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 is authored by Christopher P. Cannon, MD, FACC, is editor-in-chief of CardioSource Science and Quality.

Late-breaking clinical trials (LBCTs) have become the centerpiece of major cardiology scientific sessions. On the upside, they produce significant advances that will reshape the practice of medicine (if and when we ever adopt them), and, more recently, they’ve challenged long-held beliefs about the benefits of various older treatments.  On the other hand, they can sometimes lead to disappointment (ie. when a study produces negative findings or is too small to be definitive).

So, LBCTs—are they all that? I think so. (Although, I will also note that the other sessions are important too.) There is something to be said about being one of the first to get the scoop on new data. I love it when buzz from an LBCT spills into the hallways and gets people asking questions about the data, debating implications, and discussing what other data might be needed. Presenting an LBCT is like undergoing a worldwide peer review. How does this play in Peoria? Or Prague? Would this be something we could adopt? Would it fit in practice? These discussions in the hallways among colleagues are among the most exciting scientific interchanges we can have.

I’m particularly interested in the results of the LBCT session on Saturday morning during the Showcase Session, where Jane Armitage will present the results of the Heart Protection Study 2 (HPS2-THRIVE), looking at the effects of niacin in a mega-trial. We have thought for decades that niacin was beneficial. This was supported more recently—to both great fanfare and skepticism—by the ARBITER 6-HALTS trial that showed benefit of niacin over ezetimibe for changes in carotid intima medial thickening (in 208 patients). We heard already HPS-2 THRIVE showed no benefit – so I guess the smaller trial was wrong – and we need to rethink niacin and wonder about HDL.  We'll know more after the presentation.

Other hot trials, in my opinion, are CHAMPION PHEONIX (we know it is positive). Deepak Bhatt, MD, MPH, FACC will present along with co-chair Robert Harrington, MD, FACC – and it will be a practice changing trial. The STREAM trial and PARTNER 2 are also being presented place on Sunday. On Monday, I’ll also be interested to hear the outcomes of the MACC COM Trial, which compares PCI between Massachusetts hospitals with onsite cardiac surgery to community hospitals without onsite services (view the complete list ACC.13 LBCTs).

In each of these cases – and with the rest of the LBCTs – I’ll be there listening to the new data, hearing the panel discussion, and then walking out to the hallways to discuss it with colleagues (and later with colleagues at the CardioSourceNews desk). In this day and age of social media, you can be sure I’ll also have something to say on Twitter!

This is what the meetings are all about, and I can’t wait! See you in San Francisco.

 

This post was authored by Miguel A. Quinones, MD, MACC, chair of the ACC.13 Program Committee.

With the 62nd Annual Scientific Session & Expo quickly approaching, the program committee and ACC staff are busy putting together the final details on sessions, speakers and other meeting logistics. ACC.13 focuses on the transformation of cardiovascular care — from discovery to delivery and offers a variety of ways to advance knowledge and improve quality of care. Here are some of the things to look forward to at ACC.13:

1. Learn from the best of the best on how to integrate patient-centered care into everyday practice, including through full-day joint sessions with other cardiovascular medical specialty societies and a new in-depth integrated course in cardiology hosted by Valentin Fuster, MD, PhD, MACC.
2. ACC’s meetings are known for presenting great science, and this meeting will not disappoint with the hottest science, latest technologies and clinical applications with topics like the latest in TAVR, therapies for non-valvular AFib, drug-eluting stents, and more. 
3. There are expanded opportunities geared towards the next generation of cardiovascular professionals including networking opportunities with ACC leaders, sessions focused on career advancement, research publication and hands-on training. 
4. In order to encourage a team-based approach to care, we have content available for the entire cardiac care team ranging from a full-day pharmacology program to our popular Cardiovascular Administrator track.  
5. There are more international sessions than ever before, including an international lunchtime symposia with 22 cardiology societies from around the world.
6. There are 16 different learning pathways to choose from including the TCT@ACC-i2 Learning Pathway that features topics important to interventional cardiologists.
7. More than 300 companies and organizations will showcase the latest advances in pharmaceuticals, imaging, devices, health IT and more on the Expo floor.
8. You can earn up to 60 MOC points and can prepare for board certification at Core Curriculum and ABIM MOC Study Sessions. 
9. ACC.13 integrates new technologies including the ACC.13 eMeeting Planner App, live tweeting, live streaming, and more. 
10. It’s in San Francisco!
    

