Cardiology Magazine - Population Health

A StrategicACC Priority

FALL 2015 • VOLUME 44, NUMBER 5

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CardiologyA Member Publication of the American College of Cardiology

Cover Illlustration: Ben O'Brien

3 From the President

Cover Story

6 Three Approaches to Stratified Health

8 New Research Focuses on Alleviating the CVD Burden

14 Partners in InnovationState-Level Efforts to Improve CV Health

17 Let’s Move! A Comprehensive Initiative Helping Kids and Families Lead Healthier Lives

18 Medical Missions in Tanzania: Creating a Sustainable Health Care Infrastructure

22 A Day in the Life of an Early Career Professional

25 Hospitals Nationwide Begin Reporting PCI and ICD Measure Results

Heart of Health Policy

35 A Novel Medicare Payment Model For Cardiovascular Risk Reduction

36 ACC Around the World

38 The Pulse of ACC

What’s New in Clinical Documents

Council Perspectives From ACC’s Member Sections

ACC Response to ABIM Report on Vision For Certification and MOC Programs in 2020

Notable News

ACC in Touch

43 CV Calendar

44 Just One More

10 Get to Know Your Leaders: Kim A. Eagle, MD, MACC

18 Medical Missions in Tanzania: Creating a Sustainable Health Care Infrastructure

22 A Day in the Life of an Early Career Professional

26 Pamela Bowe Morris, MD, FACC: Fulfilling a Lifelong Passion For Fitness and Healthy Nutrition

28 Antonio M. Gotto Jr. MD, DPhil, FACC: A Lifetime of Leading Achievements in Lipid Research

32 2015

Legislative Conference:

A Fresh Dialogue on Capitol Hill

29 Chittur A. Sivaram, MBBS, FACC: Educating the Next Generation of Great Minds

30 Physician Fee Schedule and Hospital Outpatient Rules: What’s in Store For Cardiology?

4 Cover Story

Population Health: A Strategic Priority

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Fall 2015 Vol. 44, No. 5

Kim Allan Williams Sr., MD, FACC President Richard A. Chazal, MD, FACC President-Elect

Mary Norine Walsh, MD, FACC Vice President

Robert A. Shor, MD, FACC Secretary and BOG Chair

Robert Guyton, MD, FACC Treasurer

Editor in Chief John Gordon Harold, MD, MACC Executive Editor Shalen Fairbanks

Managing Editor Shannon Cline

Contributing Writers Alexandra Buck Rachel Cagan Kim Kaylor Shealy Molpus Autumn Niggles

Design Tony Ciccolella Dani Smith Merrick McSwiggan Caroline Leibowitz Production Kristen Moye Samantha Fraser

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ACC.org/ACCinTouch

CardiologyA Member Publication of the American College of Cardiology

ACC.org/ACCinTouch

This issue of Cardiology focuses on the overall theme of “population health.” The topic itself is of personal interest to me, and over this past year the College has

really stepped-up in this area. In the cover story, you’ll learn more about the recently formed Population Health Policy and Health Promotion Committee, led by Gerard R. Martin, MD, FACC, and the first-of-its-kind Population Health Retreat held at Heart House in July.

Throughout the issue, you’ll hear from presenters at the retreat, including Valentin Fuster, MD, PhD, MACC, editor-in-chief of the Journal of the American College of Cardiology about a strategy for sustaining health throughout a lifetime; Debra Eschmeyer, executive director for Let’s Move! and senior policy advisor for nutrition for the White House on the Let’s Move! initiative; and Nina Brown and Darshak Sanghavi, MD, from the Center for Medicare and Medicaid Innovation on a novel Medicare payment model for cardiovas-cular risk reduction.

You’ll also learn about state-level efforts to improve cardiovascular health, including mandatory high school cardio-pulmonary resuscitation and automated external defibrillator training, school athlete screening, statewide weight loss initiatives, smoking cessation and pulse oximetry screening to diagnose critical congenital heart defects in newborns. These efforts are just the tip of the iceberg, and moving forward, the ACC will be working closely with leaders of ACC Chapters as well as external partners to add physical education, nutrition and diet programs to its state advocacy agenda.

On a global level, the College has been supportive of the adoption of the United Nations post-2015 development agenda, which includes a standalone target on non-commu-nicable diseases (NCDs) in addition to other NCD-related

targets. The ACC, in partnership with its nearly 50,000 global members and 34 International Chapters, looks forward to supporting these efforts.

You’ll also learn more about some amazing ACC members, including Kim A. Eagle, MD, MACC, editor-in-chief of ACC.org, and Pamela Bowe Morris, MD, FACC, chair of ACC’s Prevention of Cardiovascular Disease Section Leadership Council, and a member of ACC’s Population Health Policy and Health Promotion Committee.

To round out the issue, the “Just One More” article appropriately includes an infographic to share with patients on type 2 diabetes. November is Diabetes Awareness Month, and it’s a good time to be mindful of the ACC tools and resources available to help you, as clinicians do your part to prevent and treat this disease that affects more than 30 million children and adults in the U.S. alone. The College is excited about being part of the Diabetes Collaborative Registry, a joint effort between the ACC, American Diabetes Association, American College of Physicians, the American Association of Clinical Endocrinologists and the Joslin Diabetes Center.

In the coming months you’ll likely hear more about the College’s work in the population health space, so stay tuned!

Kim Allan Williams Sr., MD, FACC ACC President

A Spotlight on Population Health EffortsFr

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Population health is not easy to define. It is at a complex intersection between an increasingly diverse population, an evolving health care system, traditional public health and elaborate social policies.

As part of its Strategic Plan, the College has revved up efforts to engage partners and pursue global cardiovascular-related objectives, support members to improve the health of populations, and encourage cardiovascular team-facilitated patient education.

In order to help guide the College as it pursues these population health oppor-tunities, the ACC recently formed a Population Health Policy and Health Promotion Committee. In July, the Committee hosted ACC members and external stakeholders at Heart House for a population health retreat, which aimed to define population health and health promotion for the ACC, discuss whether the College is prepared to engage in primary prevention, and prioritize partners and targeted activities related to population health and health promotion in the College.

The meeting convened a diverse array of experts from government agencies, universities, medical specialty societies and private sector partners to discuss primary

prevention, health equity and social determinants of health, the changing health care landscape, and the role of primary care professionals in advancing cardiovascular health. The lineup of speakers – which included experts from the Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, U.S. Food and Drug Administration, U.S. Department of Health and Human Services, the White House and more – shared how their organizations are making strides in reducing cardiovas-cular disease.

The Committee is currently hard at work building a population health agenda for the College that

encompasses a holistic view of health promotion. “If we are to successfully contribute to alleviating the cardiovascular disease burden, we must work with our partners to address critical risk factors and design and support policies that generate the greatest health benefit by improving cardiovascular health outcomes,” says Gerard R. Martin, MD, FACC, chair of the ACC Population Health Policy and Health Promotion Committee. “We have only just begun to dip our toes in the population health waters, and there is tremendous enthusiasm by members and partners and numerous opportu-nities on the horizon for the College.”

We have only just begun to dip our toes in

the population health waters, and there is tremendous enthusiasm by members and partners and numerous opportunities on the horizon for the College. Gerard R. Martin, MD, FACC

Continued on next page

ACC.org/ACCinTouch 5

Three Approaches to

Stratified Health By Valentin Fuster, MD, PhD, MACC

When we are trying to establish goals toward improved cardiovascular health or health promotion on a

population-wide scale, it is important to remember that we need unique strategies at

different stages of our lives, depending on the varied scientific/physiopathological background and educational/behavioral tools appropriate for each stage.

Because significant challenges exist, I am proposing a strategy for sustaining health throughout a lifetime, which involves a stratified approach at three different age ranges that could be most effective in promoting cardiovascular health or preventing the progression of disease – even among those at highest risk for cardiovascular events. This strategy cannot be employed in the same way at the same time for every individual. These are strategies pertaining to health promotion that my colleagues and I have learned through recent studies and trials across the globe.

s the first approach to stratified health is within the first 25 years of life, it is reasonable to assume that at that stage there is no significant cardiovascular disease yet in most

individuals. We have learned that the optimal period of time to motivate behavior in favor of health is between the ages of three to five years. Indeed, there is evolving evidence that our behavior as adults has its roots in the environment that we grew up in from age three to five years. Furthermore, unhealthy diets begin to influence cardiovascular disease markers early in life. Conditions such as dyslipidemia, high blood pressure, impaired glucose

tolerance, as well as obesity and metabolic syndrome may become rooted as early as three to five years of age, increasing the risk of development of atherosclerosis in adolescence and early adulthood.

During these ages, educational topics can include how the body and heart work, healthy food habits, physical activity and emotional habits to avoid addictions. In the SI! Program for Cardiovascular Health Promotion in Early Childhood, for example, intervention was designed to be applied at all preschool levels in 24 Madrid, Spain, schools for the purpose of promoting cardio-vascular health among children using their proximal environment (school, teachers and families). Improvement was initially demonstrated during the first year of intervention. This program

translated into a beneficial effect on adiposity, with maximal effect when started at the earliest age and maintained over three years. The results presented in the Madrid SI! Program align well with those obtained previously in a Colombian initiative. After intervention, Colombian preschoolers were followed-up for 36 months, sustaining the effect toward healthier behaviors and ultimately leading to a nationwide expansion of the program. The critical question will be answered when these children are 15 to 20 years of age. In other words, can intervention at age three to five years affect health behaviors when these children reach adulthood?

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…can intervention

at age three to five years

affect health behaviors when these children reach adulthood?

…we concluded that incorporating

detection of subclinical atherosclerosis

irrespective of anatomic territory,

in addition to cardiovascular

risk factors,

would motivate patients to change their lifestyle.

6 Cardiology Fall 2015ACC.org/ACCinTouch

For the second opportunity for stratified health, the age range of 25 to 50 years appears to be the right time to evaluate subclinical disease,

about which we have been learning a significant amount through noninvasive imaging techniques. In two recent bioimaging studies, we assessed approxi-mately 10,000 asymptomatic adults >40 years of age using multimodality vascular imaging of the coronary arteries with electron-beam computed tomography for calcification and of the carotid arteries with 3-D ultrasound. We found that subclinical athero-sclerosis was highly prevalent, detectable in both the coronary and carotid vascular territories (more recently also in the ilio-femoral region) in close to 60 percent of participants. Thus, we concluded that incorporating detection of subclinical atherosclerosis irrespective of anatomic territory, in addition to cardiovascular risk factors, would motivate patients

to change their lifestyle. Through the use of advanced imaging technologies, we are now testing in such adult populations with manifested subclinical disease whether addressing risk factor profile through “group therapy” or an intensified and “around-the-clock” personalized approach is more beneficial in terms of changing lifestyle and preventing progression of the disease than the usual conventional means.

The third opportunity for stratified health is for individuals >50 years, when cardiovascular disease has often begun to manifest itself symptomatically or by an adverse event. It is

of value to approach this population by taking into account the total body vasculatures, including the heart and the brain. It has been increasingly recognized that degenerative brain disease is intimately linked to the vasculature and overall burden of atherosclerosis disease. Specifically, the heart-degenerative brain disease axis is perceptible across a very broad spectrum of disease, from macrovas-cular large-vessel coronary, carotid or ilio-femoral diseases leading to myocardial infarction or stroke, to microvascular small vessel changes causing dementia. Thus, we must make a transition from primarily considering the coronary vessels to looking at the entire individual in terms of systemic cardiovascular disease, which includes the neurovascular region. Furthermore, in the elderly population with already manifested disease, two pharmacological challenges need to be addressed: Can adherence to medication be improved? Can medication be simplified such as with the use of a polypill?

In summary, at every age range, there are specific scientific/physiopathological backgrounds and educational/behavioral tools available to best intervene. Although there have been external pressures to make “medicine” more personalized or precision-based – terms that have yet to be clearly defined – those of us who are actually entrusted to keep people healthy need to start approaching the population with a stratified health strategy.

Fuster is director of Mount Sinai Heart; physician-in-chief of Mount Sinai Hospital; and editor-in-chief of the Journal of the American College of Cardiology.

He spoke on these approaches during ACC’s Population Health Policy retreat in July and received an award from the Population Health Policy and Health Promotion Committee at the retreat for his leadership in changing the landscape and improving patient health through the lifespan.

…in the elderly population with already

manifested disease, two pharmacological

challenges need to be addressed: Can

adherence to medication be improved?

Can medication be simplified such as with the use of a polypill?

