performing PCI.

A medical professional carries two primary levels of responsibility: toward our profession and toward our patients. The majority of physicians are caring, competent and good-natured. Incidents that cast doubt on our collective integrity may distort our practices and relationships in numerous ways, but they also present an opportunity for each of us to reaffirm, in the strongest terms, our fundamental ethical commitments. 

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.

This year, in addition to providing a discussion forum on various issues facing cardiology, I want to use the ACC in Touch Blog to provide you with a first-hand glimpse into the meetings, trips and other engagements that your ACC leadership team is undertaking on your behalf.

In the past two weeks, ACC President-Elect Dr. John Harold, Interim Chief Staff Officer Tom Arend and I flew to Boston to attend the Heart Rhythm Society's (HRS) Annual Scientific Sessions, which had close to 13,000 attendees. While there, we met with HRS leadership, including outgoing President Dr. Bruce Wilkoff, Incoming President Dr. Anne Gillis, and had an open discussion on how to improve overall communication between our two societies, as well as how best to collaborate around quality projects like NCDR.  Education was also a topic. We discussed including a full day of programming by HRS at ACC.13 in San Francisco (similar to ACC.12), and a reciprocal session on quality at the 2013 HRS meeting. Both teams felt this open face-to-face dialogue brought new perspectives and improved current relations and communication.

From there, we flew to Las Vegas for the SCAI 2012 Scientific Sessions, where we were joined by ACC’s Chief People Officer Cathy Gates and former ACC President Dr. Ralph Brindis. We met with the SCAI leadership including newly installed President Dr. Jeff Marshall, President-Elect Ted Bass and others. We discussed topics ranging from our collaborative efforts on clinical documents like appropriate use criteria, to the importance of ACE (Accreditation for Cardiovascular Excellence) for accreditation of interventional laboratories. We also clarified the role of the ACC Interventional Academic Council as an advisory body to College leadership on interventional matters. It was a welcoming meeting and one that I feel furthers our collaboration in the field of interventional cardiology.

On May 19, I found myself back in my home state of Texas to participate in two great events in Dallas. The first was the Texas ACC Chapter meeting.  Former AMA President Dr. Jim Rohack shared his views on the health care system and its future, while I spoke on why physicians should be involved and “get off the sidelines”—an important stance for advocacy, professional education, or even mentoring of the future generations of cardiologists. Many thanks to ACC Texas Governor and BOG Chair-Elect Dr. David May, as well as the program committee, for a very successful program.

Also on May 19, I attended the celebration of the 60th anniversary year of Mended Hearts. Mended Hearts and Mended Little Hearts are great organizations with more than 18,000 volunteers helping patients recovering from heart surgery and/or other procedures. I had the honor to be the keynote speaker at the event, sharing with the audience of close to 500 volunteers the latest advances in cardiovascular medicine, and importantly emphasizing our strong collaboration with Mended Hearts in patient education and engagement. Gus Littlefield, president of Mended Hearts and Mended Little Hearts, surprised me by affectionately presenting the College with a special recognition award for our collaboration and emphasis on patient-centered care.

Next stop was Washington, DC, for the ACC’s Clinical Quality Committee retreat chaired by Dr. Joe Drozda. During a break in the meeting, I was introduced to “Twitter” – a form of social media I had avoided until I learned that more than 12,000 ACC members, media, consumers and others are “followers” on at least one of the College’s Twitter feeds. I am now honored with the distinction of being the first ACC Tweeting president! You can follow the various ACC Twitter accounts, as well as my own at @williamzoghbi.

My last stop in the week was San Juan, Puerto Rico, for the 23rd Annual Puerto Rico Chapter Meeting. I was here last year, and was reminded again this year about just how impressive this educational meeting is. Besides excellent scientific sessions with speakers like Drs. Mike Adams, Anne Gillis and Mike Quinones, the unique evening gala dinner brought together ACC members and their families celebrating distinguished faculty, research fellow winners and graduating fellows from training programs. Big thanks to Puerto Rico Governor Dr. Luis Rodriguez Ospina for his phenomenal leadership.

As president, my travel and other schedules may be grueling, forcing many life changes, including the art of exponential multitasking. However, being there with you, learning your issues, receiving your feedback first hand (positive or critical) and getting to connect with many of you (even through our blog or Twitter!) is what this experience is all about… it is priceless.