Over the next few weeks leading up to the meeting, you’ll hear from other leaders who will dive deeper into several of these reasons and share all of the exciting things to look forward to.

Advanced registration ends on Jan. 30, so register today and save.

For more information about ACC.13, visit www.accscientificsession.org.

A number of hot trials have been coming out of AHA’s meeting in Los Angeles over the past few days, including several with positive results that underscore the future of cardiology and stem cell therapy.

Results from the POSEIDON trial indicate that transendocardial injection of allogeneic and autologous mesenchymal stem cells (MSCs) without a placebo control were both associated with low rates of treatment-emergent serious adverse events, including immunologic reactions in patients with left ventricular (LV) dysfunction due to ischemic cardiomyopathy. In addition, results from the ALCADIA trial suggest that transplantation of autologous cardiac-derived stem cells (CSCs) with controlled release of basic fibroblast growth factor (bFGF) is both safe and effective in treating injured human hearts with reconstruction of the post-ischemic environment. While the SCIPIO trial results suggest that infusion of autologous CSCs harvested from the left atrial appendage at the time of coronary bypass surgery in patients with ischemic heart failure is safe and beneficial in both ventricular function and myocardial viability. These effects are sustained at 2 years and improve over time (read the full CardioSource article here). Whether these exciting new observations are sustained in a larger cohort of patients remains to be determined in future studies. 

These innovative advances in stem cell therapy offer opportunities to cure, not just treat, patients with cardiovascular disease, and show how far we’ve come over the past decade since the first application of stem cell transplantation occurred in 2000 involving heart failure therapy. Phase I and Phase II trials have since indicated that it is both feasible and safe for physicians to isolate stem cells and to transplant them. Results however on improvement in ventricular function, viability and outcome have been mixed. Researchers are going back to the bench to gain more insight into the basic and molecular mechanisms of stem cells to improve the potential clinical effectiveness of this approach and also concurrently looking at the best methods of stem cell types and delivery. Among the methods being tested are direct epicardial injection, intravenous infusion and endocardial delivery. However, no single method has emerged as a major winner or standard.

One thing is certain, we will continue to see this hot topic emerge in future meetings (including ACC.13 in San Francisco) and publications as the science rapidly evolves and as we look for novel and more definite cures for heart failure in our patients.

Visit CardioSouce.org for additional AHA 2012 meeting coverage. Also, be sure to follow @ACCinTouch on twitter for the most up-to-date news coverage.

The ACC’s Board of Governors are the foot soldiers of the College. With a teamwork-focused BOG, previously insurmountable changes can be more easily attainable. A few years ago, the Door-to-Balloon (D2B) initiative gained traction once the BOG decided it was a top priority. We saw first-hand how as a team, the BOG can enact change to make the environment better for physicians, the care team and most importantly, patients. When the BOG get behind something, our collective voice is often heard and the initiative comes to fruition. Our ultimate goal is to be that voice for the members of the College.

Tackling changes across the board is a lofty goal with its share of challenges. During my tenure as Chair of the BOG, I’m proposing we model our strategic plan at the state level after the mission and pillars of the College – bringing local relevance to national priorities by involving the states in two-way communication and decision-making with national goals:

• Membership: Ensuring that all states have the opportunity for success is key. We must focus on member value and preserve the brand of the College.
• Education: Focusing on need-based programs and using traveling educational resources and web-based activities for continuity of state-wide initiatives.
• Advocacy: Teamwork shines here more than any other area of the College. We must partner and invest in ourselves and relationships with payers, lawmakers, strategic partners and each other to ensure the voice of the College is heard.
• Science and Quality: The BOG should participate in all ACC quality initiatives including guideline and appropriate use criteria development as well as our registries including the NCDR^®. The BOG can help develop new registries and embrace existing registry data to help affect quality patient care. This is clearly one place where the “doers” of the College can really take action.

