This post is authored by Michael Scherlag, MD, FACC, governor of the Oklahoma chapter of the ACC.

As a pious devotee to evidence-based therapies, forgive me for reciting the (unproven in large trials) litany of diseases which have been benefited from renal denervation (RDN): hypertension, congestive heart failure, diabetes, sleep apnea, ventricular tachycardia, atrial fibrillation, PVCs, SVT, rapid ventricular response with atrial fibrillation, diastolic dysfunction, anxiety, depression, etc. Whenever it is shown to regrow hair, you can count me in. However, it is quite clear that resistant hypertension is dramatically reduced following RDN.

The procedure is easy to perform and assuming the Symplicity HTN 3 trial is positive, and assuming that the U.S. Food and Drug Administration approves it, and assuming that Centers for Medicare & Medicaid Services will reimburse it...our patients will no longer be subjected to drugs that are unproven/difficult to take. Irrational exuberance aside, as with any new therapy, it must be carefully evaluated, tested, analyzed and distributed in a standardized fashion. The ACC is in the best position to develop a registry to ensure that appropriate patients are being treated and these patients are followed for side effects which may in some cases be beneficial and hopefully not detrimental.

The science sounds pretty simple. An electrode catheter is placed against the wall of the artery and radio frequency ablation heats the nerves leading to their inactivation. In essence, disconnecting the sympathetic afferents/efferents of the kidneys from the brain thereby decreasing blood pressure. This would be simple, but it is also probably incomplete. There is still a lot to learn about the basic science. The ACC will encourage the dissemination of this science as it is uncovered.

Indulge me with some predictions for RDN. If my understanding of the physiology is correct, this should be effective for inappropriate sinus tachycardia, possibly neurologic movement disorders, or even Takotsuboʼs cardiomyopathy. Could RDN or an offshoot of this procedure supplant a significant number of implantable cardioverter-defibrillators? Will this be the first time a new technology actually lowered the cost of health care? Could reflex sympathetic dystrophy be treated with denervation of blood vessels to the affected limb? With this potential, one thing is certain: it is an exciting time to be a cardiologist.

Check out a recent article in CardioSource Interventional News: “Resistance is Futile: Renal Denervation Takes on Hypertension.”

This *post is authored by Andrew M. Freeman, MD, FACC, chair of the ACC’s Early Career Professionals Section, and editor of the Patient-Centered Care CardioSource Clinical Community.

We’ve all been there – a busy clinic with a patient who has lots of questions and can’t quite make sense of your chicken-scratch, grade-school level coronary tree drawings. If you’re not in the medical field, it’s often very hard to wrap one’s head around the fact that someone is going to stick a balloon in the artery that supplies your heart. Of course, you’ve been working diligently to make sure that your patients are truly in the know, understand what’s going to be done to them, and that they are “captaining” their own health-ship. Being patient-centered in your delivery of care means involving your patients in their decisions about medications, intervention, and the overall disease processes. But, as we all have experienced, getting a patient up to speed quickly can be a daunting task.

This is where your ACC steps in. With the CardioSmart Explorer App for the iPad 2, you can select from many common health conditions and “bring to life” for patients what these conditions mean and what their treatments can look like. With a wave of your fingers, you can show a patient their heart muscle, its coronary anatomy, and the processes of a stent implantation. You can also mark up an anatomically and functionally correct digital model of the heart, and email this image directly to your patient. If your patient has atrial fibrillation, you can now show them how the electrical system of the heart works and how it can go awry.

The power of this application lies in its user friendliness, availability on the iOS (Apple) platform and its ability to show disease states and treatments with animations and pictures. Really, a picture is worth thousands of words. The concept of coronary disease and PCI with stenting can now be explained in 2 minutes instead of 20 – and can be instantly rewound, forwarded, and played in slow motion until all can grasp what this means.

Ultimately, this means your patient no longer comes to you with the “I don’t know what they did to me 5 years ago, but it involved a hole in my leg” phrase. Instead, you have a well-informed patient who understands exactly what has been done and why. Discussing procedures is now easier, and the risks and benefits of those procedures can be more clearly explained when the patient understands just how the procedure works.

