This post is written by JoAnne M. Foody, MD, FACC, editor of CardioSmart.org and medical director of the Cardiovascular Wellness Center and Pollin Cardiovascular Wellness Program at Brigham and Women's Hospital.

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American Heart Month provides us with an opportunity to build awareness of the number one killer in the U.S. Throughout the month of February, CardioSmart^TM, the ACC’s nation-wide health initiative to improve heart health, will be working with its partners to bring awareness of the importance of prevention and disease management.

In a statement released Feb. 1 by the Department of Health and Human Services, Secretary Kathleen Sebelius explained, “each year, countless American families are impacted by heart disease and stroke. Although its risk factors can be prevented or controlled, it is still the leading cause of death for all Americans and accounts for $1 out of every $6 spent on health care.”

CardioSmart launched in 2008, under the leadership of former ACC President Alfred Bove, MD, MACC, and his “Year of the Patient.” CardioSmart is working to empower patients to take ownership of their lifestyle choices and medical decisions through everyday strategies for heart health and education on the daily choices that impact health and wellness such as diet, exercise, smoking and medication adherence. The goal of the initiative is also to facilitate patient-provider partnerships to ultimately improve outcomes of cardiovascular care.

The ACC and CardioSmart have several activities planned for the month, including participation in partner activities like the NHLBI’s Red Dress Fashion Show in NYC and regional Coca-Cola Live Positively events. Social Media efforts will also play an important role in education and awareness. The ACC and CardioSmart will be offering heart-healthy tips throughout the month through their Facebook and Twitter pages. The ACC and CardioSmart will also be participating in the NHLBI's The Heart Truth Twitter chat about heart health today at 1 p.m. ET. To participate as an individual, use the hashtag #HeartChat.

Throughout the month of February, for each "like" the CardioSmart fan page receives on Facebook, CardioSmart, courtesy of its sponsors, will donate $1 to Mended Little Hearts, and Coca-Cola Live Positively will match each CardioSmart dollar. Click here to learn more.

We hope you will take part in American Heart Month as an individual either by participating in regional awareness events or engaging with us on Twitter and Facebook.

For more information, visit the Heart Month page on CardioSmart.org for tools and tips for patients including a Heart Month Tip of the Week and follow @CardioSmart and @ACCinTouch on Twitter and “like” CardioSmart and American College of Cardiology on Facebook.

This post is written by Manesh Patel, MD, FACC, lead author of the updated appropriate use criteria for coronary revascularization and the John Bush Simpson Assistant Professor of Cardiology at Duke University, assistant director of the Duke Cardiac Catheterization Laboratory and director of Duke Catheterization Lab Research.

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Yesterday the ACC along with the Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, and Society of Cardiovascular Computed Tomography released updated appropriate use criteria (AUC) for coronary revascularization.

Coronary Artery Disease (CAD) occurs when the arteries supplying the heart with oxygen and nutrients narrow and become blocked. According to the National Heart, Lung, and Blood Institute, CAD is the most common type of heart disease, and is the #1 cause of death for both men and women in the U.S.

As a result of the increasing prevalence of CAD, continued advances in surgical and percutaneous techniques for revascularization and concomitant medical therapy for CAD, and the cost of revascularization, there has been heightened interest regarding the appropriate use of coronary revascularization.

The updated appropriate use criteria replace a previous set published in 2009, and help patients, physicians, and payers determine when it’s reasonable to do a procedure that is intended to improve the patient’s quality of life, health status, and long-term survival. The updated criteria can also assist patients and physicians with health-related discussions and shared decision-making, so that patients are confident they are getting the right procedures for them.
In particular, the updated criteria address the following two areas:

1. Re-evaluation of the indications for the treatment of multivessel CAD with symptoms by PCI and CABG as a result of data from the SYNTAX trial, which came out after the original AUC were published; and
2. Specific indications that represent gaps identified when mapping the 2009 AUC to the CathPCI Registry^®.

Like previous appropriate use criteria, the scope of indications is purposely broad and intended to represent the most common patient scenarios for which, in this case, coronary revascularization is considered. As a result, the clinical scenarios presented and scored were developed to represent common situations encountered in everyday practice and include information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing and coronary anatomy. They are not inclusive of every possible clinical situation.

