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April Greetings
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This week brings Good Friday, Easter, and Passover, for many of us a time of observation and reflection. May it be a time to be with family and loved ones, a time for reflection, and I send my thanks to you all for the care you give to our patients. We are blessed for that opportunity, and they are blessed by your care.
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April News
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Dear Oregon ACC members,
The 2012 ACC Chicago meeting brought together the wonderful combination of science, learning, and time to share with many new and old friends from around the country. I have asked some of the OHSU fellows and other Oregonians attending the meeting to share their experiences and perspectives, and will add a few thoughts of my own.
The meeting was preceded by the Board of Governor's meeting. Your voices were heard as the Board of Governors and the Board of Trustees grappled with challenges inherent in the limitations of current appropriate use criteria and terminology. With the BOG garbed in white "Team BOG" shirts, and the BOT sporting black "Team BOT", the BOG articulately and with great passion, presented the membership concerns that the AUC, Rand terminology: appropriate, uncertain, and inappropriate, create misconceptions among payers that uncertain is inappropriate, and should not be done. This is leading to denials, and worse, the implication that we are mistreating patients. Defenders of the terminology heard our message loud and clear that by developing these criteria, we were looking to support quality and best practices, and not punish us for uncertain decisions, uncertain because there is a lack of randomized controlled data. We do not have research on all of the more than 3000 scenarios created, nor will we. Such suggestions as "helpful, possibly helpful, and not helpful" were presented to the BOT as alternatives to the current terminology.
Later that afternoon, the BOG and BOT removed the team shirts and gathered for what was for me, the highlight of the ACC meeting, a session on the "Legends of Cardiology," with Dr. Jane Somerville stealing the show. The session featured 5 "Legends" including Dr. Eugene Braunwald, Dr. Valentin Fuster, Dr. Antonio Colombo, Dr. Magdi H. Yacoub, and Dr. Somerfield.
Dr. Somerfield, feisty, irreverent, a brilliant physician and story teller, resonated with me, as she shared her pioneering work in GUCH (Grown Up Congenital Heart disease) but also especially as she told of the challenges she faced as a woman in cardiovascular medicine more than 50 years ago. She spoke about her life with cardiac surgeons she has known. Of course Oregon's Dr. Albert Starr appeared in several of her photos at surgical occasions from around the world throughout her career. A self-proclaimed troublemaker, she regaled the audience with stories of her schooling at a "boys school" during the war, preparing her for future challenges, her terrible surgical talent-her hands and brain were not connected-but through it all a passion for learning how to save the patients with lethal congenital heart disease.
I found it fascinating that all of these "Legends" were born outside the United States. An engagement in developing world-wide prevention and population health is a common "second career" direction for the new goals of these giants.
Looking back, and then looking forward, I was moved from the acknowledgement of the contributions of these heroes to a fabulous segment of the meeting, the "Innovations" track. Reigning in healthcare delivery excesses, reducing costs, maintaining quality, managing delivery transformation, but not losing our focus on innovation seems to be at the core of our challenge going forward.
Congratulations to Dr. Sanjiv Kaul who was honored with the 2012 Distinguished Scientist Award (Translation Domain) in recognition of his major contributions to the advancement of scientific knowledge. Dr. Kaul received his award at the annual Convocation ceremony.
Below, Councilor Ty Gluckman relates his comments on ACC12.
For me, this year's ACC 2012 meeting was packed with lots of wonderful learning opportunities, including late breaking clinical trials, sessions dedicated to lifelong learning, and interactive poster presentations. It also afforded me the chance to catch up with former colleagues and enjoy some of the great sites in Chicago. One of the most rewarding things about attending the meeting, though, was the chance to participate in ACC committee meetings.
I currently sit on three ACC national committees: the Cardiosource editorial board, the ACC Point of Care advisory group, and the Best Practice Quality Initiatives subcommittee. Each provides a distinctly different experience, with the chance to learn much more about the inner workings of the College.