As you can tell, the excitement behind this powerful application is tremendous – and for good reason. This kind of technology is the future of patient-centered medicine and no longer relies on “back-of-the-napkin” line drawings. Your ACC is proud to have brought this project to fruition, for you, our valued members.

This week is National Public Health Week, check out CardioSmart.org and the Patient-Centered Care CardioSource Clinical Community for additional tools and resources available to help prevent, treat and manage cardiovascular disease, while facilitating patient-centered care.

*A version of this article also ran in the CardioSmart Tech column on the Patient-Centered Care CardioSource Clinical Community.

Charles Darwin once stated: “It is not the strongest of the species that survive, nor the most intelligent that survives. It is the one that is the most adaptable to change.”

The field of cardiology is continuously changing, and exciting advancements made over the past few decades have led to the discovery of life-saving treatments and therapies.

A recently published article in the Journal of the American College of Cardiology by Robert Roberts, MD, MACC, and colleagues discusses one such advancement: genomics in cardiovascular disease. The authors explain the history of the development, but note the conundrum, “a major challenge to health care policy makers, physicians, care givers and end users are being created by the convergence of two major technologies: cost effective DNA sequencing of the whole genome and digitalization of patient data. The progress of DNA sequencing is said to have improved 10,000 fold in the past 8 years, while our ability to store, retrieve and analyze data has only improved 16 fold.”

They continue that “some claim that the convergence of these two technologies is the tipping point for personalized medicine. It could be costly not to realize we are at the cusp of the new era of personalized medicine.” They envision an “era of population medicine where ‘one drug fits all’ will be replaced by medicine based on one’s genetic composition, molecular makeup and how it affects the particular disease phenotype in that individual.”

The authors compare the “informational revolution” to the industrial revolution and quote Stuart Firestein, who noted, “from 5,000 years ago until 2003, humanity created a total of five exabytes (a billion gigabytes) of information. From 2003 to 2010, we created this amount every two days and in 2013 we created this amount every 10 minutes. Another way of stating this is to realize that every few hours we create more information than all of the information created by humanity since the start of civilization.”

Leave your thoughts about the advancement of genomics in cardiovascular disease below.

As cardiovascular science marches forward, certainly demonstrated at the ACC.13 Annual Scientific Session, so too does the way technology is used to expand communication. Innovation has changed the way we practice medicine—witness TAVR, the use of LVAD and the emergence of new pharmacology for the betterment of our patient care—and similarly, innovation has forever altered the way we locate and  consume the latest science and education reports as well as how we share education information with patients. This weekend, smart phones and tablets dominated the hallways of the convention center at ACC.13. While many attendees were using their devices to browse sessions and plan their schedules using the ACC.13 eMeeting Planner app, thousands of others, myself included, were using them to soak up as much knowledge as possible. With hundreds of events taking place in three separate buildings, it was impossible to be at every session that sounded interesting. The ACC’s meeting Twitter account (@ACC_2013) was my go-to source for everything that was happening in San Francisco, allowing me to follow thought leaders from across the spectrum of cardiology, each reporting, in real time, updates from a variety of venues including late breaking clinical trials, esoteric sessions on orphan diseases and impromptu FIT meetings with giants of cardiology. I wasn’t alone. The hashtag #ACC13 has been used more than 4,500 times by nearly 1,200 people and still counting. That makes ACC.13 the most “connected” meeting to date with more than 5 million impressions worldwide. 

On Saturday, I shared my personal experience with the use of social media in medicine during a presentation in ACC Central. In my hectic daily life, I take advantage of Twitter to get the most up-to-date information —from clinical to health policy to world news—delivered to the palm of my hand, enabling me to be the most informed physician I can be. It’s also helped me discover and innovate, adapting other cutting-edge tools and resources to my benefit.  This in turn helps me better serve my patients and run a more successful practice. 