The new appropriate use criteria will certainly stimulate discussion regarding appropriate use of revascularization. A rating of uncertain does not mean that it’s not reasonable or should not be done. These are areas where we don’t have definitive evidence and think more research is needed. That’s where physicians apply their clinical experience and knowledge to patient care and patients express their wishes. The authors and I hope physicians, surgeons, caregivers and patients have a conversation in each individual case about the best way to improve patient outcomes.

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To learn more, visit CardioSource.org. Be sure to check out the Jan/Feb issue of Cardiology magazine for the complete cover story. Also view the Heart Minute video with commentary from Peter Block, MD, FACC below. Do you agree? Leave your thoughts in the comments section.

This post was authored by Dipti Itchhaporia, MD, FACC, chair elect of the ACC’s Board of Governors.

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According to WomenHeart, heart disease is the leading cause of death of women in the U.S. Nearly five times as many women will die from heart attacks alone this year than will die from breast cancer. Women have a 28 percent increased risk of dying as compared to men to die within the first year after a heart attack. Unfortunately, the vast majority of cardiovascular research has been performed on men and/or data have not been separated out based on gender.  Where men and women have been studied separately, some important differences have been identified.

Yesterday the ACC co-hosted a Gender Data Forum with the Society for Cardiovascular Angiography and Interventions’ (SCAI’s) Women in Interventions, to explore the information and statistics that are available. The forum featured primary investigators from major clinical trials who discussed gender data differences in their trials that specifically looked at anti-platelet and anti-thrombolytic therapies in Acute Coronary Syndrome (ACS). Studies included PLATO, TRITON, CURRENT OASIS, GRAVITAS, HORIZONS/ACUITY, ATLAS ACS, Fondaparinux, Integrellin, Abciximab, CHARISMA and CURE, and FRISC II.

By examining and discussing the results from these studies and commenting on the comparative effectiveness, the goal was to hone in on the differences in these studies that we could further explore and better understand as we think about future research and trials examining differences in gender. A further goal is to increase gender specific data in future studies.

Overall the forum was successful and there were several ideas that resulted from the discussions as we look to impact regulatory agencies, industry, physicians and patients to reduce health disparities.  Our hope is to compile our learnings from the forum into something that can be useful and more widely distributed, so stay tuned for more information. In the meantime look for upcoming ACC educational sessions on women’s health disparities, including the Heart of Women’s Health meeting in January and hot topics at ACC.12 in Chicago.

This post was authored by Carolyn Bridges, MD, Associate Director for Science, Immunization Services Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC).

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If you don’t make a strong recommendation for your patients to get a flu shot—who will?

Every year, CDC reminds physicians and the public that people with high risk conditions—including people with heart disease and stroke—need a flu shot to help prevent hospitalizations and even deaths from complications from influenza.
But every year, only about 40% of patients 18 to 64 years old with cardiac disease get vaccinated.

You can change that.

Some cardiologists may have traditionally felt that vaccination discussions should take place under the aegis of primary care providers or other clinicians.  And, many specialty providers may not have the staff or facility to support patient vaccination programs in their office, or they may not see their patients regularly during flu season.

It’s time for a new tradition. Studies show that a physician’s recommendation and offering flu vaccine are strong predictors of patient vaccination. In other words, if you strongly recommend a flu shot—your patients will get vaccinated.  These days, if you don’t carry flu vaccine in your office, there are multiple options for your patients to get flu shots. You can write them a ‘prescription’ to remind them and emphasize the importance of preventing severe illness from influenza.

Why is it so important for your patients?

People with heart disease are at high risk for developing serious complications from flu. In fact, among adults hospitalized with influenza, cardiovascular disease is one of the most common chronic conditions.  And, among adults that died from 2009 H1N1, cardiac disease was second only to chronic lung disease among existing co-morbidities.

Need more convincing? Having cardiac disease is estimated to increase the risk of influenza-related hospitalization by almost 3 fold. (*references 1-9)

There’s further incentive—of a positive nature: randomized studies of influenza vaccination of patients with existing cardiovascular disease show that flu vaccination decreases the risk of acute coronary syndrome and cardiovascular disease-related deaths. (*references 10-12)

Based on the risk of severe illness from influenza and the benefit and known safety of influenza vaccination, both the American College of Cardiology, American Heart Association, and the Centers for Disease Control and Prevention recommend the flu shot for patients with cardiac disease. (*references 13-14)

You’ve got both the carrot and the stick in your hands. It’s time for a new paradigm—where all cardiologists take a more active role in ensuring that their patients are vaccinated against influenza each year.  This goes beyond asking patients “So, did you get your flu shot?”  It goes beyond merely suggesting that a flu shot might be a good idea.   Your strong recommendation and instructions to patients about where to get their vaccine, if you don’t offer vaccination in your office, are needed to protect your patients against influenza.