Representing more than 50 Chapters consisting of incredible cardiovascular professionals is an exciting challenge – and a task that my predecessor, Thad Waites, MD, FACC, did with ease and professionalism. I look forward to the accomplishments we will see from the Chapters this year and the change in perception of the BOG to one that stands for strategic priority decision making across all four pillars of the College.

For more on Itchhaporia’s strategy for the BOG, look out for the May/June issue of Cardiology magazine.

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

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Results from the ASCERT study released today during the final Late-Breaking Clinical Trial session found that patients who underwent PCI had a higher death rate in the first four years after treatment than those who had opted for coronary artery bypass graft (CABG) surgery. The study, which used combined patient data from the ACC’s CathPCI Registry, the Society of Thoracic Surgeons CABG database and the Medicare claims database, suggests better survival in patients undergoing CABG compared to PCI.

While past studies have suggested that the two treatments have similar long-term outcomes, others have shown better outcomes with CABG. Patents and doctors tend to choose the less-invasive PCI when both treatments are an option. Recently updated ACCF/AHA Guidelines for CABG and PCI state that PCI to improve patient survival is a reasonable alternative to CABG in stable patients with left main CAD who have a low risk of PCI complications and an increased risk of adverse surgical outcomes. The guidelines also confirm the superiority of CABG compared to medical therapy and to PCI for most patients with 3-vessel disease.

Should physicians start recommending CABG over PCI as a result of this study? The answer is no. A major limitation of observational studies, such as this one, is that the groups may not have the same level of risk, and so it is possible that the worse outcomes in the PCI patients were related to these patients being sicker overall. These results do, however, underscore the importance of the Guideline-recommended “heart team” approach to determine which procedure should be used. This approach means that the interventional cardiologist and the cardiac surgeon review the patient’s condition, determine the pros and cons of each treatment option, and then present this information to the patient, allowing him or her to make a more informed decision. Results from studies like ASCERT should be shared with patients as part of the decision-making process.

Read more on the study here.

There is no denying that change is in the air when it comes to large medical meetings like the ACC’s Annual Scientific Session and Expo. Not only has the rapid growth and use of mobile technologies made it easier to stay up-to-date on scientific research and guidelines, tough economic times and increasing regulations governing relationships with industry have limited travel sponsorships and overall meeting funding.

However, while these changes are very real and require a shift in focus from decades past, they don’t overshadow or negate the importance of these meetings in providing a one-stop-shop for the hottest clinical breakthroughs, increasingly important maintenance of certification opportunities, and forums for professionals across the spectrum of care delivery to network and share ideas.

At ACC.12 in Chicago, the College under the guidance of ACC President David Holmes, Jr., MD, FACC, has taken a renewed look at the meeting format and offerings and developed a well-rounded agenda that accommodates both the changing landscape of cardiology and the changing needs of the professional world.

In particular, the meeting format has been changed to feature new science in the mornings, followed by afternoon sessions focused on actual application of the science. Many of these sessions take advantage of innovative new technology to allow for the “piping in” of live cases from around the globe, as well as online debate and conversation with panel presenters while the session is occurring.

In addition, the College recognizing the importance of working closely with partner cardiovascular societies both in the U.S. and around the globe, is featuring numerous co-sponsored sessions each day with societies like the Society of Vascular Surgery, The Society of Thoracic Surgeons, the International Society for Cardiovascular Translational Research, the Heart Rhythm Society, the Heart Failure Society of America, the American Society of Echocardiography, the American Heart Association, and others. On a global scale, the record 18 International Lunch Symposia, which are jointly sponsored by ACC and international cardiology societies, will cover topics ranging from using registries for quality improvement; best practices for treating adult congenital cardiology; improving outcomes for patients with acute coronary syndromes; and more.