Just because ACC.13 is a wrap, doesn’t mean social media will fade into the background. One out of every seven minutes spent online is on Facebook and there are 340 million tweets sent each day. Surprisingly, while only 19 percent of cardiologists believe social media channels are very or extremely effective for sharing insight on medical news, research, developments and treatments, there has been a rapid uptick in engagement across ACC’s suite of social media channels. At this stage in the game, it’s clear that social media is here to stay and I encourage all of you to get on board to become more informed, well-rounded clinicians.

It’s hard to believe that in just a few days, a year of planning for ACC.13 will come to fruition. I have the pleasure of kicking-off the ACC’s 62nd Annual Scientific Session & Expo during the opening showcase session held Saturday, March 9 from 8 – 10 a.m. PT in the Esplanade Ballroom.

It is a session you won’t want to miss, as I will be introducing the speaker of the 2013 Simon Dack lecture, one of the ACC’s Legends of Cardiovascular Medicine: Valentin Fuster, MD, PhD, MACC.  I’ll also be giving out the first CardioSmart Patient Advocate Award to Larry King. His foundation – the Larry King Cardiac Foundation – is celebrating 25 years of providing funding for life-saving cardiac procedures for individuals who, because of limited means and no insurance, would be otherwise unable to receive treatment.

I’ll also announce the official launch of the College’s innovative Lifelong Learning Portfolio for the cardiovascular professional, in addition to the redesigned CardioSmart.org for patients and their care team.

We’ll then hear from the investigators of the first Late Breaking Clinical Trials of ACC.13.  From there, ACC.13 will be in full-swing with three full days of the latest science, oral sessions, LBCTs, MOC sessions, and more.

As you are preparing for your trip here are a few last minute reminders:

• If you haven’t already, be sure to download the ACC.13 eMeeting Planner App. The mobile app really is the best way to navigate through the meeting. Here are two tutorials for a detailed look at using the app:  "How to Create and Export Your Schedule" and "How to Use Filters".
• If you are a social media user, be sure to follow @ACC_2013 on Twitter and use the hashtag #ACC13. My opening session will be live-tweeted from the @ACC_2013 Twitter account, and you’ll get the latest news throughout the meeting. Check out the other ways to stay connected through social media here.  

I hope you all have safe travels to San Francisco and I look forward to seeing you all in the City by the Bay!

With the increase in use of technologies such as Smartphones, tablets and e-readers, mobile devices are now a part of our everyday lives. These technologies have become increasingly popular over the past few years and have the ability to be truly transformative in our work flow as well as the way we communicate with one another other globally. To that end, the ACC has developed several mobile resources for you and your patients that hopefully you will find helpful.

The CardioSmart Explorer App is the first medical app by the ACC, was previously available exclusively to members of the ACC for free, but is now also available to the general public for a nominal fee (to download the App click here). The app is available for the iPad 2 and is designed to help you explain medical conditions and procedures to patients and thus enhance the clinician/patient relationship at the point of care. (Watch the demo video below or click here). Physicians and health care professionals can review and discuss common heart problems and treatment options by utilizing the app’s high-resolution cardiac graphics and animation, as well as walk step-by-step through the structure of an animated 3-D beating heart by swiping up or down through seven basic layers of normal cardiac anatomy.

In the works is the AnticoagEvaluator App, an ACC risk assessment tool that will launch at ACC.13. This tool is an easy and fast way for clinicians to assess stroke and bleeding risk and the benefits and risks of antithrombotic therapy in patients with chronic atrial fibrillation. The app will be free for ACC members and will be available for use on iPhone, iPad, and Android devices starting in early March.

In addition, the ACC has created a new ACC Connect App for members. The App is available for both iOS (iPhone, iPad, and iTouch) and Android devices, and allows cardiovascular professionals to stay connected through their electronic devices. Features include a searchable member and ACC staff directory, the ability to update individual contact information, news feeds from the ACC, and access to important ACC phone numbers. As a member, I encourage you to check your own profile for accuracy. To download on an iOS device, click here. For Android devices, click here.

For those attending ACC.13 in San Francisco, meeting attendees should download the ACC.13 eMeeting Planner App. This easy-to-use App allows you to personalize your meeting by searching for sessions by specialty, interest area, and role in the cardiovascular care team. Plus, get access to Expo info, animated maps, Twitter feeds and more (to download the App click here).  There will also be several sessions at ACC.13 targeted at mobile technologies and social media. Watch these tutorials on "How to Create and Export Your Schedule" and "How to Use Filters" for a more detailed look at using the ACC.13 eMeeting Planner App.