For more information, visit the CDC website. You can order free materials, review the ACIP guidelines, or find further information for yourself, staff, and patients.

The CDC and the ACC have partnered with QuantiaMD to bring you a succinct 5-minute presentation covering recommended Immunization Practices for these high-risk patients. Please note a free QuantiaMD registration is necessary to view entire presentation.

Other resources available on the ACC’s patient-centered website, CardioSmart.org, include patient fact sheets in both English and Spanish. Follow the ACC on Twitter and Facebook for additional tips and information and participate in the Forum Discussion on Prevention in the CardioSource Communities.

*View all references here.

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Please note that statements or opinions expressed herein reflect the views of the contributor, and do not reflect the official views of the ACCF, unless otherwise noted.

This post was authored by Michael Chernew, PhD, who sits on the Editorial Panel for the ACC/AJMC Community on Payment Innovations and is a MedPAC Commissioner.  Dr. Chernew's views, however, are his own and do not represent those of ACC, AJMC or MedPAC. 

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A lot has been written of late about the Sustainable Growth Rate (SGR) system.  One point of consensus appears to be that the system is not sustainable. It needs to be repealed.  The controversy surrounds what to do after the repeal.  Ideally, the physician payment system of the future would promote beneficiary access to high quality care and be fiscally sustainable. 

The estimated 10 year cost of replacing the SGR with a freeze in physician fees is over 300 billion dollars.  Replacement with a fee schedule that is adjusted for inflation would be even more costly and options to finance the costs are limited.  Debt financing seems impossible given out current fiscal situation.  An increase in taxes is possible, but seems politically infeasible.  Without taxes or deficit spending, funding an SGR fix requires cuts from elsewhere in the budget, including elsewhere in Medicare. 

The recent MedPAC recommendation assumed financing entirely from Medicare, though MedPAC did not necessarily endorse financing exclusively from Medicare.  This exercise illustrates how difficult financing is.  MedPAC was only able to offset a fraction of the 300 billion dollars by accumulating a series of cost saving measures that affect a wide range of providers and beneficiaries.  Because the offsets were incomplete, cuts in physician fees were still needed to avoid increased Medicare spending.  With constraints against raising taxes or debt financing, alternatives are limited.  Tweaks to payment around the fee-for-service framework are unlikely to achieve significant score able savings and unlikely to pave the way to the health care system we deserve. 

Shifting costs to beneficiaries is possible.  In fact, reform of the benefit design to encourage judicious use of care and improve cost consciousness among patients can improve efficiency and help fund an SGR fix.  This benefit redesign should be a part of the solution; however, it is not clear how much could be saved through such redesign and it is unlikely to be the sole foundation of a solution.  Changes to benefit design will certainly raise serious concerns about equity, access and quality depending on how such a shift is implemented.  In the meantime, payment reform must be addressed.

A way out of the world characterized by the grim fee trajectory remains, but it requires a change in business model.  In addition to the payment proposals, MedPAC offered recommendations that support new delivery models.  Even with the recommended fee cuts, the projected payment per beneficiary rises.  If providers can capture the overall revenue, control rising volumes and eliminate waste (which most agree is significant), high quality care can be coupled with financial success.  Clearly, such a transition will not be easy and evidence that providers can be successful is emerging, at best.  The regulations necessary to guide such a system are still being developed and far from perfect.  Yet the alternative, as the MedPAC recommendations illustrate, is not appealing.  Getting on with the task of reforming the whole system seems the only way forward.

Additional Resources:

• Community on Payment Innovations
• How much savings can we wring from Medicare?
• SGR Issue Brief

This post is authored by Immediate Past-President Ralph Brindis, MD, MACC. 