All of these education sessions are vital for professionals to earn Maintenance of Certification (MOC) credits, an increased point of emphasis at ACC.12. For example, entire afternoons will be dedicated to a review the fundamentals, such as MOC and clinical interpretations, with an increased number of MOC sessions from past meetings so attendees can complete much of their required elements and core content. This is something not offered to attendees at European meetings, but is vital for professional development.

Of course, networking is something else that can’t be done behind a desk and in front of a computer. ACC.12 provides many unique opportunities for cardiologists, nurses, nurse practitioners, practice administrators, pharmacists, training directors, fellows in training and others to come together in a forum not seen anywhere else. Only at ACC.12 will there be opportunities to meet and ask questions of cardiovascular legends credited for making the delivery of cardiovascular care what it is today. whenever 20,000 people who love cardiovascular science, clinical research, and health policy get together to describe the future, it has to both a very special and unique experience.

As the needs of cardiovascular professionals are changing, the ACC’s meeting is changing with them. The need for cutting edge cardiology science, education and innovation to better benefit patients and save lives will never diminish. ACC.12 shows just how far we’ve come in ensuring the meeting remains relevant and continues to benefit all cardiovascular professionals in terms of their learning and scientific needs.

Whenever 20,000 people who love cardiovascular science, clinical research, and health policy get together to describe the future, it has to be a very special and unique experience.

A study published earlier this week in The Lancet shows that treating heart attack patients with an infusion of their own heart-derived cells helps damaged hearts re-grow healthy muscle. The study results are from the Cedars-Sinai Heart Institute clinical trial CADECEUS and is the first-of-its-kind stem cell procedure.

As it has shown that cardiosphere-derived cells (CDCs) reduce scarring after myocardial infarction, increase viable myocardium, and boost cardiac function in preclinical models, the authors aimed to assess safety of such an approach in patients with left ventricular dysfunction after myocardial infarction.

The study involved 25 patients who had suffered a myocardial infarction that left them with damaged heart muscle. Eight patients received standard care, and the remaining 17 received the stem cell treatment. The results showed that one year later, scar size was reduced from 24 percent to 12 percent of the heart in patients with cells. Patients also experienced sizable increase in healthy heart muscle following the experimental stem cell treatments. Patients in the control group who did not receive stem cells did not experience a reduction in their heart scars.

Eduardo Marban, MD, PhD, director of the Cedars-Sinai Heart Institute who invented the procedures and technology involved in the study noted, “While the primary goal of our study was to verify safety, we also looked for evidence that the treatment might dissolve scar and regrow lost heart muscle... this has never been accomplished before, despite a decade of cell therapy trials for patients with heart attacks.”

While the grim concerns about the alarming contributions of health care costs to the national deficit seem to dominate the conversation, who could deny that this is an unprecedented and exciting time for the cv community! Science is moving fast. The ACC wants more medical research and NIH funding to pursue innovative, life-saving therapies. Although funding of stem cell research is often a topic of controversy, we need to publicly educate how life-saving therapies like these are exactly what innovators in medicine and science strive to achieve.

Let’s not forget that this type of innovation requires funding and support, and it’s not looking good for those of us in the U.S. folks. President Obama’s Fiscal Year 2013 Budget Proposal freezes funding for NIH, and many in Congress advocate for significantly slashing funding for innovation and research.  Nonetheless, innovators like Marban are paving the wave of the future. Let’s have at it!

Under the leadership of Alice Jacobs FACC, the ACCF/AHA Task Force on Practice Guidelines and ACC/AHA guidelines staff held a Methodology Summit in mid-December as part of AHA and ACC’s ongoing efforts to improve the guidelines methodology and rigorous development process. With the American Heart Association, our partner in these regards for almost three decades, we together also want to compare and contrast the current ACCF/AHA guidelines methodology with the standards proposed in the Institute of Medicine’s (IOM) two recently published reports, Clinical Practice Guidelines We Can Trust, and Finding What Works in Health Care: Standards for Systematic Reviews.