Prom = promotion; QoL = quality of life; Subcl = subclinical J Am Coll Cardiol. 2015; 66(14):1627-1629

Fall 2015 Cardiology 7ACC.org/ACCinTouch

New Research Focuses on

Alleviating the CVD Burden

comprehensive Population Health Promotion issue recently published in the Journal of the American College of Cardiology (JACC ) focuses on issues that broadly impact public health and the

prevention of cardiovascular disease and related conditions. Highlights of the JACC Population Health Promotion issue include:

Unsaturated Fats, High-Quality Carbs:

Replacing saturated fats with unsaturated fats and high-quality carbohydrates may have the most impact on reducing the risk of cardiovascular disease, according to a study by Frank B. Hu, MD, PhD, et al. The study found that when saturated fats were

replaced with highly processed foods, there was no benefit. “Our findings suggest that when patients are making lifestyle changes to their diets, cardiolo-

gists should encourage the consumption of unsaturated fats like vegetable oils, nuts and seeds, as well as healthy carbohy-drates such as whole grains,” Hu says. In an accompanying editorial, Robert A. Vogel, MD, FACC, states that “healthfulness clearly lies in the quality or type of both fat and carbohydrate.”

Blood Pressure (BP) and Diabetes:

Elevated BP may be associated with increased risk of diabetes, according to Connor A. Emdin, HBSc, et al. In a

prospective analysis of 4.1 million patients without vascular disease or diabetes, 20 mmHg higher systolic BP was found to be associated with a 58 percent higher risk of diabetes, while a 10 mmHg higher diastolic BP was associated with a 52 percent higher risk. “These investigators offer an excep-tionally rigorous evaluation of the relation between BP and incident diabetes,” states Donna K. Arnett, MSPH, PhD, in an accompanying editorial comment. “This study provides a strong rationale for continued research into the biological basis and pharmacological implications of the observed association.”

Smoking Cessation:

An analysis of medical costs associated with atherosclerotic lower extremity peripheral artery disease (PAD) found that health care costs in one year were $18,000 higher in smokers with PAD than non-smokers with the condition. Accord-

ingly, smokers may be more likely to be hospitalized for leg events, heart attack and coronary heart disease related to athero-sclerotic PAD than non-smokers with PAD. In an accompanying editorial, Geoffrey D. Barnes, MD, MSc, FACC, and Elizabeth Jackson, MD, MPH, FACC, note the study highlights the urgent need for smoking cessation among PAD patients and that getting patients to quit may improve care and save significant health dollars over the long term.

Impact of Childhood Stress:

A 45-year study of nearly 7,000 people born in a single week in Great Britain in 1958 found psychological distress in childhood – even when conditions improved in adulthood – may be associated with higher risk for cardiovascular disease and diabetes later in life. “This study supports growing evidence that psychological distress contributes to excess risk of cardiovascular and metabolic disease

and that effects may be initiated relatively early in life,” says lead author Ashley Winning, ScD, MPH. “Early prevention and intervention strategies focused not only on the child but also on his or her social circumstances may be an effective way to reduce the long-lasting harmful effects of distress.” In an accompanying

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editorial comment, E. Alison Holman, PhD, FNP, explains that it may not be helpful for clinicians to focus on “managing” known cardiovascular disease risk factors like smoking, obesity, elevated cholesterol and lack of exercise without addressing under-lying risk factors that affect patients.

Global Food Consumption:

More than 80 percent of cardiovascular disease deaths occur in low- and middle-income countries, but very little data on the impact of diet on cardiovascular disease exists from these countries. A state-of-the-art review summarizes the evidence relating food to cardiovascular disease and how the global food system contributes to dietary patterns that greatly increase the risks for populations with poor health. The authors identify what an optimal diet for reducing cardiovascular disease looks like – giving the traditional Mediterranean diet as an example – and suggest that it may be possible to recreate this diet in other regions using appropriate similar food replacements based on food avail-ability and preferences.

Fructose and Cardiometabolic Health:

There is compelling evidence that drinking too many sugar-sweetened beverages, which contain added sugars in the form of high fructose corn syrup or sucrose, can lead to excess weight gain and a greater risk of developing type 2 diabetes and cardiovas-cular disease, according to a research letter by Vasanti S. Malik, ScD, and Frank B. Hu, MD, PhD. The study – the most compre-hensive review of the evidence on the health effects of sugar-sweetened beverages to date – also takes a closer look at the unique role fructose may play in the development of these conditions.

Achieving Ideal Cardiovascular Health:

Promotion of a healthy diet and physical activity will likely help in achieving the ideal cardiovascular health goals set by the American Heart Association, according to

a research letter from Adnan Younus, MD, et al. In a review of 18 studies related to cardio-

vascular health metrics, researchers found that diet metrics were suboptimal, while BP and body mass index (BMI) metrics reported less than 50 percent. Focusing efforts on promotion of healthy diet and exercise may indirectly influence BMI, BP and fasting glucose metrics, according to the authors.

Early Healthy Lifestyle Intervention:

Introducing healthy lifestyle behaviors to children in preschool may improve their knowledge, attitude and habits toward a healthy diet and exercise, and may lead to reduced levels of body fat, according to Valentin Fuster, MD, PhD, MACC, editor-in-chief of JACC, who was an author of the study. Through the SI! Program, researchers in Madrid implemented a three-year healthy

lifestyle intervention for three to five year olds that used their school, teachers and families to promote cardiovascular health through healthy diet, increased physical activity, understanding of the human body and managing emotions.

“We need to focus our care in the opposite stage of life – we need start promoting health at the earliest years … in order to prevent cardiovascular disease,” states

Fuster. (See related article, pages 6 - 7) In a related editorial comment, Deepak L. Bhatt, MD, MPH, FACC, et al., says the program

is groundbreaking, and follow-up studies to further pinpoint the exact mechanisms by which the program achieved positive effects on young children’s health will be vital for implementing the program in other areas and informing the design of future global programs.

Risk Factor Management: Three cross-sectional surveys of EUROASPIRE show challenges in

applying prevention guidelines in clinical practice for acute coronary artery disease patients, according to a research letter from Kornelia Kotseva, MD, PhD, et al. The results of the surveys show increases in obesity and diabetes amongst the patients, while the proportion of persistent smokers remained the same. “The life-saving treat-ments for acute coronary artery disease … must be matched by modern preventive cardiology programs combining a professional lifestyle inter-vention with effective risk factor control to reduce total cardiovascular risk,” states Kotseva.

Read the full JACC Population Health Promotion issue at OnlineJACC.org.

J Am Coll Cardiol. 2015;66(14).

Population Health and Early Career Professionals: Personalized lifestyle counseling is a skill all fellows in training and early career professionals

should learn, according to Joshua Schulman-Marcus, MD, in the issue’s Fellows in Training

and Early Career Column. He notes that communicating with patients and families on lifestyle

changes has the potential to prevent cardiovascular disease. “Fellows should be offered

the opportunity to work with and get advice from nurse practitioners and other health team

members, many of whom have deep experience in counseling patients,” comments Schulman-

Marcus. “Cardiologists must continue to provide support and resources

for behavioral change without judgment and provide this care with

consistent emphasis on the critical importance of the patient’s efforts,”

states Pamela Morris, MD, FACC, chair of ACC’s Prevention of

Cardiovascular Disease Section, in a response.


K im A. Eagle, MD, MACC, found himself drawn to the notion of service at a young age. While in college at Oregon State University he thought about joining the ministry, but also found

himself drawn to science and human science in particular. An advisor pointed him in the direction of medicine, noting that the field would blend those two interests. “I’m very blessed that I made that choice,” he says, adding that he feels like the cardiovascular field chose him instead of the other way around. “In medical school I found myself running to the library to read about cardiovascular problems,” he says. “I naturally was drawn to it.”

Now the editor of ACC.org, Eagle has always been interested in education. When he was a cardiovascular fellow, one of his mentors, Adolph M. Hutter, MD, MACC, suggested Eagle join the ACC. Upon joining, he quickly became involved with the College’s educational efforts. However, his path to becoming editor of ACC.org first began during his tenure at Massachusetts General Hospital where he served as the editor of a newsletter on cardiovascular disease published by the New England Journal of Medicine. Soon after, Eagle became the editor of ACC’s Current Journal Review, which would then become CardioSource Journal Scan when the publication shifted from print to digital. Eagle was also involved with CardioSource.org during its early

stages and served as interim editor in 2001. Last year, when CardioSource.org started its transition to ACC.org and was in need of an editor, Eagle jumped at the opportunity to apply, saying he “[loves] working with the College in both digital and live education.”

Even with the large overhaul ACC.org has seen, Eagle and the ACC.org team have many more plans for the future. “ACC.org is really at the beginning of its journey

of meeting the needs of our members,” he says. “We’ve come a long way to make the site more searchable, personal and faster, but we have a long way to go. I’m excited about our team in content creation and our ability to deliver information where the members want it, how they want it and when they want it.” There are plans for greater linkage between ACC.org and the Journal of the American College of Cardiology website as well as expanded e-learning capabilities so that members can get their Maintenance of Certification and Continuing Medical Education credits at a moment’s notice. Eagle also has a vision for greater personalization such as packaging key infor-mation in different ways for members depending on their areas of interest. But all of these changes won’t come overnight. “There will be steady changes as ACC.org morphs into its destiny for the College,” he says.

In addition to his interest in educational roles, Eagle has previously held numerous leadership positions within the College. He has been a member of the Guideline Task Force, chair of the Task Force for the Development of Performance Measures in Cardiovascular Care, has served on the Annual Scientific Session Program Committee, and was a member Board of Trustees from 2001 to 2005. Eagle is currently the director of the Samuel and Jean Frankel Cardiovascular Center

at the University of Michigan, where his research programs have led quality improvement initiatives across the state of Michigan in acute myocardial infarction, heart failure and coronary angioplasty.

While serving on the National Heart, Lung, and Blood Institute’s External Advisory Committee from 2002 to 2006, Eagle heard from experts about childhood obesity

and the current status of alleviating the problem. He says that he

ACC.org is really at the beginning of its journey of meeting the needs of our members.

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Kim A. Eagle, MD, MACC Science, Service, Philanthropy and Family


was completely discouraged about the minimal work being done to actually influence how much children ate and moved. “I thought to myself, I live in a college community that has recreational parks, many programs and full service grocery stores available to everyone. I wanted to try to do something here.”

He decided to help create Project Healthy Schools (PHS), which started in 2004 and was initially funded by the University of Michigan and several grateful patients. PHS is a health curriculum for middle schools, focusing on children aged 12 to 14. He explains that this age group was chosen because it is a time of transition for kids and a time when kids might challenge their parents about what kind of food is being served at home and other lifestyle decisions. The aim is to establish behaviors that may last throughout their lifetime.

The program has five simple goals that form the basis of a healthy lifestyle: eat more fruits and vegetables, reduce sugary food and beverages, eat less fast and fatty food, be active every day (exercise at least 150 minutes per week) and spend less mindless time in front of a screen. PHS works with participating school cafeterias to switch in healthier food choices, including the food and beverages found in vending machines. The students participate in 10 interactive lessons at Continued on next page

I think people listen to health care providers more than politicians. Parents of our children think doctors and nurses should be leading efforts to improve our community health.… Being a vocal health professional helps to make these changes happen.

school and teachers are given lesson plans with all necessary infor-mation and materials. Students also participate in a variety of events throughout the school year to encourage them to embrace the five goals. These activities include gardening, bike rides, field days and 5Ks. School Wellness Teams, made up of administrators, teachers, food service staff, and even students and parents who want to be involved, work to improve the school environments and plan activities to celebrate and improve health.

Prior to and after the pilot program was completed at one school over a 10-month period, the team had students take standardized questionnaires and undergo stress testing, blood pressure, body mass index measurements and laboratory tests. The results showed that the program had made a difference compared to baseline measurements. “The kids tell us they are being more active and the data reflects that,” Eagle says. “They also appear to be more fit.” PHS also reports that these benefits appear to persist in participants even after the program ends, as three year follow-up data has shown the continued effectiveness of the program. PHS has published findings from the program in peer-reviewed journals over the 10 years of its existence and presented findings at many regional and national conferences, including an abstract at ACC.14.

Eagle notes that the program will be in 60 Michigan middle schools this year and has reached over 40,000 students to date. Students from areas with fewer resources such as full service grocery stores and parks, see the most benefit from the program, Eagle explains, saying that it is an example of the “dose effect.” “We have a bigger impact on the health of these students than those living in communities with a lot of resources,” he adds. “However, it is harder to sustain in these schools because there is a greater turnover of teachers and administrators. If we systematize this, we can really make a difference in the health of our country. Nothing would bring me more joy than to see a health curriculum in every middle school in the state.” PHS is also working to develop a new high school curriculum, where students will sign on to learn about the science of being healthy.

What’s New on ACC.org?

ACC.org, the College’s online home offering in-depth scientific and educational content, the latest updates in cardiology, member resources and more, has recently undergone some exciting enhancements. In response to member feedback, updates have been made to improve search and browsing functions; streamline access to JACC journal articles and special features like Editor-in-Chief audio summaries; and provide one-click access to Member Section homepages.

ACC.org also offers special members-only access to content and personalization features such as:• Recommended For You Content

View personalized content matching your declared interests each time you log in.