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Health Affairs, along with co-sponsors the ABIM Foundation, the California HealthCare Foundation and the Foundation for Informed Medical Decision Making, hosted an event on Oct. 19 focused on discussions around Medicare savings ideas for the federal budget “Super Committee.”  Implantation of ICDs was one of the hot-topic areas in a session on Medicare coverage policy, with speakers highlighting overuse of the procedure among physicians as a major contributor to Medicare costs. Suggestions were made to require prior authorization as a means of reducing Medicare costs.  

It is important to note that the science surrounding ICD implantation is constantly evolving but guidelines and Medicare coverage policy take more time. That being said, it is true that recent studies have indicated a wide variation in ICD implantation. A study published earlier this year in the Journal of the American Medical Association (JAMA) found that ICD implantations were not in accordance with practice guidelines in 22.5% of patients, most commonly because of newly diagnosed heart failure (62%) or an MI within 40 days (37%). The risks of in-hospital death and complications were significantly lower when the ICD implant was consistent with practice guidelines (0.18% and 2.4%, respectively) than when it was not (0.57% and 3.2%, respectively). 

While these statistics are sobering, the ACC and the Heart Rhythm Society (HRS) already have programs and processes in place to turn the tide, so to speak, and ensure providers are appropriately using this procedure on the right patients. For one, the Centers for Medicare and Medicaid Services, has mandated that every U.S. hospital that implants ICDs for the purpose of primary prevention of sudden cardiac death participate in the ACC and HRS ICD Registry. Over the last year we have made great strides in enhancing this registry to allow for the connection of longitudinal Medicare administrative data of ICD patient outcomes -- such as mortality and repeat hospitalizations -- with our in-patient hospital registry data. This longitudinal follow-up assessment will extend our knowledge base substantially. In addition, the electrophysiology community is not only closely examining practice patterns but working more closely with staff responsible for entering ICD Registry data to ensure that the data quality is at the highest level. The ACC and HRS are also encouraging the practice of shared decision making, particularly in the elderly, for the use of ICD implants for prevention of sudden cardiac death. Recent studies actually show substantial underuse of ICD therapy for prevention of sudden cardiac death (SCD).  

Unlike prior authorization, which may reduce costs but not necessarily ensure appropriate patient care and/or change provider behavior, registry use can do all three by ensuring greater adherence to practice guidelines, providing insight into practice patterns and also extending overall physician knowledge and evidence base. At the end of the day, ICDs are effective in stopping life-threatening arrhythmias and enhancing survival and overall quality of care. We believe that we are moving in the right direction to ensure cost-savings in the Medicare system and welcome the discussion on how to do this even better.

This post is authored by Immediate Past-President Ralph Brindis, MD, MACC.

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Today, the Journal of the American Medical Association (JAMA) released a study, co-authored by Harlan M. Krumholz, MD, SM, FACC, on the significant downward trend in hospitalization for Medicare beneficiaries with heart failure (HF). Since 2008, HF hospitalizations decreased by an impressive 30 percent. There has also been a 30 percent reduction in morbidity and mortality from cardiovascular disease in the last decade and acute myocardial infarction rates were down by 23 percent from 2002 to 2007. These results highlight how far we have come in cardiovascular treatment and care and open the door for future innovation.

Over 5.8 million Americans suffered from HF in 2006 alone, making it the number one cause of hospitalization and rehospitalization for aging adults. Additionally, we are all too familiar with the excessive amount of resources that HF eats up, pushing cost of care limits during a time when Medicare spending has run rampant.  Given these circumstances, HF is an area that greatly benefits from these and future reductions.  

However, the recent JAMA findings also point to areas that need improvement in the way of HF. The rate of hospitalization for black men declined at a lower rate than the national average and a substantial variation by state remains.  Additionally, the one-year mortality rate was only reduced slightly over the ten-year period, remaining high at 29.6 percent. This sobering statistic reminds us of how much more work needs to be done in applying our evidence-based medicine to this vulnerable cohort of patients and of the research that is still needed to alter the fairly dismal prognosis of this lethal disease.

These findings follow on the heels of an August paper in Circulation that unveiled stunning improvements in door-to-balloon (D2B) times.  The study found that D2B times were reduced by over 30 percent, from 96 minutes in 2005 to 64 minutes in 2010. The percent of patients treated within 90 minutes increased from 44 percent to 91 percent over those same years. Even more remarkably, the percent of patients treated within 75 minutes increased from 27 percent to 70 percent.