Last August, the Task Force initially commissioned five Workgroups to consider what, if any, changes or improvements should be implemented to enhance our development process and evidence review and evaluation. Each Workgroup was charged with 1) reviewing the IOM Report recommendations and sections of the current tools available for developing/conducting systematic reviews relevant to their topic; 2) comparing and contrasting the recommendations with our current ACCF/AHA methodology, including an analysis/discussion of the gaps and barriers; and 3) drafting recommendations/considerations for changes and improvements to the evidence review process and the COR/LOE including a discussion of why we may or may not implement changes.

The invited members of each Workgroup (including all Task Force members), in addition to guests at the Summit, brought a diversity of experience and expertise to this initiative. Participants included methodologists, biostatisticians, clinical and research cardiologists, epidemiologists and nurses as well as leadership from both the ACC and AHA. An official report which will include the final proposals and recommendations developed during the Methodology Summit is being prepared. This report will be shared with the leadership of the ACCF/AHA and then published.

We are also thinking to increase the technological ability to search the huge volumes of clinical recommendations we have amassed to allow clinicians to be able to more effectively and instantly use this science and knowledge more effectively at the point of care. Dr. Rick Nishimura wowed the Task Force with a strategy and plan to create what I’d call a ‘virtual curator’ IT system that could re-structure the data in our future (and present) guideline data to make it available in new ways. It’s time!

If you are attending ACC.12 in Chicago, be sure to check out the session “What’s New in the ACCF/AHA Guidelines,” on Sunday, March 25, from 4:30 – 6:00 p.m. in McCormick Place North, N228.
The session will discuss the recently published ACCF/AHA Clinical Practice Guidelines as well as an update on changes to the ACCF/AHA methodology.

As 2011 comes to a close we can look back with pride on all of the accomplishments in the field of cardiovascular medicine over the year. Whether it was all of the great science presented at ACC’s scientific session in New Orleans; development of new and/or updated guidelines reflecting how to best use new treatments or drugs; participating in the United Nations Summit on Non-Communicable Diseases; or partnering with public and private entities on the Million Hearts Initiative – we have made great strides. Our field can be a challenging one at times, but the end results are well worth the battle.

One of the accomplishments I am most proud of, however, is our work related to transcatheter valve therapy (TVT). Early 2011 brought us the PARTNER Cohort A trial, which looked at this transformational procedure that had been used in 40 other countries outside the U.S. until this year. Soon after, The Society of Thoracic Surgeons (STS) and ACC together developed a high-level societal overview on TVT to ensure safe introduction of the therapy into the U.S.  Michael Mack, MD, president of STS, and I testified at a Food and Drug Administration (FDA) committee hearing about the importance of a team-based approach when implementing this procedure.

In the past few months, not only has the FDA approved this new technology, which has the promise and potential to significantly affect the management of patients with severe aortic stenosis, but the Centers for Medicare and Medicaid Services (CMS) has opened up a National Coverage Determination analysis at our request. We are ending this year with the official launch of the STS/ACC TVT Registry^TM, which will track patient safety and real-world outcomes related to the newly introduced transcatheter aortic valve replacement (TAVR) procedure. The Registry is a great example of teamwork between professional societies as we worked closely with STS, the FDA and CMS, with input from The Society for Cardiovascular Angiography and Intervention (SCAI) and The American Association for Thoracic Surgery (AATS). We are continuing to work closely with these stakeholders on the development of future clinical documents and educational programming to ensure appropriate use of this new therapy. It is our hope that our efforts now will serve as the model when new devices or therapies are developed in the future.

We’ve had quite an exciting year, and as we head into 2012, I am excited for what this next year will bring!

What do you think were some of the great innovations of 2011?