The ACC also offers ways to review CardioSource.org content on your iPhone, iPod touch, iPad, Android and Blackberry through the CardioSource Mobile App. Further, several of ACC’s print publications feature apps including the JACC iPad edition App (which was named one of the top medical education apps, and one of Apple’s top 80 medical apps); the Cardiology magazine App available for the iPad, iPhone and iPod touch; and the CardioSource World News App for the iPad. Other mobile resources include heart songs and ACCEL.

Further, CardioSmart offers several mobile resources for patients. The free CardioSmart Med Reminder app is designed to help patients take their medications as prescribed in addition to serving as a personal medication record (PMR) to help patients communicate to their health care providers about medications. Other mobile resources include free SMS text messaging services for patients in the U.S. looking for tips to prevent cardiovascular disease or to quit smoking.

There are so many tools and different ways we can impact health care. I do hope you find these tools useful in your daily work, providing you with content and tools at your fingertips for improved efficiency and effectiveness in providing health care.  Under Incoming President John Harold, MD, MACC’s direction next year, I am confident the ACC will take its digital strategy to the next level, with even more mobile offerings and tools to help the cardiac care team and their patients achieve their goals.

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

Fellows in Training (FITs) who attend ACC.13 will notice some new developments this year as FIT programming has reached new heights and is truly better than ever!

This year's FIT programming is more concise. The length of some of the forums has been reduced and streamlined. Sessions about finding a job, academic and private practices, and education in academic practices have been integrated.  More time has been allotted for engaging our expert speakers, and practical advice (thinking about that VA job?) will be delivered in a fun and lively fashion.

This year's FIT programming is more comprehensive. With all there is to see at ACC.13, we made a real effort to provide specialized niche programs for those interested FITs. There are several small group mentoring sessions this year. Interested in intervention, heart failure, prevention and/or international opportunities? Check out the FIT program for networking and mentoring sessions in the FIT Lounge (which will be located in South, Room 206).

This year's FIT programming is more collaborative. The key word here is participation! Join the amazing Mayo Clinic duo (FITs Jeff Geske, MD and Mike Cullen, MD) as a roving reporter for the FITs on the GO video blog. Engage and interview session leaders, ACC staff, and other FITs to get their impressions of the meeting, and well, frankly, share a laugh!  (Check out the kick-off video below and if you are interested in joining the roving reporter team email fits@acc.org). Also be sure to keep your Twitter account open and handy – there will be special announcements and prizes for FITs distributed only on social media channels.  Be sure to follow @ACC_2013 and use the hashtag #ACC13 and #ACCFIT during the meeting.

This year's FIT programming is more innovative. If you attended ACC.11 and ACC.12, do not expect the same FIT experience. We have new sessions on social media and health information technology. There is a FIT-directed cardiovascular innovations program — learn from successful entrepreneurs how to take your idea to fruition. Learn how to get that paper published — and hear a first-hand account of a thorough review and revision process from the first author of a recent JACC article. Support your fellow FITs in the enlivened Jeopardy competition and "Stump the Professor" sessions.  

In addition to all of this, the always popular "Mix & Mingle” session, where you can personally engage the masters of cardiology, will again be held in San Francisco. This is the chance of a lifetime — to ask questions about how to craft your career, advice on your research, or to simply shake the hand of those that have built the cardiology we know today.

Importantly, much, if not all of the FIT programming has been arranged in order to permit you to attend other important activities at ACC.13 — to minimize overlap between those "must-see" sessions.  We expect this to be the best FIT experience yet, and look forward to seeing you in San Francisco!

For more information about FIT activities at ACC.13 visit accscientificsession.org. Also check out FIT content on the ACC.13 eMeeting Planner App and select “Browse FIT Sessions” to view an agenda built just for FITs.