The importance of programs focused on increasing quality and decreasing health care costs is confirmed by these studies. The ACC remains dedicated to appropriate use criteria, guidelines and initiatives such as Hospital to Home (H2H) and the D2B Alliance and is leading the way to further reductions in hospitalizations and rehospitalizations across the country.  

We should all be proud to be a part of this win for our patients and the institution of cardiology!

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For some time now, the lack of continuous care for congenital heart disease (CHD) patients who are transitioning from the pediatric to adult care settings has been a concern for adult cardiology practices.  Although many CHD patients require specialized care, many more still end up in adult cardiology clinics. I experienced two scenarios when seeing CHD patients in my nonurban practice; a basic layman’s history is provided or several storage boxes of records are presented that must be reviewed and summarized.  One is inadequate; the other is cumbersome and subject to errors of oversight.  A complete, organized patient history is difficult to come by and ultimately can threaten the quality of care as these cases continue to increase in volume. Enhancing collaboration between a coordinated care team, to include congenital heart specialists, and CHD patients would open the doors to consistent and efficient treatment.

I have come up with the acronym DOORRS to sum up the essential information patients should easily be able to provide their cardiologist upon an initial visit. 

D  Initial Diagnosis 

O  Operations Chronologically with institution and surgeon 

O  All Operative Notes 

R  Most Recent diagnostic studies and results 

R  Recommended follow up 

S  Special considerations or previous complicating factors unique to this patient 

I have received positive and encouraging feedback from colleagues and the College on this issue, which affects us all but to which there is no easy solution.  I know the ACC’s Adult Congenital and Pediatric Cardiology (ACPC) Section is on top of this issue and is dedicated to collaborating with patient advocacy groups, such as the Adult Congenital Heart Association, on promoting professional and patient resources for CHD patient care.  For the College’s part, several ACC chapters have supported past National Congenital Heart Lobby Day activities, which have focused primarily on advocating for national CHD surveillance tools.  

The Congenital Heart Futures Act (included in the ACA) authorizes establishing a population-based surveillance registry (through the CDC's existing National Center on Birth Defects and Disabilities). However, the funding for this expansion has not been appropriated.  

To compound the issues related to care of the CHD patients, limited outcomes data regarding CHD treatment is available. The NCDR’s IMPACT Registry™ (IMproving Pediatric and Adult Congenital Treatment) has been established to assess the prevalence, demographics, management and outcomes of pediatric and adult patients with CHDs who are undergoing diagnostic catheterizations and catheter-based interventions. The collection and analysis of this data facilitates performance measurement, benchmarking and quality improvement initiatives.  The IMPACT Registry, which has collected over 3,000 patient records so far, will provide significant contributions to the knowledge base and outcomes associated with CHD. While this is exciting and a big step forward, gaps in data collection and outcomes reporting remain in other CHD care settings, most notably the ambulatory setting.  

I look forward to hearing your thoughts on ensuring congenital heart disease patients receive appropriate care as they age and move out of the pediatric setting.  What have you done in your practice to increase efficiency for adult CHD patients? What resources and educational tools would be helpful to your care of adult CHD patients?  

Make sure to check out the Nov./Dec. issue of Cardiology Magazine for an article on ACHD.

By Thom Rooke, MD, FACC, Krehbiel Professor of Vascular Medicine at the Mayo Clinic and Alan T. Hirsch, MD, FACC, Professor of Medicine, Epidemiology and Community Health, at the University of Minnesota Medical School. Rooke is the chair of the PAD Guidelines Writing Committee. Hirsch is its vice chair.

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The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) today released updated guidelines for the diagnosis and management of peripheral artery disease (PAD), as part of PAD Awareness Month. The updated document provides agreed-upon approaches and treatments for PAD that clinicians can apply to help improve patient care.

PAD is a major American health problem. It affects one out of every 20 Americans over the age of 50, making it one of the most common cardiovascular diseases. In addition, its effects can be devastating: heart attack, stroke, leg amputations and death all can result from PAD. Despite this, scientific advances have made it possible to inexpensively and accurately diagnosis the disease, as well as effectively treat it.