As many of you know, Cardiosource (www.cardiosource.org) is the primary website for the ACC and is responsible for providing an electronic portal into all of its activities: Science and Quality, Certified Education, Advocacy, Meetings, and Practice Management to name just a few. My responsibility is to Science and Quality and more specifically, involves managing all of the guideline and clinical documents that the College produces. Because one third of all hits on Cardiosource involve a guideline or clinical document search, it is important that we help providers find the information they need as easily as possible. Much of this past year has been spent indexing each clinical document to a Learning Pathway, redesigning the A to Z search tool, and working with third parties to improve the College's search engine.
The ACC Point of Care (POC) advisory group sprung from the frustration shared by many of us in trying to navigate lengthy guidelines and clinical documents to find simple clinical answers. While Cardiosource provides access to all ACC guidelines and clinical documents, these are cumbersome to sort through and unless you know exactly where to look, the search for the answer to a clinical question can be more frustrating than fulfilling. Most of our committee time has been spent refining a new search tool called CardioCompass, which is currently live in a beta-version on the Cardiosource website. This tool helps to search guideline documents and find specific answers to questions posed. It is a significant move in the right direction of providing real-time answers to customized searches.
The Best Practice Quality Initiatives subcommittee is arguably one of the most demanding, but also rewarding groups that I have had the pleasure of sitting on in the ACC. The charge of the subcommittee is to oversee the development and dissemination of best practice solutions to support quality improvement efforts in cardiovascular clinical care. There exists strong interaction between this group and other quality programs (e.g., CPIP, H2H, D2B, FOCUS, Patient-Centered Care) and educational initiatives (e.g., PI-CME activities, life-long learning). Thus far, the group has built toolkits for heart failure and atrial fibrillation to close prominent performance gaps in these areas.
While dedication to these committees requires considerable time, they afford the opportunity to meet wonderful individuals from across the country. I encourage each of you to not only get involved in the ACC here in Oregon, but also nationally as well. You will not be disappointed.
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One of our OHSU Fellows, Sajeevani Kim, reports back:
My main objective at ACC was to go to talks that would help me with the Boards' preparation (in a few months!). I went to several 'core/lifelong' series of talks which gave overall reviews. Overall, at the end of these lectures, I felt confident with my knowledge in general CV medicine and truly felt that OHSU had trained me well!
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And expressing the essence of the meeting, Dr. "Ravi" Pasala Ravichandran shared the following:
ACC 12 at CHICAGO
These cardiologists know how to have a party. It was certainly good cardiovascular training to walk from one end to another looking for the correct room. I attended two committee meetings (ACCHF and Surgeon's scientific council) and as many talks as possible before the bar opened. One striking observation was the involvement of cardiac surgeons in almost all activities pertaining to innovation and collaboration in cardiovascular care. In keeping with the same theme I attended "The Legends in Cardiology' talks by Magdi Yacoub and Jane Summerville. They were both brilliant. (Looks like the British are back).
There were a lot of discussions on TAVI, Atrial fibrillation, Heart failure, LVADs, CRT, Ischemic MR, etc, all cutting edge topics. There was significant focus on guidelines and appropriateness of care. There was feeling that collaboration will lead to more appropriate care.
I attended a few combined sessions of Spanish, Indian and Pakistani cardiology societies. What a great idea from ACC! It was nice to know we all have same challenges in the future.
I liked a few talks and topics with the intention of focusing on them in our next year symposium. The session "Sex, Scoring, Sadness, Statins and Surgery" was interesting. I avoided all talks on PCI except presentation of ASCERT study in Surgeons council that showed the advantage of CABG over PCI for stable angina. The IHSS practice guidelines session was great. The talks on Leadership and Governance were very good. The Quality of care and Outcomes topic were great, but sad to see very few people attending those talks! The talks on Myocardial and pericardial disease were a great reprieve from PCIs, LVADs, TAVIs and CRTs.
Lessons learned -
In the future, all the topics in cardiovascular care should involve multi-disciplinary approach. Surgeons should invite cardiologists (legends) to speak in their meeting. Always discuss topics on leadership, quality of care and Outcomes even if nobody attends. Useful ideas for our next symposium.
Thanks, all, for sharing. Sandy
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SAVE THE DATE ON YOUR CALENDAR....