The last week of December is always a good time to look back and reflect, and also look forward to the next year, setting new resolutions to help us achieve our goals. This past year has been a busy one for the College, and I’ve been honored to serve as President.  In this blog post, I would like us to reflect on the successes of the past year and take pride in the accomplishments that our member volunteers and staff helped achieve. These have spanned the areas of education, quality, advocacy, membership and international engagement. Here is, in my opinion, a list of ACC’s top 10 successes of 2012:

1. The College launched a new online Lifelong Learning Portfolio to help members track educational needs, as well as learn more efficiently based on preferred topics and formats.
2. The College has embraced a new digital strategy and is improving online education resources based on user feedback, including an improved layout, the addition of CardioCompass and more. We have launched several mobile Apps adding to ACC’s collection, including the ACC Connect App, the CardioSource Mobile App, and for those attending ACC.13 the ACC.13 eMeeting Planner App, and more.
3. The ACC expanded its online and print publication coverage and now covers more clinical news than ever on CardioSource.org.  In addition to the Cardiology magazine print publication, this year the College launched CardioSource WorldNews and  CardioSource InterventionalNews to keep members up to date on both clinical and member news.  In 2013 the ACC is launching a new Journal of the American College of Cardiology (JACC) focused on heart failure.
4. The ACC is enhancing CardioSmart to help CV professionals explain patient conditions at the point-of-care.
5. The College increased its focus on patient-centered initiatives like Million Hearts and Choosing Wisely aimed at preventing heart disease/stroke and ensuring appropriate care. We’ve also elected our first public member to the Board of Trustees.
6. The College’s National Cardiovascular Data Registry (NCDR^®) launched the STS/ACC TVT Registry™, along with dashboards for the ACTION Registry^®-GWTG ™ and ICD Registry™ so that hospital performance data can be tracked in real-time.
7. The College is developing new quality initiatives around cardiometabolic health and anticoagulation use, along with new clinical toolkits on heart failure and atrial fibrillation to help clinicians meet guideline recommendations at the point of care.
8. 90 percent of ACC PAC-supported candidates (104) won their respective elections in November 2012, strengthening the College’s allies on Capitol Hill.
9. On the international front, the College is expanding international reach to create a more collaborative membership environment across the globe. We have added 10 international Chapters this year, and recently welcomed our 26th chapter; our international membership has reached more than 6,000 members.
10. The ACC’s social media presence is growing strong with more members joining these channels; I became the first Tweeting President with my Twitter account @WilliamZoghbi. Plus, we now have over 12,000 likes on ACC’s Facebook page and more than 6,000 following @ACCinTouch on Twitter!

As we get ready for the year ahead, I hope you can take pride in all that we have accomplished together at the College. I hope you’ve all had happy holidays and I look forward to a great new year!

This post is authored by James Tcheng, MD, FACC, co-chair of the ACC’s Informatics Committee

As we kick off the 7th Annual National Health IT Week, I’m reminded of just how far discussions around health IT have evolved in a relatively short time. Only a few years ago, the conversation was focused on how to choose an electronic health record (EHR) system. Today, we have moved beyond basic implementation to discussing how best to leverage systems to provide meaningful and timely clinical decision support, improve patient communications, reduce errors, and improve delivery of high quality care.

A recent ACC survey of cardiovascular practices found that 74 percent of practices are using, or are in the process of implementing, an EHR system. In addition, most practices are either already participating or plan to participate in the federal EHR Incentive Program. This is great news on a number of fronts. Not only does more structured and interoperable data enable increase quantitative decision making and improve clinical decision support, the availability of data will ultimately enable a learning health care environment that continuously returns information useful to improving health care delivery, quality, and outcomes. (Important note: Oct. 3 is the last day for eligible professionals to begin their 90-day reporting period for the 2012 EHR Incentive Program. To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012).

That’s not to say we don’t still have challenges. In fact, one of the biggest challenges is how to best optimize the potential of health IT now that so many providers are on board.  Health technology solutions are inherently complex, requiring substantial resources to maintain and optimize. But there are severe constraints on available resources, and funding is not distributed equally. Changes in the IT portfolios will need to occur without compromising care during transition periods.  Also given the fast-moving nature of health IT, maintaining the security and privacy of information is a challenge. (This will definitely need to be a focus as we move forward with exciting opportunities around mobile technologies).