• Personalized Digest Emails Receive topic-specific digest emails immediately, daily or weekly

summarizing the latest ACC.org content, cardiovascular news and Section updates.

• My Library Access, build and organize a personal library of bookmarked content.

Log in and personalize your account to take advantage of these member benefits. Visit ACC.org/Personalize for step-by-step instructions.


Eagle Continued from previous page

Eagle adds that cardiologists and other health care providers have a unique role in the health of children. “I think people listen to health care providers more than politicians. Parents of our children think doctors and nurses should be leading efforts to improve our community health. It is important for those of us in this profession to be involved. Being a vocal health professional helps to make these changes happen.”

He is also involved in numerous other projects including research on quality, cost-effectiveness, the use of practice guidelines in cardiovascular care, acute coronary syndromes, aortic diseases and cardiovascular disease in special populations. He also founded Project My Heart Your Heart, which is developing the processes through which pacemakers might be recycled for reuse in low income nations.

Eagle attributes his passion for philanthropy to a mentor who helped him early in his studies. He was working as a fishing guide to put himself through school, when a client, Don Hopkins, took an interest in his career. He offered to help pay for his college and medical school tuition. “Along with my parents, he allowed me to go through school debt free and not have that burden hanging over my head. I saw the power of philanthropy at a young age and that resonated with me,” he says.

In addition to Hutter, Hopkins and his parents, Eagle says he’s had “too many mentors to count,” but does name a few that have had a huge impact. Larry Cohen, MD, FACC, who mentored him as a student, “showed me what being a cardiologist was all about. He taught be about the importance of bedside cardiology and relationships with patients and families.” Other mentors throughout Eagles’ career include

Roman W. DeSanctis, MD, FACC, who he calls his “medical father” and who guided him in his studies of aortic diseases and as a writer in clinical research. He credits George Thibault, MD, with helping him to think about the quality and value in medicine. He says that Valentin Fuster, MD, PhD, MACC, editor-in-chief of the Journal of the American College of Cardiology, who he worked with directly for two years, had a profound

influence on him. “He made me think about the whole world as a place for medicine and research and how we might connect with others. Valentin expanded my vision. His guidance and way of thinking led me to start the International Registry of Acute Aortic Dissection.” Eagle also credits his parents with teaching him the impor-tance of hard work and honesty. He is particularly grateful for his colleagues

at the University of Michigan’s Frankel Cardiovascular Center. “My day-to-day colleagues keep me grounded in our core values of respect and compassion, collaboration, innovation and a commitment to excellence.”

Family is also important to Eagle, who says he is grateful to his wife, Darlene, and his son, Taylor. Having grown up in Yellowstone, MT,

he enjoys fly fishing and skiing. He volunteers at the University of Michigan’s St. Mary’s Student Parish and cheers on the Wolverines during the football and basketball seasons. He is also involved with the Ann Arbor Symphony Orchestra, where he served as president for several years. As a board member for World Medical Relief, he retains a desire to help improve health in low-income nations.

He values the friendships he has made through the College, saying that the ACC “has allowed me to meet fabulous people from all over the world who are doing great things in care, education and research. It’s such a joy to be involved in the ACC. I never would have imagined that it would have become such an important part of my professional experience.” “Faith, family, friends, colleagues and health … these are the things that really matter,” he says.

ACC.org Editorial Board

Editor-in-Chief

Senior Associate Editor, Clinical Trials and News

Kim A. Eagle, MD, MACC

Deepak L. Bhatt, MD, MPH, FACC

Associate Editor, Education

Associate Editor, Clinical Documents

Ragavendra R. Baliga, MBBS, FACC

Tyler J. Gluckman, MD, FACC

Associate Editor, Innovations

Associate Editor, CardioSmart

Brahmajee K. Nallamothu, MD, FACC

Martha Gulati, MD, MS, FACC

Associate Editor, Journal Scan


David S. Bach, MD, FACC

Elizabeth A. Jackson, MD, FACC



Debabrata Mukherjee, MD, FACC

Prashant Vaishnava, MD

For a full list of ACC.org Journal Scan and Clinical Trial editorial team leaders, as well as Clinical Topic Collection editors, visit ACC.org/Editors.

Faith, family, friends, colleagues and health; these are the things that really matter.


With expert opinion and clinical wisdom compiled from over 130 world-renowned experts, ACCSAP®8 has everything you need to know about adult clinical cardiology. Earn the CME credits and MOC points you need to stay licensed and certified with this self-assessment program.

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Statewide Weight Loss Initiative

ccording to the Centers for Disease Control and Prevention, Kansas ranks 13 in the U.S. for obesity with an adult obesity rate of more than 31 percent. Championed by Dhanunjaya R. Lakkireddy,

MBBS, FACC, governor of the ACC’s Kansas Chapter, the Chapter has been busy planning and implementing the One Million Pounds and 10 Million Miles initiative to promote a “leaner and fitter Kansas.” The initiative is focused on creating a healthier and more active Kansas by tackling the obesity epidemic of the state’s citizens head on. The program

requires active collaboration amongst a number of groups including the state government, hospitals, physicians, insurance companies, technology partners and citizens of Kansas, all of whom are working toward the goal of losing one million pounds and walking 10 million miles in a span of one year.

“To lead a happy and healthy life is the fundamental right of every human being,” says Lakkireddy. “The One Million Pounds and 10 Million Miles initiative is a step in the right direction to motivate people of Kansas to take ownership of their right for healthy living.” He adds that the Chapter is working on the logistics and collaborating with other organizations with a kick off planned for early 2016.

Mandatory High School CPR and AED Training

When an individual goes into cardiac arrest, prompt and effective bystander CPR may double or triple their chance of survival. However, 70 percent of Americans report feeling “helpless to act” during an

emergency because they do not know how to perform CPR. The West Virginia Chapter of the ACC this year helped pass legislation mandating CPR and AED

training as a high school graduation requirement. Several chapters have also made this issue a priority, including Ohio and Connecticut where Laxmi S. Mehta, MD, FACC, governor of the Ohio Chapter, and Gilead I. Lancaster, MD, FACC, governor of the Connecticut Chapter, have testified and remain vocal advocates in their respective states.

In recent testimony, Mehta emphasized the impact that the lack of timely and effective CPR has on Americans. “Every year nearly 424,000 people in the U.S. suffer out-of-hospital sudden

State-Level Efforts to Improve CV Health

s part of its five-year Strategic Plan, the ACC has set priorities to ensure that it is a leader in efforts

to reduce the burden of cardiovascular disease in U.S. and global populations. This focus on population health cascades down through the College’s state chapters. However, many states have been working on prevention and health education efforts for years prior to the College’s formalized focus. Some of the hottest topics in the states center on mandatory high school cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training, school athlete screening, statewide weight loss initiatives, smoking cessation and pulse oximetry screening to diagnose critical congenital heart defects (CHDs) in newborns.

Throughout the past year, ACC’s state chapters have made immense strides in local, state-level efforts to improve cardiovascular health of residents. Here are just a few stories from states that have been making positive waves:

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School Athlete Screening

This year, Texas and South Carolina introduced legislation that would have required those participating in school

athletics to have an electrocardiogram (EKG) as part of their pre-participation physicals. The ACC Sports and Exercise Cardiology Section Leadership Council played a pivotal role in both instances. Chapter leaders presented alternative plans focused on obtaining patient and family health information and developing emergency care plans for sports venues that include CPR-trained volunteers and AED availability. Interactions with legislators in the form of personal meetings, hearing testimony, letters and press interviews made the difference in defeating bills mandating EKGs in these states.

Meanwhile, the New Jersey Chapter of the ACC was instrumental in arming health care providers with training and professional development to aid in the pre-participation assessment of student athletes. The training, among the first of its kind in the U.S., comes in the form of an educational and instructional video known as a professional development module. It came about after New Jersey Governor Chris Christie in 2013 signed the Scholastic Student-Athlete Safety Act which established measures to ensure the health of student athletes. The bill served as a response to the recommendations drafted by the New

Jersey Task Force on Screening of High School Athletes for cardiovascular disease, led

by Lou E. Teichholz, MD, FACC, past New Jersey ACC Chapter Governor.

The state law requires that the New Jersey Depart-

ments of Education and Health develop the module in consultation with not only the New Jersey Chapter of the ACC, but also working in concert with the New Jersey Chapter of the American Academy of Pediatrics, the New Jersey Academy of Family Physicians and the American Heart Association. The collaboration resulted in the Student Athlete Cardiac Screening Professional Development Module, which was funded by ACC’s New Jersey Chapter, and sets out to increase the assessment skills of those medical professionals such as physicians, physician assistants and nurse practi-tioners who perform student-athlete assessments and screenings.

“Members of the ACC are committed to dramatically reducing the incidence, severity and complications of cardiovascular disease, and this training program will go a long way in promoting prevention, reducing disparities in health care, and improving personal and

population-based cardiovascular health,” says Joel S. Landzberg, MD, FACC, president and governor of ACC’s New Jersey Chapter. “It’s

an honor to assist the state in developing and rolling out this important public health and education program.

To date, the New Jersey module has equipped more than 5,000 professionals with pre-participation assessment training.

cardiac arrest and only 10.4 percent survive, making it one of the leading causes of death in the country,” she said. “Five minutes makes the difference in survival.” She cites the support of the cardiovascular community as a key component in helping to find cost-effective ways of implementing this mandatory graduation requirement. “We are ready to help implement [this legislation] and help put thousands of potential lifesavers into the community each year,” she said. While there has not been a decision in Ohio on this legislation, the Ohio Chapter continues to actively support the effort to make CPR training a

graduation requirement.In early October, Charles I. Berul, MD, FACC,

the ACC’s Board of Governors representative for Washington, DC, testified during a DC City Council hearing on a bill requiring the placement of AEDs

and training personnel in all schools in the city. According to Berul, “This bill will save lives! However, AED training should not be limited to coaches and school nurses. Equipping these students with vital AED and CPR skills would put thousands of potential lifesavers in the community each year.”

The ACC has been a longtime supporter of AED and CPR training requirements for high school students. Furthering this effort, ACC staff has worked with the National Lieutenant Governor’s Association to pass a policy resolution recommending that students are trained in CPR and AED before graduating from high school. As of October, the total number of states with similar legislation is 26, with New York and North Dakota being the latest states to mandate CPR training as a high school graduation requirement.



Tackling NCDs at the State Level

Under the leadership of Michael Mansour, MD, FACC, immediate past chair of the BOG, the Delta Medical Society adopted a resolution pledging support of the United Nations campaign to

reduce mortality and morbidity from non-communicable diseases 25 percent by 2025. The resolution indicates that “the Mississippi Delta has the highest incidence of cardiovascular disease and death in Mississippi,” and that the state “closely reflects the high incidence and

death from cardiovascular disease and death as seen in low- and middle-income countries.”

Mansour offered the resolution at the Mississippi State Medical Association annual meeting. It was accepted and will be used to educate state lawmakers on the importance of smoking cessation, diabetes awareness and wellness-education improvements. Other states are consid-ering similar efforts.

Pulse Oximetry Screening

CHDs are the most common cause of infant death due to birth defects, and upwards of 200 infants with undetected critical CHDs are discharged each year from hospitals in the U.S. Pulse oximetry newborn screening, a simple,

inexpensive bedside test to determine the amount of oxygen in a newborn’s blood and the pulse rate, can identify some infants with a critical CHD before they show any signs. The ACC has long advocated for the universal coverage of these screenings for newborns, as studies have shown that this approach to early detection of more subtle forms of congenital heart disease can prevent related complications and promote early diagnosis and treatment.

To date, 46 states and the District of Columbia have enacted pulse oximetry screening requirements, with Washington, Colorado and Hawaii approving bills in the first half of 2015. The District of Columbia is the most recent addition to the list with the law taking effect in September. Vermont is proceeding with regulation as well, leaving only Wyoming, Idaho and Kansas without laws in place. ACC Chapters have been instrumental in grassroots efforts to advocate for these bills through hearing testimony, meetings with legislators and by joining forces with stakeholders such as the American Heart Association.

What’s Next For the States?

As part of the College’s Population Health Retreat held this past

summer, the ACC Population Health Policy and Health Promotion Committee identified state advocacy and patient education as key components of its agenda. Thanks to this focus, the ACC will be working closely with leaders of ACC Chapters as well as external partners to add physical education, nutrition and diet programs to its state advocacy agenda.

These stories from the states are just a handful of examples of how ACC’s chapters are working at a grassroots level to advocate for state-level changes to improve the cardiovascular health of their residents. Look for more on successes and progress around population health and prevention efforts in the states in upcoming issues of Cardiology, as well as on the ACC in Touch Blog.