For the 9th Annual
Oregon Cardiovascular Symposium
June 2 - 3, 2012
Doubletree Lloyd Center Hotel
Portland, Oregon
| Another outstanding cardiovascular education event awaits you on June 2 - 3, 2012 at the 9th Annual Oregon Cardiovascular Symposium.
Online Registration will open next week. Plan for a full day of CV education on Saturday, June 2nd and 1/2 day on Sunday, June 3rd.
The Symposium has been approved for CME, CEUs and AAFP credit for Family Practice MDs.
Here's a quick look at the topics being presented and the superstar presenters doing the teaching:
Cardiovascular Screening Imaging Tests in Asymptomatic Patients - Digging for Gold or Asking for Trouble?
Presenter TBD
Cardiovascular Effects of Cancer Therapy: The Culprits and New Screening Approaches
Ed Yeh, MD, The Univ. of Texas - MD Anderson Cancer Ctr.
Case Presentations that May Change Your Practice
OHSU Cardiology Fellows
ACS in the Era of Choices for Antiplatelet and Antithrombotic Therapy
David Moliterno, MD, Univ. of Kentucky Medical Center
Beyond Resuscitation for Out of Hospital Sudden Cardiac Death - Angio and ICD for All?
John DiMarco, MD and David Moliterno, MD
Behind the Surgical Curtain - Applying Knowledge of OR Procedures to Recognize Post-op Complications
Michael Mack, MD, Baylor Health
Percutaneous Options for Mitral Regurgitation - Clip, Push and Spear
Saibal Kar, MD, Cedars-Sinai
The Burning Question: When to Ablate Atrial Fibrillation? And How?
John DiMarco, MD, Univ. of Virginia
The Palliative Pump: Ventricular Assist Devices
Ranjit John, MD, Univ of Minnesota - CT Surgery
Problem Solving with Pacers and ICDs
Eric Stecker, MD, OHSU
Peripheral Arterial Disease - Diagnosis and Management - Greg Moneta, MD, OHSU
The Multidisciplinary Valve Clinic - What is a Heart Team? - Michael Mack, MD, Baylor Health and Saurabh Gupta, MD, OHSU
Online Resources for the Clinician
Mark Huth, MD, Southern Oregon Cardiology
Cardiovascular Disease in the Pregnant Patient
Martha Grogan, MD, Mayo Clinic
Defining Appropriate Use of PCI in 2012
Ralph Brindis, MD, Past President ACC, Kaiser Permanente
Lipoproteins, Particle Size, Particle Number, and PLA2 - Is it Worth the Effort?
Richard Wright, MD, Pacific Heart
Ethics and End-of-Life Approaches to the Patient with End-stage Cardiovascular Disease
Eric Fromme, MD, OHSU and Sarah Goodlin, MD, VA Hosp.
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SAVE THE DATE
For a Special Working Heart Club Dinner
June 27th - Location TBD
| If you are in the cath lab, either doing coronary work or EP, this Heart Club is for you. We will engage and challenge Oregon Cardiology to take ownership of the data which is going to be driving our quality measurements from insurers and the public. Currently this data is being collected and driven by the hospitals. We need to take over this important part of our care.
Dr. Ralph Brindis is really the father of the NCDR, and he will lead us to the excellence we know Oregon can achieve.
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Mended Hearts and the Oregon ACC
| Mended Hearts Align with ACC Chapters Thanks to all the chapters who are doing such exceptional work in coordinating efforts with the Mended Hearts Chapters in their states! As our members have begun interacting with their ACC chapters, a few chapters have asked for an article with more information about the alignment and Mended Hearts. This article is located here.
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Support the ACC PACs
National and Chapter
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I WOULD ASK ALL OF YOU TO GIVE TO OUR ACC PAC-THOSE DONATIONS HELP KEEP OUR VOICE ALIVE. In this election year we need to keep our contacts and lines of communication open. The radiologists, hospital lobby, pharma lobby and plaintiff's lawyers are out for different goals, and are way ahead of us in funding their PACs. Please note, in Oregon, each of us is allowed a $50 tax credit, or $100 for couples filing jointly.
http://oregontaxcredit.com/
Link to Oregon ACC PAC
Link to ACC National PAC
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