However, reducing its prevalence will require more active detection. The focused update details the specific population who would benefit from an active approach to PAD diagnosis through ankle-brachial index (ABI) diagnostic testing. Specifically, the document recommends that ABI diagnostic testing is performed beginning at age 65, rather than age 70. This decision was based on mounting evidence demonstrating that people 65 and older have a one in five chance of having either symptomatic or asymptomatic PAD. 

Other recommendations set forth in the guidelines include:

• Strengthening efforts to help individuals with PAD quit smoking and, in turn, lower rates of heart attack, stroke and lower limb amputations. This includes consistently asking current and former smokers about tobacco use at each visit, as well as proactively offering support through counseling, pharmacologic therapies and/or formal smoking cessation programs
• Considering leg artery angioplasty as a first line treatment for certain individuals with severe PAD who may face amputation. Because angioplasty does not provide an ideal treatment for all patients with PAD, in particular for those in whom a lifespan greater than two years is anticipated, traditional vascular surgery may be more durable and most effective
• Understanding new data showing that aortic aneurysms can be safely treated by both traditional open surgical and less invasive endovascular treatments with nearly equal efficacy and safety

The guidelines provide a road map to greater prevention opportunities, which will be necessary if we are to reduce the number of people needlessly affected by PAD. Full text of the new guidelines -- which update the original 2005 recommendations and are collaboration with representatives from the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine and Society for Vascular Surgery -- are online, as is a summary on CardioSource.

This post is written by President-Elect William Zoghbi, MD, FACC.   

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Yesterday and today, I am in New York City representing the ACC at the landmark United Nations (UN) Summit on Non-Communicable Diseases (NCDs).  ACC CEO Jack Lewin, MD, is accompanying me in advocating for the inclusion of cardiovascular disease (CVD) in the UN’s eight Millennium Development Goals, an imperative step to combating NCDs in the developing world. Driving leaders around the world to address this issue are the astonishing statistics surrounding NCDs: 82% of the 17.1 million deaths caused by CVD occur in the world’s poorest countries -- that’s 14 million deaths per year. Despite this, only 3 percent of global funding is allocated towards NCDs.  

The General Assembly kicked off the meeting by unanimously approving without a vote a political declaration that creates a plan of action for combatting NCDs. Although the declaration does not contain specific targets for reductions in morbidity and mortality, it does contain an agreement to develop a comprehensive global monitoring framework for NCDs in 2012, as well as a set of voluntary global targets and indicators. Other commitments included in the declaration are to:

• Accelerate the implementation of the Framework Convention on Tobacco Control
• Eliminate industrially-produced trans-fats in foods, and implement interventions to reduce consumption of salt, sugars and saturated fats
• Curb harmful use of alcohol
• Restrict the marketing to children of foods high in fats, sugar and salt.

While imperfect, the declaration has galvanized the focus on this pandemic and is critical a first step to improving the health conditions of people worldwide.

• Tobacco control/elimination
• Sodium reduction
• Promoting healthy diet and exercise (low fat, sugar and alcohol intake, increased physical activity)
• Generic multidrug treatment for patients with high risk of NCDs

While significant attention has been paid to the above areas in developed nations, little education exists on these issues in the developing world. Worldwide, over 1.3 billion people smoke, 600 million have hypertension, and 220 million battle diabetes. These risk factors contribute to the estimated $500 billion per year NCDs cost in low-income and middle-income countries. Community programs -- such as Let’s Move, which was mentioned by U.S. Surgeon General Regina Benjamin, MD, during a lunch session as a program that could enable people to adopt healthier lifestyles -- are reported to have a 5-year return on investment of $5.60 for every dollar spent.

The Holmes, et al., paper is very clear on the need for worldwide unity and collaboration among leaders from the UN, World Health Organization (WHO), global and local governments, foundations, non-government organizations, and pharmaceutical companies, among others.

As a member of the Partner’s Group of the NCD Alliance, the ACC is epitomizing this collaboration by working with organizations such as the World Heart Federation and the Global Health Council to maximize international efforts to reduce the impact of NCDs. Given the success of NCDR in the U.S., Middle East and Asia, there is potential for developing nations to engage these tools to track their progress on CV care, ultimately improving their patients' outcomes.

Stay tuned for developments in the coming days as we continue to participate in the UN NCD Summit. Follow @ACCinTouch on Twitter for live updates and visit the American College of Cardiology Facebook page for photos and conversation revolving around the Summit. 

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