State Level Efforts Continued from page 15


Let’s Move! A Comprehensive Initiative Helping Kids and Families Lead Healthier Lives By Debra Eschmeyer

Over the past three decades, childhood obesity rates in America have tripled, and today, nearly one in three children in

America are overweight or obese. The numbers are even higher in African American and Hispanic

communities, where nearly 40 percent of the children are overweight or obese. If we don't solve this problem, one third of all children born in 2000 or later will suffer from diabetes at some point in their lives. Many others will face chronic obesity-related health problems like cardiovascular disease, high blood pressure, cancer and asthma.

Recognizing the importance of improving the health and well-being of our country’s most precious resource, First Lady Michelle Obama launched the Let’s Move! initiative in 2010. Let’s Move! is a comprehensive initiative dedicated to helping kids and families lead healthier lives. Through Let’s Move!, the First Lady has sparked and sustained a national conversation around healthy families and is enabling progress through lasting policy and public private partnerships.

And it’s working: childhood obesity rates have stopped rising, and we have seen an encouraging drop in obesity rates among children ages two to five years old. Across America, 1.6 million kids are now attending healthier daycare centers where fruits and vegetables have replaced cookies and juice, and more than 30 million kids are eating

healthier school breakfasts and lunches. Nearly nine million kids attend Let’s Move! Active Schools, where they get 60 minutes of physical activity a day. Restaurants are working to create healthier kids’ menus, and food and beverage companies cut 6.4 trillion calories from their products. Eighty million people now live in a Let’s Move! city, town or county where kids can walk to school on new sidewalks, participate

in a summer meal program or join a local athletic league. Religious leaders are also teaching their congregations about healthy eating.

Despite this progress, more work remains to ensure every young person can lead a prosperous and productive life.

Everyone has a role to play in reducing childhood obesity and improving child health, and physicians and health care providers play an important role in reaching families directly

with messages on the importance of nutrition and physical activity for a healthier lifestyle.

Check out the Let’s Move! map on LetsMove.gov, to learn more about community programs and to get involved. The site also offers new ideas and tips to increase opportunities for kids to eat healthy and be active. Don’t forget to stay updated on our latest efforts and share your successes by liking “Let’s Move” on Facebook and following @LetsMove on Twitter.

Eschmeyer is the executive director for Let’s Move! and senior policy advisor for nutrition for the White House. She spoke on the Let’s Move! program during ACC’s Population Health Policy retreat in July.


Medical Missions in Tanzania: Creating a Sustainable Health Care Infrastructure

In 2006, the non-governmental organization Madaktari Africa began its mission to improve health care and create medical autonomy

in Tanzania, Africa, through the training and education of local medical personnel. In more recent years, Dilantha Ellegala, MD, a neurosurgeon and the founder of Madaktari, reached out to Centra Health in Lynchburg, VA, for assistance in the creation of a cardiology program. Since then, Peter O’Brien, MD, FACC, a practicing cardiologist with Centra Health, has played an integral role in the establishment of this successful and life-changing program.

Madaktari’s focus on sustainability in building the Tanzanian health care infrastructure was what piqued the interest of O’Brien, who, prior to his time in Tanzania, had never participated in medical mission work overseas. “At that point in my career, I felt very blessed,” says O’Brien. “I was practicing in a great community for a very good health care system; I had fantastic partners and enjoyed my work, so I felt like it was time to give something back.” He was enthusiastic about embarking on his first medical mission with Madaktari, primarily because of their use of a “train forward” methodology, which focuses on investing time and knowledge into training local providers to deliver care autonomously. “Although I can’t say I knew exactly what I was getting myself into,” O’Brien jokes.

O’Brien explains that Tanzania is unique among sub-Saharan African nations, in that it is a relatively peaceful and stable democracy. Although poor, Tanzania is growing economically, partially due to the nation’s current presidential administration’s commitment to improving the well-being and health care of its populous. He also expresses special appreciation for the work of Mohamed Janabi, MD, who was a physician champion

At that point in my career, I felt very

blessed. I was practicing in a great community for a very good health care system; I had fantastic partners and enjoyed my work, so I felt like it was time to give something back. Peter O’Brien, MD, FACC


in Tanzania. “Dr. Janabi, a cardiologist and the president of Tanzania’s personal physician, was not only an extremely astute clinician and capable administrator, but also a visionary. He envisioned the creation of a center of excellence in East Africa,” he explains.

Having fully committed colleagues in every facet of the cardio-vascular team is a critical part to succeeding in these medical missions. O’Brien’s first trip included partners and staff from Centra Health, as

well as Eric R. Powers, MD, and Peter L. Zwerner, MD, from the Medical University of South Carolina (MUSC)

in Charleston. “MUSC has been an equal partner in this effort. MUSC, Madaktari and our group have formed an incredible partnership, and we alternate taking teams over there. We are very indebted to them for the resources, teaching, support and guidance that a great academic center can provide.”

O’Brien explains that an experienced cath lab nurse, who can also scrub in on cases, is an essential member of the team. He gives special credit to Jordan Slayton, RN, whom he describes as being “vital” to the Madaktari efforts. “She has helped tremendously in educating the nursing staff and cardiovascular technicians, teaching them everything from administering drugs and circulating during cases, to prepping the table, scrubbing and handling the catheters

and wires,” he says. “But in addition to being a nurse and case assistant, she is also a leader and program builder.” He notes that Erick Funke, MD, Joy Simmons, RN, Adrian VanBakel, MD, and Kayla Norton, RN, have all made important contributions as well.

Working in this new environment presented the team with several unfamiliar obstacles. According to O’Brien, it was often the small and unexpected hitches that created the biggest threats to success. One such example occurred when, after months of preparation, upon arrival the team realized that the manifold cable was not compatible with a monitor cable, which would render the team incapable of monitoring any pressures during diagnostic cardiac catheterization. Eventually, the team was able to finagle a makeshift system using arterial lines. “I felt like we

were resorting to duct tape and chewing gum,” explains O’Brien. “By working through these challenges with the teams in Tanzania, we learned to be very patient, optimistic and resourceful.” That creativity and persis-tence paid off. In January 2014, the first ever cardiac catheterization in Tanzanian history was performed at Muhimbili National Hospital in Dar es Salaam. “It was a simple procedure, but what a thrill. I felt like we took a huge step forward that day,” he notes. Since then, a percutaneous coronary intervention program has been instituted.

An ongoing challenge faced by the team is the lack of resources, specifically what are known as “consumables,” like drapes, gowns, catheters, wires, etc. The acquisition and transport of such items remains a challenge. O’Brien and his colleagues would typically pack a suitcase full of equipment generously donated by vendors in the U.S. Other materials were mailed, but several shipments were lost in customs. Such inconsistency necessitated months of meticulous planning for each trip. While the resource acqui-sition process has gradually improved as the program has grown, O’Brien laments the barriers still encountered regularly.

While not all of these obstacles are typical to O’Brien’s domestic practice, there was a notable similarity between his practice in Tanzania and in Virginia: the challenges of building a program. “To build and develop a program, you have to overcome inertia and convince people to do things a different way. You have to rally stakeholders around a shared goal; you must be patient and learn from any setbacks,” he explains. “If you can remind people that it’s not about the doctors or staff, but about the patient on the table, you’ll be successful,” he adds.


To build and develop a program, you have to overcome inertia and convince people to do things a different way… If you can remind people that it’s not about the doctors or staff, but about the patient on the table, you’ll be successful.


In addition, there are also similarities in the benefits that follow the establishment of data registries. Chad A. Hoyt, MD, FACC, and Joyce Nicholas, PhD, collaborated with the ACC to create a streamlined version of the NCDR data form, allowing Madaktari to collect demographic clinical and outcomes data on patients. “This program, inspired by the NCDR, is still in its early stages, but we are very excited,” says O’Brien. “I told the Tanzanians that they could do something that took physicians in America decades to figure out, collect quality data on every case and use that to drive change.” The collected data will be used to track disease patterns and clinical characteristics in order to get a better grasp of the magnitude of cardiovascular disease in the region, along with facilitating feedback to improve patient safety and outcomes.

The College has also been supportive of plans to establish an ACC Chapter in the region. “I think the creation of an ACC Regional Chapter would enhance the level of professionalism among their cardiovascular specialists,” says O’Brien. “It will also make available

many of the educational and quality improvement resources that we take for granted.” He believes there are mutual benefits of interna-tional chapters. “Bringing together delegates from various countries to gain a global perspective of cardiovascular disease and health care delivery is a worthwhile endeavor. Prior to my trips, I didn’t realize the extent of coronary artery disease and other non-communicable diseases in East Africa,” he says.

In order to continue its mission to build self-sustainable systems of health care. O’Brien expressed the desire to recruit more partici-pating health care providers. Currently, Madaktari is working to launch cardiothoracic surgery and electrophysiology programs; however, all disciplines and professionals – pharmacists, nurses, interventionalists, administrators, echocardiographers, along with others – are needed.

A change in perspective has been the most prolific take-away from O’Brien’s work in Tanzania. “There is something very rejuvenating and enlightening about going to another culture, practicing, learning and teaching,” he says. “I have come to realize that many of the things that I consider to be problematic in my day-to-day practice in the U.S. are not that big of a deal. And establishing this program, which has already impacted the lives of so many Tanzanian patients, has been immensely gratifying.”

To learn more about Madaktari’s life-saving work, visit Madaktari.org. You can also follow the organization on Facebook, as well as Twitter @Madaktari.

Tanzania Continued from page 19

There is something very rejuvenating and enlightening about going to another culture, practicing, learning and teaching. I have come to realize that many of the things that I consider to be problematic in my day-to-day practice in the U.S. are not that big of a deal. And establishing this program, which has already impacted the lives of so many Tanzanian patients, has been immensely gratifying.


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COURSE DIRECTORValentin Fuster, MD, PhD, MACC

Co-sponsored by The New YorkCardiological Society of:

DECEMBER 11 – 13, 2015New York Hilton - Midtown

Register Today at ACC.org/nycvsymposyum

New YorkCARDIOVASCULAR SYMPOSIUM Major Topics in Cardiology Today

John J. Ryan, MD, FACC, may be considered an early career cardiologist, but he is also considered a mentor and a leader at the University of Utah Hospital, where he works in the Division of Cardiovascular Medicine and is an assistant professor in the Department of Internal Medicine. He was recruited in 2013 to help build and grow the Dyspnea program, and is co-director of the Dyspnea Clinic, a combined, multidisciplinary Pulmonary Hypertension and Heart Failure with Preserved Ejection Fraction program between the University of Utah Division of Cardiovascular Medicine and Pulmonary Medicine. In addition to his duties at the University of Utah Hospital, he is involved in numerous ACC projects, and is a member of the ACC.org Editorial Board, a member of ACC’s Informatics and Health Information Technology Task Force and a member of the Annual Scientific Session Program Committee.

A Day in the Life of an Early Career Professional

Ryan informally meets with resident Jessica Huston, MD, as they are about to visit a patient in the intensive care unit.

Ryan starts his mornings by checking emails on his way to the cardiovascular center where he will spend his day in clinic.

9:00 a.m.

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Photos by Jen Pilgreen, University of Utah Health Care

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After checking in with a patient, Ryan and Huston meet to go over the patient’s procedure. Using a model heart and graphics, Ryan mentors Huston and discusses the proper next steps.

Ryan visits with a patient in the intensive care unit during his morning rounds. He checks her vitals and asks about how she’s feeling and her goals for the day. Ryan is known as one of the friendliest physicians in the hospital and is often seen joking and laughing with his patients.


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Before seeing his next patient, he checks in with the nurse and medical staff, and reviews his patient’s chart.

Ryan checks his emails while taking the elevator back to the cardiovascular center to see a patient.

Ryan meets with James Fang, MD, FACC, and Nathan Hatton, MD – staff from the cardiology and pulmonary teams – to discuss a mutual patient with a complex condition who is traveling from rural Utah.

A Day in the Life Continued from prevous page

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Hospitals Nationwide Begin Reporting PCI and ICD Measure Results

s of Nov. 2, data on several medication discharge measures related to percutaneous coronary intervention and implantable cardioverter defibrillator procedures are publicly available for the first time. CathPCI Registry hospitals and ICD Registry hospitals that

volunteered to participate in ACC’s public reporting program now have their results posted on ACC’s CardioSmart website. By publicly reporting, hospitals demonstrate their dedication to quality improvement and transparency, and empower patients to make informed decisions about their cardiovascular care.

“Our hope is that by tracking and publicly reporting these measures we can raise awareness of variation where it exists and help to ensure consistent, evidence-based care is provided across the U.S.,” said ACC President Kim Allan Williams Sr., MD, FACC.

A Data Quality Checklist is now available to help NCDR hospitals ensure that all steps in their data management process produce complete, accurate, reliable and valid data. This tool is part of a new Public Reporting Toolkit designed to help NCDR hospitals improve on overall quality and performance for all registries, as well as publicly reported CathPCI Registry and ICD Registry metrics.

Learn more about ACC’s public reporting program at ACC.org/PublicReporting.