We also need to move beyond the current emphasis on financial levers to push Meaningful Use compliance.  The real drivers ultimately will be increases in usability, efficiency, and productivity.  Until a true return on investment can be achieved, health IT will remain on the wrong side of the ledger, and thus will be subject to compromise.  A plan for long term assistance with the costs of Health IT should be considered.

When it comes to health IT, my best advice is to never be afraid to tear down what was previously built. Technology evolves rapidly and what was once a good plan/design/technology may not be optimal in the future. We need to be flexible and forward thinking – as do governments, consumers and health care systems. To borrow the National Health IT Week theme, we need to come together with “one voice, one vision [to] transform health and care.”

Be a part of Health IT Week:

• Take part in the “Health IT is…” Twitter Chat on Friday, Sept. 14. at noon ET moderated by @HIMSS and @HealthStandards. Use the hashtag #HITsm and follow ACC's @Cardiology account.
• Visit the ACC’s Health IT Resource Center for information on e-prescribing, the EHR Incentive Program, and choosing and using an EHR.
• Share your thoughts on Health IT on this blog, or on the ACC’s Facebook page.
• For additional information about National Health IT Week, visit healthitweek.org
  

If you’ve visited the Education section of CardioSource.org lately, you may have noticed new and exciting developments. The College recently soft launched our new Lifelong Learning Portfolio (LLP) section.

In my latest President’s Page in JACC, I detail the various offerings within the portfolio which includes a customized and enhanced approach to educational activities. Through this LLP, the ACC aspires to become the primary source for maintaining and documenting the highest level of physician competence in terms of patient care. The College is indebted to Rick Nishimura, MD FACC for his vision, to Mary Ellen Beliveau, ACC’s chief learning officer and senior vice president of the Lifelong Learning Division, to Dino Damalas, ACC senior vice president for Information Technology, and to the many member volunteers and staff for making this vision a reality and for breaking new grounds in Education.

Each ACC member will have his/her own LLP that stores personal data. The LLP will enable members to design, access, and fulfill their own personalized curriculum based on their own interest areas, preferred learning formats, and practice gap areas. The “My Transcript/My MOC Tool” will help members understand changing certification requirements and track their progress in continuing medical education and maintenance of certification (MOC). Any credits earned through the ACC will be automatically transmitted into an individual's portfolio, while any credits earned outside the ACC can be manually entered and scanned to maintain a complete transcript. 

We are excited to announce that BOT Member Harlan Krumholz, MD, FACC, will serve as the LLP's new editor-in-chief beginning in January 2013. Dr. Krumholz and his editorial team will increase the online product portfolio to 300 activities, to provide even more options for maintaining and enhancing competency.

In addition, the College has released CardioCompass, a semantic tool that will help users navigate guidelines, appropriate use criteria (AUC), and other clinical documents. By simply entering an open-ended question into CardioCompass, individuals will be pointed to the specific portion of the guideline, AUC, or clinical document that addresses their needs. In the future, CardioCompass will also be available as a pop-up user tool while learning activities are in progress in order to provide immediate access and answers to clinical documents. CardioCompass will also be available as a mobile application for use at the point of care. By the ACC.13 Scientific Sessions, we hope to add additional source documents to CardioCompass, such as self-assessment programs, consensus documents, the clinical trial database, and journal scans.

All of the tools and offerings within the new LLP are truly unique and align with my presidential year focus of patient-centered care – a style of care that emphasizes education and involvement of patients in medical decision making; integration of medical care, and application of principles of disease prevention and behavioral change. By providing members with tools that will strengthen their education, knowledge and continuous learning, we are well on our way towards providing the best care possible for our patients.

By early 2013 we will “hard launch” the Lifelong Learning Portfolio, which will allow for the features and functionality needed to simplify the many challenges of a clinician's day-to-day activities. I encourage you to look around the new LLP and use the comment section below to give us your feedback to further enhance the product, and let us know what you think of these exciting new tools!