Fulfilling a Lifelong Passion For Fitness and Healthy Nutrition

Cardiology recently sat down with Pamela Bowe Morris, MD, FACC, to discuss her career path in cardiology and her thoughts on the future of population health. She is currently

the director of preventive cardiology, co-director of Women’s Heart Care, and an assistant professor of medicine at the Medical University of South Carolina. Morris serves as the chair of ACC’s Prevention of Cardiovascular Disease Section Leadership Council, and is a member of the ACC Scientific Session Program Committee, ACC’s Population Health Policy and Health Promotion Committee, the ACC Expert Consensus Clinical Pathway Task Force, and the LDL: Address the Risk Oversight Committee.

What initially drew you to medicine? How did you come to specialize in cardiovascular disease prevention?

As a student I was torn between careers in medicine or in teaching. I come from a large extended family of educators with numerous outstanding role models and mentors. Fortunately, however, I did not have to choose. A career in academic medicine has enabled me to pursue both career pathways.

During my cardiology fellowship at Duke Medical Center I was initially attracted to basic science research and spent one year in a protein chemistry lab working to isolate growth factors involved in angiogenesis. However, at the completion of my fellowship I was asked to remain on faculty as medical director of the Duke University Preventive Approach to Cardiology program, now known as the Duke Center for Living. My lifelong passion for fitness and healthy nutrition seemed like a natural fit for one of the largest cardiac rehabilitation, nutrition and wellness programs in the nation. The program’s comprehensive lifestyle management approach to cardiovascular health and disease prevention was the brainchild of Andrew Wallace, MD, in 1975. That was the beginning of my nearly 30-year-long career in prevention.

How has this training shaped your career?

Dyslipidemia was highly prevalent among these high-risk patients, but our pharmacological therapies were quite limited until the approval of the first statin in 1987. At that time, in collaboration with endocrinology colleagues, we established the Duke Lipid Clinic. The exercise and nutrition resources at Duke, the diabetes expertise of endocrinology, and my interest in dyslipidemia provided the perfect clinical setting for comprehensive management of dyslipidemia and cardiovascular risk reduction.

In 1990, I joined the faculty of the Mayo Cardiovascular Health Clinic in Rochester, MN. During that time my colleagues, John Rumberger, MD, PhD, FACC, and Jerry Breen, MD, were investigating the prognostic role of imaging coronary artery calcium by electron beam computed tomography scanning. As patients were identified with subclinical atherosclerosis, they were referred to the Cardiovascular Health Clinic for development of protocols for risk factor modification depending upon the extent of disease. I have maintained an ongoing interest in preventive imaging, and certainly decades of research have now validated the important role of calcium scoring in atherosclerotic cardiovascular disease (ASCVD) risk assessment.

What do you find most rewarding about teaching? What do you hope to impart on your medical students?

My greatest joy in teaching is seeing “the lights go on,” when a student or mentee truly understands an important concept in patient care. It’s that moment when they understand my passion for prevention and connect with the patient’s priority – quality of life. Patients really value a focus on wellness rather than disease management.


As chair of ACC’s Prevention of Cardiovascular Disease Section Leadership Council, what would you say are the main priorities of the Section as the College looks to define ‘population health’?

The ACC has long been a leader in the transformation of care for patients with established cardiovascular disease. The formation of the Prevention of Cardiovascular Disease Leadership Council and Section in 2014 affirmed ACC’s position that reduction of morbidity and mortality from ASCVD also demands effective preventive strategies, including lifestyle interventions and risk factor modification with evidence-based pharmacotherapies. The multidisciplinary members of the Council bring broad expertise and interest in the areas of the genetics of ASCVD and risk factors; health care disparities; nutrition; physical activity and cardiac rehabilitation; smoking cessation; preventive imaging; the management of complex dyslipidemias, diabetes and cardiometabolic disease; and hypertension. As the ACC broadens its focus from the prevention of disease or recurrent events in the individual patient to preserving the cardiovascular health of populations, the Council is well-positioned to provide support and guidance.

What are some of the challenges to implementing preventive health initiatives in populations at high risk for cardiovascular disease?

Significant disparities in access to health care and heart-healthy nutrition are critically important barriers to successful implementation of preventive health initiatives in high-risk populations. These disparities are the focus of the Disparities Work Group of the Prevention Council, led by Gladys Palacio Velarde, MD, FACC. In collaboration with the Nutrition Work Group, co-chaired by Penny M. Kris-Etherton, PhD, and Andrew M. Freeman, MD, FACC, the Disparities Work Group is currently exploring the concept of “nutrition deserts” and their impact on cardiovascular health.

How will ACC.16 address prevention and population health more so than in years past?

As part of a strong program addressing prevention at the ACC.16, a “Lifestyle Intensive” will be offered focusing on effective implementation of nutrition counseling and “deep-dives” into important issues in exercise counseling and prescription, controversial and misunderstood issues in heart-healthy nutrition, and updates on smoking cessation counseling and use of electronic cigarettes. Learn more about the intensive at accscientificsession.org.

What role do you see technology playing in the prevention and population health sphere?

The ACC has been at the forefront of developing mobile apps to provide clinicians with fingertip access to evidence-based guidelines. The ACC Statin Intolerance app guides providers with a systematic approach to the patient with muscle-related symptoms on statin therapy. Compliance with evidence-based statin therapy is suboptimal and this approach can help the clinician evaluate for secondary causes of myalgias, risk factors for statin intolerance, drug interactions that may predispose to myalgias and can ultimately encourage the patient to continue long-term treatment. This and other ACC apps are available at ACC.org/apps.

How have your ACC membership and mentors impacted the course of your career?

My membership in the College has immeasurably enriched my career satisfaction by providing mentors, opportunities for networking, involvement in advocacy, lifelong education, and the chance to play a role in advancing cardiovascular disease prevention.

However, the words of my mentor, Salvatore Chiaramida, MD, FACC, have guided me and truly impact the daily joy I experience in my career in cardiovascular disease prevention: “Do what you love and do it for yourself, not for greatness.”

My greatest joy in teaching is seeing 'the lights go on,' when a student or mentee truly understands an important concept in patient care. It’s that moment when they understand my passion for prevention and connect with the patient’s priority – quality of life. Patients really value a focus on wellness rather than disease management.


ntonio M. Gotto Jr., MD, DPhil, FACC, first became involved in cholesterol research while he was

a fellow at the National Heart, Lung, and Blood Institute at the National Institutes of Health (NIH). “I wanted to take advantage not only of my medical training, but also of the years of research experience I had gained by pursuing a career in which I could study a disease in the laboratory and simultaneously apply it to patients in the clinic,” he says. “Basic research and clinical research in atherosclerosis and lipoprotein metabolism provided me the opportunity to study these disorders at the laboratory, as well as treat patients, and also pursue clinical studies in the treatment of patients in the clinic and hospital wards.”

Gotto’s work in the field of lipoproteins and atherosclerosis has transformed the way patients with dyslipidemia are treated. While at the Baylor College of Medicine in Houston, TX, Gotto and his colleagues completed groundbreaking research that has led to greater understanding of the apoB protein and lipid modification.

In recognition of his accomplish-ments, Gotto was awarded the Lifetime Achievement Award at ACC.15. He says that the award “does not just reflect on me, but also all my colleagues, family and friends, who have supported my career over many years.” Gotto feels that the honor recognizes not only his contributions to research on the causes of atherosclerosis and relationship between dyslipidemia and cardiovascular disease, but that it also recognizes his efforts to educate the public about the risk of cardiovascular disease and how to prevent it.

Currently the Dean Emeritus for Weill Cornell Medical College and Provost for Medical Affairs Emeritus for Cornell University, Gotto received his under-graduate degree from Vanderbilt University, where he says both Vice Chancellor Madison Sarratt and F. Tremaine (Josh) Billings, MD, encouraged him to pursue a career in academic medicine and to apply for a Rhodes scholarship at Oxford University. “At Oxford, Sir Hans Krebs, the professor of biochemistry, and Sir Hans Kornberg, my immediate supervisor, encouraged me to pursue a doctorate in biochemistry in their laboratory and to incorporate research into my professional goals.”

He credits Kurt Isselbacher, MD, at Massachusetts General Hospital, with encouraging him to pursue a career in academic medicine and says Donald Fredrickson, MD, at the NIH provided him with an opportunity to enter the field of lipoprotein research and clinical lipidology in relation to cardiovascular disease. Finally, he says that Michael E. DeBakey, MD, FACC, and Ted Bowen, PhD, “provided me with an environment and opportunities to pursue my career in cardiovascular medicine at Baylor

College of Medicine and Methodist Hospital in Houston.” Gotto served for 20 years as the chair of medicine at Baylor before he took his current position at Cornell. “These years of administrative medicine also provided me with the opportunity to influence the careers of students, fellows and younger faculty,” he adds.

Gotto acknowledges the importance of the support and understanding of his wife and family throughout the different chapters of his career. “Without my family support system, I certainly could not have pursued the various activities I have been fortunate enough to experience,” he says. He advises that those pursuing a career in the medical field should “set aside time for your family and yourself and to involve yourself in activ-ities that benefit others and expand beyond your own narrow personal interest.”

Gotto’s interests outside of work include spending time with his family, particularly his grandchildren, at his home in Maine, and with the friends he has made and patients he has treated all over the world. He also enjoys playing tennis, reading, sports and political discussions.

In recognition of his accomplishments, Gotto was awarded the Lifetime Achievement Award at ACC.15. Gotto feels that the honor recognizes not only his contributions to research on the causes of atherosclerosis and relationship between dyslipidemia and cardiovascular disease, but that it also recognizes his efforts to educate the public about the risk of cardiovascular disease and how to prevent it.

Antonio M. Gotto Jr. MD, DPhil, FACC: A Lifetime of Leading Achievements in Lipid Research


Chittur A. Sivaram, MBBS, FACC: Educating the Next Generation of Great Minds

s a cardiology fellow, Chittur A. Sivaram, MBBS, FACC, was drawn to the potential of the echocardiography field, which at that time was maturing as a new diagnostic tool. “Its solid foundation in morphology and physiology, along with its future potential in the management

of cardiovascular diseases was appealing to me,” he says. “Since that time we have had further advances in echocardiography, including Doppler imaging, transesophageal echocardiography and 3-D echocardiography resulting in promises well kept.” Sivaram also acknowledges that his interest in photography also played a role in his interest in image formatting. “I consider echocardiography a place where art and science intersect.”

He has served the College in many education efforts, including serving as chair of the Cardiology Training and Workforce Committee, and as a member of both the Fellowship Education Redesign Task Force and the Lifelong Learning Oversight Committee, among others. Sivaram was the recipient of the Gifted Educator Award during ACC.15, which he considers a “validation of my pursuits as an educator for over 30 years.” For the last 20 years, he has served as the director of the Cardiology Fellowship Training Program at the University of Oklahoma Health Sciences Center in Oklahoma City, OK.

As an educator, Sivaram appreciates the importance of mentorship and points to a few individuals who have guided him throughout his career. First, his parents offered him support and encouragement throughout his education. He says that Ralph Lazaara, MD, at the University of Oklahoma has always

supported him, and he admires Patrick T. O’Gara, MD, MACC, and Rick A. Nishimura, MD, MACC, for their excellence in teaching and mentoring. Sivaram is also inspired by younger colleagues, such as Jeffrey Kuvin, MD, FACC; James A. Arrighi, MD, FACC; Andrew M. Kates, MD, FACC; and Douglas E. Drachman, MD, FACC, due to their intellect and professionalism.

A fellow of the ACC since the mid-1980s, Sivaram credits Charles F. Bethea Jr., MD, FACC, for pushing him to become more involved with ACC’s Oklahoma Chapter in the early 2000s, which lead to more leadership opportunities on both the state and national level. He served as the ACC Oklahoma Governor from 2005 to 2008, a role he describes as “a rich opportunity for professional growth and a window for active participation in finding solutions for problems facing our profession.”

Sivaram has also worked closely with ACC’s Fellows in Training (FIT) and Early Career Sections. He notes that it has “been fascinating and rewarding to see the ascent of many of the past FIT leaders to more challenging positions

within the College.” He applauds the gains the College has made to allow FITs, early career professionals and other members of the cardiovascular care team to have

meaningful participation within the College and urges his colleagues to guide and mentor these individuals to seek out these opportunities within the ACC. “The

future of the educational mission of our training institutions is bright,” he says. “I am pleased that many of these gifted colleagues will refine their skills and reach

their best potential though opportunities created for early career members by the forwarding-thinking philosophy of ACC leadership.”

Outside of work, Sivaram enjoys reading, both fiction and non-fiction books, as well as films, theater, photography and following along with political debates.

The future of the educational mission of our

training institutions is bright. I am pleased that many of these

gifted colleagues will refine their skills and reach their best

potential though opportunities created for early career

members by the forwarding-thinking philosophy of ACC

leadership.


2016 Physician Fee Schedule and Hospital Outpatient Rules: What’s in Store For Cardiology?

In October, the Centers for Medicare and Medicaid Services (CMS) released two final regulations that will impact cardiovascular profes-sionals next year. These rules determine the payment levels and

associated policies for services provided under the Physician Fee Schedule and the Hospital Outpatient Prospective Payment System. Consistent with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), physicians will see a 0.5 percent formula increase on Jan. 1, 2016. Unrelated payment formula changes result in an estimate that payment for cardiology services will neither increase nor decrease from 2015 to 2016. However, this estimate is based on the entire universe of cardiology services and can vary widely depending on the mix of services provided in a practice.

Some of the most important provisions for cardiology include:

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CMS maintains most existing policies applicable to the Physician Quality Reporting System (PQRS) for

the 2016 performance year. Under most individual reporting options, eligible professionals will

continue to report at least nine measures across at least three domains. Failure to successfully report PQRS quality measures in 2016 will continue to result in a -2 percent payment adjustment in 2018.

CMS finalized the process for selecting AUC

developed by national professional medical specialty societies and other provider-led entities for the AUC consultation requirement that will apply to professionals ordering advanced imaging services.

CMS seeks review of 103 services with Medicare allowed charges of $10 million or more as a prioritized

subset of codes under the statutory category of "codes that account for the majority of spending under the physician fee schedule." This list includes transthoracic echocardiography, electrophysiology device monitoring services and 3-D electrophysiology mapping. SPECT-MPI services were removed from the list after the ACC and other stakeholders indicated they did not fit the specified criteria.

CMS will delay the requirement that

clinicians ordering advanced imaging services (i.e., CT, MR, SPECT) consult with appropriate use criteria (AUC) through a qualified clinical decision support mechanism starting on Jan. 1, 2017. CMS will issue additional regulations on this program in the calendar year (CY) 2017 and CY 2018 rulemaking cycles.

CMS collected initial comments related to the

implementation of the Merit-Based Incentive Payment System and Alternative Payment Model payment pathways and will continue consider these comments along with those received through a MACRA Request for Information.

Physician Fee Schedule


CMS finalized revisions

to physician self-referral (Stark)

regulations that it believes will accommodate delivery and payment system reform, reduce burden and facilitate compliance.

CMS continues its policy to package payment for items and services

that are integral, ancillary, supportive or adjunctive to a

primary service. Starting in 2016, payment for bivalirudin and abciximab will be packaged into the Ambulatory Payment Classification (APC) payment for the primary procedure, such as a percutaneous coronary intervention or percutaneous transluminal coronary angioplasty.

CMS finalized changes to its existing "rare and unusual" exceptions policy to allow Part A payment on a

case-by-case basis for inpatient admissions that do not satisfy the two-midnight benchmark. The Agency will use quality improvement organizations to educate doctors and hospitals about Part A payment policy for inpatient admissions. Certain restrictions on recovery audit contractors' review of admitting decisions will also be implemented. These include changes to the "look-back period," limits on additional documentation requests and requirements for timely reviews.

CMS finalized updates to the APC structure for

imaging services, including the creation of the Level 4 Nuclear Medicine and Related Services group to appropriately recognize the resource costs and clinical distinctions of PET imaging services.

For 2017 and subsequent years, hospitals that fail to meet the requirements

of the Hospital Outpatient Quality Reporting Program will receive a 2 percent reduction to their annual fee schedule update factor. CMS will also continue to explore electronic clinical quality measures for use in future years.

For 2016, CMS will implement nine new Comprehensive APCs (C-APCs), including one new C-APC for comprehensive

observation services. This will provide a single payment for all services received during a non-surgical encounter with a high-level outpatient hospital visit or emergency department visit and eight or more hours of observation. All surgical procedures, regardless of the date of service, will be paid separately.

Application of the Value-Based Payment Modifier on 2018 payments will be

expanded to non-physician eligible professional solo practitioners and group practices (i.e., physician assistants, nurse practitioners and clinical nurse specialists) based on the 2016 performance period.

Hospital Outpatient Prospective Payment System

Stay tuned to ACC.org and the ACC Advocate for a detailed analysis of the rules.


#ACCLegConf in Action

2015 Legislative Conference: A Fresh Dialogue on Capitol Hill

During the 2015 Legislative Conference, more than 400 cardiovascular professionals were in Washington, DC, advocating for cardiovascular

professionals and their patients on Capitol Hill and learning about legislative and regulatory changes that will impact their practices. For the first time in many years, cardiology had a fresh message to take to lawmakers now that the Sustainable Growth Rate is history. ACC members urged Congress to take the following action:

• Cosponsor H.R. 3355/S. 488, a bill that would expand access to cardiac rehabilitation by allowing physician assistants, nurse practitioners and clinical nurse specialists to supervise cardiac, intensive cardiac and pulmonary rehabilitation programs.

• Leverage the expertise and experience of medical specialty societies to promote the usability of electronic health records by care team members.

• Support new funding for the National Insti-tutes of Health and the U.S. Food and Drug Administration at the levels provided in the House-passed 21st Century Cures Act.

• As the Medicare Access and CHIP Reauthorization Act is implemented, work with medical specialty societies and federal agencies to develop alter-native payment models that allow clinicians to provide the most effective and efficient care to their patients.

Before meeting with legislators in their offices, hundreds of ACC members gathered in the Cannon House Office Building for a special Congressional Breakfast during which Rep. Larry Bucshon, MD (R-IN), Sen. Dan Sullivan (R-AK) and Rep. Tom Price, MD (R-GA) gave remarks. Minority Whip Steny Hoyer (D-MD) also stopped by to greet the crowd. During the breakfast, Wendell Primus, senior advisor to House Minority Leader Nancy Pelosi, (D-CA) accepted ACC's 2015 President's Award for Distinguished Public Service on her behalf. Earlier this month, outgoing Speaker of the House John Boehner (R-OH) also accepted the President's Award. Pelosi and Boehner were honored with the awards for their roles in crafting and passing the Medicare Access and CHIP Reauthorization Act of 2015.

For full coverage of the conference, visit Blog.ACC.org.

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BY THENUMBERS

Attendees at the PAC Dinner

Conference Attendees

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BY THENUMBERS

Attendees at the PAC Dinner

Conference Attendees

LeglislativeConference

37Early Career Members

47Cardiovascular Care Team Members

94

Fellows in Training

13

CardiovascularAdministrator Members

Users Tweets109 479

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Get the Fellows in Training perspective of Legislative Conference with the FITs on the GO Video Blog. Visit YouTube.com/FITsontheGO

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ACC.org/ACCinTouchFall 2015 Cardiology 33

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In October, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology released two final rules that

align all three stages of the Electronic Health Record (EHR) Incentive Program (also known as "Meaningful Use"). In addition to finalizing program requirements for the 2015-2017 reporting periods, the rules combine Meaningful Use into one single stage. According to the agencies, the alignment aims "to advance electronic health records with added simplicity and flexibility."

While the ACC is a longtime advocate of EHRs as a way to improve the quality of patient care, the College has voiced its concerns with moving too quickly with Meaningful Use imple-

mentation. "Many of the requirements for Stage 2 proved unattainable," said ACC President Kim Allan Williams Sr., MD, FACC, in response to the rules. "Large numbers of providers either haven't met them or, after trying and failing, have given up. That is why it is vital that CMS consider participation data from the current stage to see what is working and what isn't before outlining an upcoming stage. We cannot establish a long-term health care program that does not take into account what we can feasibly attain in the short-term, transitional period."

The ACC will continue to work with CMS to determine how Meaningful Use will align with the new Merit-Based Incentive Payment System which will go into effect in 2017. The ACC is currently reviewing the rules and will formally weigh in during the 60-day comment period.

Robert M. Califf, MD, MACC Nominated as FDA Commissioner

Robert M. Califf, MD, MACC, has been nominated by President Barack Obama as the next Commissioner of the U.S. Food and Drug Administration (FDA). Califf currently serves as the FDA Deputy Commissioner for Medical Products and Tobacco, a role he accepted in early 2015.

“Dr. Califf has a long history of collaborating with the FDA both internally and as an external advisor,” said the ACC in a letter to leaders of the Senate Committee on Health, Education, Labor, and Pensions. “This experience will

enable him to quickly move forward with implementing key initiatives and advancing the agency’s mission.” ACC’s letter of support also notes how Califf, in his current role, provides expert guidance on a diverse array

of projects ranging from clinical trial improvements to the use of observational data such as those from registries to improve access to new therapies.

Before joining the Agency earlier this year, Califf frequently lent his expertise to the FDA through service on the Advisory Committee on Cardiovascular and Renal Drugs and its Science Board Working

Group. He has also served in several leadership positions within the Institute of Medicine (IOM), including the IOM Clinical Research Roundtable, the IOM Committee on Medication Errors and the IOM Board on Health Sciences Policy. He is also one of the foremost experts in clinical trials, with more than 1,200 peer-reviewed publications.

ICD-10 Transition is Official

fter many years of planning and several implementation

delays, the transition to ICD-10 became official on Oct. 1. Now that the transition has been made, remember to use ICD-10 codes for all claims with dates of service after Oct. 1, 2015, and ICD-9 codes for all dates of service before then. If you have trouble using ICD-10, visit CMS.gov/ICD10 or contact your Medicare and Medicaid liaisons for any related inquiries. Visit ACC.org/ICD10 for cardiology-specific resources.

While the ACC is a longtime advocate of EHRs as a way to improve the quality of patient care, the College has voiced its concerns with moving too quickly with Meaningful Use implementation.

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A Novel Medicare Payment Model For Cardiovascular Risk ReductionBy Nina Brown and Darshak Sanghavi, MD

In the best of all possible worlds, clinicians would know precisely who would someday go on to have a heart attack or stroke, and be able to intervene

well in advance to prevent those outcomes. But for all of the remarkable advances and technology, we still lack a critical tool – a time machine. What if we could transport patients into the future to provide them a sneak peek at their health outcomes, and quality of life? What impact would

this have on motivating sustained engagement in critical lifestyle inter-ventions, treatment compliance and medication adherence?

At the Center for Medicare and Medicaid Innovation, a novel model seeks to widely implement the next best thing: the 10-year cardiovascular risk calculator endorsed by the ACC and American Heart Association (AHA). To date, most payment incen-tives for providers have focused on standardized targets for cholesterol and hypertension control. The model will instead ask providers and patients to focus on how these and more risk factors work together to influence patient’s comprehensive cardiovascular risk. Though not a time machine or crystal ball, this approach does furnish a predictive algorithm that gives providers and patients a glimpse at how their cardiac health will look in the not-too-distant future. Ideally, this view will also encourage helpful preventive actions.

The Million Hearts Cardiovascular Risk Reduction Model is the largest payment model test of a preventive intervention ever performed by the Centers for Medicare & Medicaid Services

(CMS) for Medicare fee-for-service beneficiaries. The five-year model incentivizes providers to use the ACC/AHA Atheroscle-rotic Cardiovascular Disease risk calculator to manage their highest risk patients. It aims to reduce cardiovascular disease risk through patient level risk assessment and shared-decision making. Providers will utilize risk scores to facilitate meaningful conversations that empower patients to take ownership over

their health and life. It is the first CMS model to pay for prevention by tying payments to panel-wide 10-year cardiovascular risk reduction. This design specifically encourages clinicians to manage risks across their entire population of patients, and is designed for a randomized evalu-ation.

CMS looks to trusted members of the clinical community, such as the ACC, to help develop the underlying scientific literature and practices that inform preventive care. As a result, the model closed enrollment in October 2015 with numerous applications and strong interest from providers in all 50 states. The model

plans to enroll 300,000 Medicare Fee-For-Service beneficiaries.CMS looks forward to the model launch in 2016, and to

continued strong focus on improving health, lowering costs, and delivering high quality care.

Brown and Sanghavi are from the Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services in Baltimore, MD.

Sanghavi presented this model during ACC’s Population Health Policy retreat in July.

The Million Hearts Cardiovascular Risk Reduction Model is the largest payment model test of a preventive intervention ever performed by the Centers for Medicare & Medicaid Services for Medicare fee-for-service beneficiaries.


Latest Science From ESC Congress 2015

Several late-breaking clinical trials presented during the European Society of Cardiology (ESC) Congress in London,

explored new technologies, and the latest advances in cardiovascular medicine.

In the OPTIDUAL trial, results showed that extending dual antiplatelet therapy (DAPT) beyond the recommended 12 months after coronary stenting “should be considered” in patients at low risk for bleeding. The trial included 1,385 patients from 58 French sites who had undergone percutaneous coronary intervention with placement of at least one drug-eluting stent for either stable coronary artery disease or acute coronary syndrome. All patients had been on DAPT for one year and were randomly assigned to continue or to remain on aspirin alone for an additional 36 months. Overall results found no statistical difference between the groups for the primary endpoint of a composite of all-cause death,

myocardial infarction, stroke and major bleeding. Rates of death were 2.3 percent in the extended-DAPT group compared to 3.5 percent in the aspirin group.

Meanwhile, results of the LEADLESS II trial, which assessed the safety and efficacy of a leadless pacemaker, found that the pacemaker may be capable of providing effective pacemaker function in a varied group of patients needing long-term pacing therapy. The multicenter study enrolled 526 patients requiring permanent single-chamber ventricular pacing. The intention-to-treat primary efficacy endpoint was met in 270 of the 300 patients in the primary cohort (90 percent) and the primary safety endpoint was met in 280 of 300 patients (93.3 percent). Device-related serious adverse events were observed in roughly one in 15 patients at six months,

including device dislodgement with percuta-neous retrieval (1.7 percent), cardiac perforation (1.3 percent) and pacing-threshold elevation requiring percutaneous retrieval and device replacement (1.3 percent). Vascular complica-tions occurred in 1.3 percent of patients.

“Leadless cardiac pacemakers create a paradigm shift in how we are going to look at pacemaker therapy over the coming years,”

UN 2030 Agenda For Sustainable Development Targets NCDs

The United Nations (UN) has adopted a post-2015 development agenda, which includes a standalone target on non-communicable diseases (NCDs) in addition to other NCD-related targets.

The 2030 Agenda For Sustainable Development addresses both the UN’s Sustainable Devel-opment Goals and ways in which countries can implement practices and partner globally to realize these goals. Specifically, the UN has indicated 2030 as the target year to “reduce by one third premature mortality from NCDs through prevention and treatment, and promote mental health and wellbeing.” Other targets include strengthening the implementation of the World Health Organi-zation (WHO)’s Framework Convention on Tobacco Control and making essential medicines both accessible and affordable.

“The [UN] has recognized the critical importance of working toward reducing the burden of NCDs rather than simply treating the disease. The targets identified in the 2030 Sustainable Agenda

are ambitious but achievable with an organized effort by the WHO and NCD Alliance,” said Gerard R. Martin, MD, FACC, chair of ACC’s Population Health Policy and Health Promotion Committee.

The ACC, in partnership with its 50,000 global members and 34 Interna-

tional Chapters, looks forward to supporting these efforts.AC

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said Jagmeet P. Singh, MD, DPhil, deputy editor of JACC: Clinical Electrophysiology. “While leadless cardiac pacemakers are only available as single-chamber pacemakers at this juncture, there will be opportunities for dual- as well as three-chamber approaches in the future. Hopefully this technology will continue to evolve and incorporate the device

diagnostic and remote monitoring capabil-ities that are present in currently available pacemakers.”

A study conducted during ACC’s Annual Scientific Sessions from 2011 to 2014 and presented during ESC Congress 2015 found that cardiologists failed to identify more than half of basic and about 35 percent of advanced

pre-recorded murmurs, but skills improved after a 90-minute training session.

The study used training tools from Heart Songs 3, an online, downloadable training program developed by the ACC to help health professionals improve their auscultation skills. The program is based on psychoacoustic research that shows it takes the human brain intensive repetition to master a new sound.

“These findings confirm the widely held view that auscultation skills among cardiolo-gists have eroded over time,” said Patrick T. O’Gara, MD, MACC, immediate past president of the ACC and a co-investigator on the study. “As shown in this and other studies, however, these skills can improve with repetition and training. Accurate auscultation is the first step in the cost-effective evaluation of patients with suspected valvular heart disease.”

For complete ACC coverage of ESC Congress 2015, visit ACC.org/ESC2015.

Scan the QR code for additional ESC Congress 2015 coverage on the ACC in Touch Blog, including daily video wrap-ups of highlights from the meeting; a blog post by Richard A. Chazal, MD, FACC, president-elect of the ACC, about how the Congress was a unique venue for cardiovascular leaders – including ACC’s own Assembly of International Governors – to come together to discuss opportunities for collaboration and innovation; as well as a post by John Gordon Harold, MD, MACC, past president of the ACC, about a global meeting on the prevention of cardiovascular disease held during the Congress.

Photos: Top left: Patrick T. O’Gara, MD, MACC, immediate past president of the ACC talks to reporters in the newsroom.

Top right: A reporter interviews Mary Norine Walsh, MD, FACC, vice-president of the ACC.

Bottom left: Kim Allan Williams Sr., MD, FACC, president of the ACC answers reporters’ questions after a press conference.

Bottom right: ACC’s presidential team – Richard A. Chazal, MD, FACC, president-elect of the ACC; Williams; Walsh; and O’Gara – visit ACC’s booth during ESC Congress 2015 in London.

Valentin Fuster, MD, PhD, MACC, editor-in-chief of the Journal of the American College of Cardiology, pictured with hundreds of preschool-age children enrolled in an ongoing, international population health study, in Madrid, Spain.

John Gordon Harold, MD, MACC, past president of the ACC, and Margaret Chan, MD, director-general of the World Health Organization, at the United Nations General Assembly Sustainable Development Conference in New York in September.

Christina Hartman, director of ACC’s Population Health Policy, Gerard R. Martin, MD, FACC, chair of ACC’s Population Health Policy and Health Promotion Committee, and John Gordon Harold, MD, MACC, past president of the ACC, outside of the United Nations General Assembly meeting.

FACCs at the Convocation Ceremony during the Chinese Society of Cardiology Congress in Shanghai, China in September.

The 9th Annual Best of ACC Cardiovascular Medicine in Mumbai, India.


WHAT’S NEW IN CLINICAL DOCUMENTS

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New ACC/AHA/HRS Guideline Addresses Management of SVT

To aid clinicians in treating SVT and distin-guishing it from other disorders, the ACC, the American Heart Association and

the Heart Rhythm Society have released the “2015 Guideline for the Management of Adult Patients With Supraventricular Tachycardia” (SVT). The document, which supersedes the 2003 guideline, contains the most updated consensus of clini-cians with broad expertise related to SVT and its treatment. To coincide with the guideline, the ACC developed an SVT Diagnosis and Treatment Tool to help clinicians quickly diagnose the type of SVT and ensure they consistently follow a prescribed algorithm for treatment of the condition. To view all of the SVT resources, including the SVT Diagnosis and Treatment Tool; Slide Set; Key Points to Remember; and CardioSmart Patient Resource, visit ACC.org. On Sept. 23 the ACC/American Heart Association Task Force on Clinical Practice Guidelines also released a report explaining the changes to the latest recom-mendation classification system, which have been integrated into the 2015 SVT guideline, and better align with the Institute of Medicine’s 2011 recommendations.

Updated Training Requirements For Clinical EP Released

The duration of required training for clinical cardiac electrophysiology will increase to two years, and the volume of procedures trainees should perform prior to completing their fellowship will increase, according to

an updated Advanced Training Statement released by the ACC, the American Heart Association and the Heart Rhythm Society, and published in the Journal of the American College of Cardiology. The statement complements the Core Cardiovascular Training Statement (COCATS 4), released earlier this year.

Societies Release Statement on the Future of Clinical Registries

While there has been a rapid increase in the number of clinical registries over the past decade, there are still broad clinical

areas and specific procedures that would benefit from the creation of a dedicated registry, according to a “Statement on the Future of Registries and the Performance Measurement Enterprise,” released Oct. 2 by the ACC, the American Heart Association and The Society of Thoracic Surgeons, and simultaneously published in the Journal of the American College of Cardiology. The statement examines the current state of clinical registries while acknowledging their future growth potential. “Registries can support the development, implementation, and evaluation of performance measures as tools for improving patient care and communicating meaningful information to patients regarding quality,” says Deepak L. Bhatt, MD, MPH, FACC, chair of the writing committee.

New Guidance Issued For Multivessel PCI, Thrombectomy in MI Patients

new focused update on primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI) was released Oct. 21 by the ACC, the

American Heart Association and the Society for Cardiovascular Angiography and Interventions, in collaboration with the

American College of Emergency Physicians, and simultane-ously published in the Journal of the American College of Cardiology. The report includes the setting of primary PCI and the relevant considerations for multivessel PCI

and thrombus aspiration. To accompany the update, the ACC developed a Primary PCI for STEMI Update Overview

Tool designed to educate physicians of the change in class of recommendation for patients with STEMI who are hemodynami-

cally stable. This tool is also intended to inform physicians of the change in the class of recommen-dation regarding manual aspiration thrombectomy for patients undergoing primary PCI.


ACC Council Addresses Need For Geriatric Cardiology Subspecialty

distinctive geriatric cardiology subspecialty is needed to respond to the complex

and unique cardiovascular needs of aging patients, according to a Council Perspective recently published in the Journal of the American College of Cardiology. The recommendation of a more robust geriatric cardiology subspecialty is the result of ACC’s Geriatric Cardiology Member Section’s examination of the future of geriatric cardiology and the evolution of the subspecialty. The authors note that while training for the subspecialty has yet to be defined, competencies would include “improved skills in diagnosis, risk management, disease management and the process of care.” They add that such training would equip providers upon completion with the skills needed to effectively care for older patients.

COUNCIL PERSPECTIVES FROM ACC’S MEMBER SECTIONS

CardiovascularTeam

MEMBER SECTION

ACC Councils Call For Greater Understanding of CV Effects of Smoking

W hile advancements have been made in the field of tobacco-related research, smoking cessation rates have slowed

in recent years, showing that there is still need for greater understanding of the cardiovascular effects of cigarette smoke exposure and electronic

cigarettes, according to a Council Perspective from ACC’s Prevention of Cardiovascular Disease Section Leadership Council and Early Career Council published in the Journal of the American College of Cardi-ology. According to the authors, in order to further reduce morbidity

and mortality from tobacco use, “it is essential to pursue knowledge of the effects of cigarette smoke exposure on the cardiovascular system at a molecular level.”

ACC Council Addresses Management of Arrhythmia-Induced Cardiomyopathies

E arly recognition of arrhythmia-induced cardiomyopathies results in symptom resolution for patients, according to a Council Perspective from ACC’s Electrophysiology

Council published in the Journal of the American College of Cardiology. The Council notes that in managing patients with arrhythmia-induced cardiomyopathy, clinicians should focus on eliminating the arrhythmia with catheter ablation and “attempt careful and aggressive control of rate and rhythm.” Long-term survival of the patient is likely following the resolution of the arrhythmia, with a low risk of sudden death.

ACC Council Perspective Offers Advice on NIH Awards

T he training of cardiovas-cular physician-scientists, while challenging, is

imperative for advancements in health care, according to a Council Perspective from ACC’s Academic Cardiology Section Leadership Council

and the Early Career Section Leadership Council, published in the Journal of the American College of Cardiology. In the paper, the authors

reflect on the current state of National Institutes of Health career development awards and give guidance to those applying.

ACC Councils Evaluate the Role of Clinical Pharmacists on the Cardiovascular Care Team

C linical pharmacists play an important role for patients on the cardiovascular care team, according to a joint Council

Perspective from ACC’s Cardiovascular Team Section Leadership Council and Prevention of Cardiovascular Disease Section Leadership Council published in the Journal of the

American College of Cardiology. In the joint perspective paper, the authors discuss the role of the clinical pharmacist, including training and certifications. They conclude that moving forward, “multidisciplinary organizations … should support

efforts to overcome legislative and compensation barriers so that pharmacists may be included in health care delivery models that allow full use of their education and training to provide high-quality patient care.”

Prevention ofCardiovascular

DiseaseMEMBER SECTION

Early CareerMEMBER SECTION

AcademicCardiologyMEMBER SECTION

FDA Updates• The U.S. Food and Drug Administration (FDA) expanded the approval of the

Edwards Lifesciences' SAPIEN XT transcatheter heart valve for aortic valve-in-valve procedures. The expanded approval comes from the one-year outcomes of the PARTNER II Valve-in-Valve Registry trial.

• The FDA has approved Boston Scientific's Synergy bioabsorbable polymer drug-eluting stent, the first device of its kind to receive approval.

• The FDA also recently gave 510(k) clearance for the robotic-assisted CorPath System from Corindus Vascular Robotics, Inc., intended for use during radial access percutaneous coronary interventions.


ACC Response to ABIM Report on Vision For Certification and MOC Programs in 2020

The American Board of Internal Medicine (ABIM) recently released a report entitled “A Vision for Certification in Internal Medicine in 2020,” that was drafted to inform the reshaping of ABIM’s Certification and Maintenance of Certification (MOC)

programs. The report, developed by the Assessment 2020 Task Force which assembled in 2013, aims to “develop a vision for the future of assessment in internal medicine and associated subspecialties” and to “stimulate discussion” around the future of certification.

According to Task Force Chair Harlan Krumholz, MD, SM, FACC, “the group sought to envision what the future could be and considered that what is possible

tomorrow may be very different from what can be done today.” With that in mind, the report includes three key recommendations that are similar to those being proposed by the ACC on behalf of its members, as well as

the rest of the internal medicine community. Specifically, the report proposes to: 1) replace the 10-year MOC exam with more frequent, less burdensome assessments; 2) focus assessments on cognitive and technical skills; and 3) recognize specialization.

The Assessment 2020 Task Force should be commended for its work over the last two years to gather input from stakeholders and develop this report that will no doubt further discussions around the future of MOC. The ACC is also appre-ciative of ABIM’s continued willingness to listen and learn from the internal medicine community. ACC’s input to date has resulted in the reversal of the double jeopardy provision; decoupling of the initial board exam from MOC participation; streamlining the ability for practitioners to get both CME and

MOC Part II credit; and delaying MOC Part IV, etc.As evidenced by the report, there is still much to be done despite the changes over

the last several months. The College understands the frustration of its members around the current MOC process and the issue continues to be a top priority for the College. In particular, the ACC strongly agrees with the report about the need to develop a new, externally-validated process for measuring competence to replace the 10-year exam with all deliberate haste. Additionally, the ACC is committed to continuing work with ABIM to research best practices for the maintenance and demonstration of competence with eventual links to patient outcomes, cost and cost-effectiveness.

The College is committed to finding a solution or solutions that best meet the profes-sional needs of clinicians, while also giving patients, the public and other stakeholders confidence that the care provided by their physicians is of the highest quality.

Stay tuned to the ACC in Touch Blog for updates on ACC MOC efforts. Additional MOC resources can be found at ACC.org/MOC.

Defining Optimal

Governance: A Key Priority For ACC’s BOT

The ACC has experienced significant growth and change over the last decade.

Much of this growth has come in response to changes in the health care environment, as well as changes to member demographics. Further, the trend toward hospital integration for a majority of ACC’s members has required the College to change and tailor its products and services to meet the different needs of members in these institutional environments.

Since the development of ACC’s comprehensive five-year Strategic Plan, designed to ensure that the College is doing the right things to fulfill its mission in this changing environment, ACC’s Board of Trustees (BOT) has made it a priority to review its governance and decision-making structures and processes. As a result of this review, the BOT recently approved several key principles of 21st century, optimal governance. They will use these principles to guide the devel-opment of performance metrics and a governance-implementation plan to be released by early 2016.

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Specifically, the report proposes to:

1. Replace the 10-year MOC exam with more frequent, less burdensome assessments

2. Focus assessments on cognitive and technical skills

3. Recognize specialization


Roberto Bolli, MD, FACC, Receives ISHR Lifetime Achievement AwardThe International Society for Heart Research (ISHR) presented the Peter Harris Distinguished Scientist Award to Roberto Bolli, MD, FACC, for his major discov-eries in cardiovascular science. Bolli serves as the chief of the division of cardiovascular medicine, director of the Institute of Molecular Cardiology, director of the Cardiovascular Innovation Institute, and vice chair for research in the department of medicine at the University of Louisville, Kentucky. Bolli’s research includes studying the use of stem cells in treating coronary artery disease patients and the use of ischemic preconditioning.

Cardiac Care, A HistoryIn his new book, The Heart Healers: The Misfits, Mavericks, and Rebels Who Created the Greatest Medical Breakthrough of Our Lives, James S. Forrester, MD, FACC, co-chair of ACC’s History Work Group, explores the history of cardiac care and how future advances will impact patients and practice. According to the publishers, the new novel is “a compelling chronicle of heart disease and its treatment, as well as a fascinating look at the future of cardiac research and the prevention of heart disease by a man who, himself, has been responsible for hugely significant advances in the field”. Forrester is the recipient of ACC’s Lifetime Achievement Award and serves as an emeritus professor and former chief of the Division of Cardiology at Cedars-Sinai.

ACC Trustee Appointed to Physician-Focused Payment Model Technical Advisory CommitteePaul N. Casale, MD, MPH, FACC, a member of ACC’s Board of Trustees (BOT),

has been appointed to the new Physician-Focused Payment Model Technical Advisory Committee, created by the Medicare Access and CHIP Reauthorization Act of 2015. Casale was nominated for this position by the ACC.

The 11 committee members, which were appointed by Gene L. Dodaro, the Comptroller General of the U.S. and head of the U.S. Government Accountability Office, will provide information and recommendations on physician payment models to the Secretary of Health and Human Services. “This committee will be a critical source of information and advice for the Secretary of Health and Human Services as the department considers new payment approaches for Medicare physician services,” said Dodaro. Casale, an interventional cardiologist, is chief of cardiology at Lancaster General Health. He is also a clinical professor of medicine at the Temple University School of Medicine and senior scholar in the department of health policy at Sidney Kimmel Medical College at Thomas Jefferson University. In addition to serving on ACC’s BOT, he is active on several College committees.

Three ACC Members Receive Glorney-Raisbeck Fellowship in Cardiovascular DiseasesJoshua M. Lader, MD, a fellow in training at the New York University School of Medicine; Adam Castaño, MD, a fellow in training at Columbia University; and Amy Kontorovich, MD, a fellow at Mount Sinai Medical Center, received the Glorney-Raisbeck Fellowship in Cardiovascular Research from The New York Academy of Medicine. Each fellowship award supports innovative research projects in the field of cardiovascular disease. Below are the fellows’ research topics:

Lader: “Mechanisms of K(ATP) Channel Activation in Adrenergically-Mediated Atrial Fibrillation”

Castaño: “Technetium Pyrophosphate Cardiac Imaging to Determine if Transthyretin Cardiac Amyloidosis Explains Paradoxical Low-Flow Severe Aortic Stenosis”

Kontorovich: “Modeling Myocarditis with Human Induced Pluripotent Stem Cells”

NOTABLE NEWS

In Memoriam:

Jack Matloff, MDThe founding chair and chair emeritus of Cedars-Sinai’s Department of Cardiothoracic Surgery, Jack Matloff, MD, passed away at the age of 82. During his long and inspirational career, Matloff created heart and lung transplant centers at Cedars-Sinai, served as the president of The Society of Thoracic Surgeons, and co-founded a series of health care executive courses at the Kennedy School of Government at Harvard University. Amongst his many awards for his dedication to service and cardiovascular health, Matloff received the Jerusalem Medal, the highest honor available to a foreign national, for his work at the Jesselson Comprehensive Heart Center at Shaare Zedek Hospital in Jerusalem, Israel. Matloff will be greatly missed by his colleagues, patients, friends and family.


ACC Announces New Shared Decision Aid

The ACC has launched a new decision aid for treating non-valvular atrial fibrillation

(AFib) patients with anticoagulation. Blood Thinners For Atrial Fibrillation: A Smart Decision Guide allows cardio-vascular care team members to have more effective conversations with their patients about their treatment options for anticoagulation by ensuring that patients have a better understanding of

their CHADS2VASC2 stroke risk score and their HAS-BLED bleeding risk. The Shared

Decision guide is part of ACC’s Anticoagulation Initiative, a comprehensive quality effort, to help facilitate a greater

understanding of AFib treatments and practice patterns, particularly given

an increasing number of new anticoagulant treatment options entering the marketplace.

ACC.org/ACCinTouchFollow @ACCinTouch on Twitter for breaking

news from all of the top cardiovascular meetings. Stay up to date on the latest news about #ACC16, including registration, featured science and more.

Interested in receiving immediate updates from the ACC? "Like"

the ACC’s Facebook page to gain access to news, meeting coverage, special promotions, and more.

ACC.org/ACCinTouchRecent posts on the ACC in Touch Blog include a blog by

Richard J. Kovacs, MD, FACC, member of ACC’s Board of Trustees, on the U.S. Food and Drug Administration’s approval of two PCSK9 inhibitors, user fee act reauthorization and off-label marketing. Others topics include a post authored by Kathy Jenkins, MD, MPH, FACC, on pediatric cardiac care and global health, and a post authored by Christie M. Ballantyne, MD, FACC, and Kim Birtcher, MS, PharmD, AACC, on the recent LDL: Address the Risk Think Tank. Check out the ACC in Touch Blog for more insights on the latest in cardiology.

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The ACC has announced that it will launch two new clinical registry programs to track real world outcomes for the treatment and prevention of stroke in patients with atrial fibrillation (AFib). The two new registries, which will focus on AFib

ablation and left atrial appendage occlusion (LAAO), will bring ACC’s total number of hospital and outpatient registries under the NCDR umbrella to 10. The LAAO Registry, will capture data on LAAO procedures to assess patient selection, procedural indications and outcomes, as well as short- and long-term safety. The AFib Ablation Registry will assess the clinical

characteristics, acute management, and outcomes of patients undergoing atrial fibrillation ablation procedures. “With a growing prevalence of AFib and a proliferation of options for treatment and stroke prevention in AFib patients, the ACC saw a need for real-world data to track and evaluate the use of these

technologies,” said ACC President Kim Allan Williams Sr., MD, FACC. “Data derived from these registries are expected to inform practices and improve patient outcomes.”

Latest Interventional Science From TCT 2015

The ACC was on-site at the 2015 Transcatheter Cardiovascular Therapeutics (TCT) meeting in San Francisco, and provided coverage of the

hottest interventional trials and news. Results of the RIVER-PCI trial showed that ranolazine did not reduce the incidences of ischemia-driven revascularization or hospitalization in chronic angina patients with incom-plete revascularization following percutaneous coronary intervention. Meanwhile, results of BRAVO 3, which was simultaneously published in the Journal of the American College of Cardiology, found that bivalirudin may be a safe and effective alternative anticoagulant in patients unable to receive heparin while undergoing transcatheter aortic valve replacement.

AFib Ablation RegistryTM

ACC IN TOUCH

For full coverage from the meeting, visit ACC.org/TCT and head to the ACC in Touch Blog for daily wrap-up videos. Look out for ACC coverage from the American Heart Association’s Scientific Sessions at ACC.org/AHA2015. Follow @ACCinTouch for the latest updates.


December 4 – 5 How to Become a Cardiovascular Investigator Heart House, Washington, DC

Course Director: Valentin Fuster, MD, PhD, MACC

ACC.org/CVI2015

December 11 – 13 New York Cardiovascular Symposium New York Hilton Midtown, New York

Course Director: Valentin Fuster, MD, PhD, MACC

ACC.org/NYCVSymposium

2016

January 16 – 20 Cardiovascular Conference at Snowmass The Westin Snowmass Resort, Snowmass, CO

Course Director: Carole A. Warnes, MD, FACC

ACC.org/Snowmass2016

February 6 – 7 2016 Women in Cardiology Section Leadership Workshop Heart House, Washington, DC

Course Directors: Sandra J. Lewis, MD, FACC Claire S. Duvernoy, MD, FACC

ACC.org/WomenLeaders

February 15 – 19 38th Annual Cardiology at Big Sky Huntley Lodge, Big Sky, MT

Course Directors: Patrick T. O’Gara, MD, MACC, FACC Kim A. Eagle, MD, MACC

ACC.org/BigSky2016

February 18 – 20 Cardiovascular Summit 2016 Cosmopolitan Hotel, Las VegasCourse Director: Howard Walpole, MD, MBA, FACCACC.org/CVSummit16

Educational Courses

International and Chapter Meetings

November 13 – 14 Washington Annual Chapter Meeting Seattle, WA

November 13 – 14 Idaho Annual Chapter Meeting Boise, ID

November 13 – 15 Global NCD Alliance Forum Sharjah, United Arab Emirates

November 14 Northern New England Annual Chapter Meeting Portsmouth, NH

November 20 – 22 Georgia Annual Chapter Meeting Greensboro, GA

November 21 Mid-Atlantic Annual Chapter Meeting Washington, DC

November 21 – 25 Mexican Society of Cardiology Acapulco, Mexico

December 3 – 6 Cardiological Society of India Chennai, India

December 4 – 7 Interamerican Society of Cardiology/Chilean Society of Cardiology and Cardiovascular Surgery Santiago, Chile

December 11 – 14 Italian Society of Cardiology Rome, Italy

December 18 – 20 California Annual Chapter Meeting San Francisco, CA

2016

January 28 – 31 Association of Physicians of India Annual Congress Hyderabad, India

February 5 – 7 Alaska Annual Chapter Meeting Anchorage, AK

February 12 – 15 Saudi Heart Association Riyadh, Saudi Arabia

February 26 – 27 Istanbul Chapter Meeting Istanbul, Turkey


Do Your Part For Diabetes Education

As November kicks off Diabetes Awareness Month, it’s a good time to be mindful of ACC’s tools and resources available to help clinicians do their part to prevent and treat this disease. CardioSmart.org has a number of resources to help patients with diabetes manage their disease, including this infographic, educational fact sheets, special patient fitness challenges and more. Additionally, a special ACC.org Clinical Topic Collection focused on diabetes and cardiometabolic disease features the latest news, expert commentary and clinical guidelines in one place. Finally, the ACC is excited to be part of the Diabetes Collaborative Registry, which is helping to change the way diabetes is understood and treated by uniting physicians, endocrinologists, cardiologists and other diabetes care providers around the shared goal of improving diabetes care and patient outcomes. Learn more about the registry at TheDiabetesRegistry.org.

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