President’s page: Cardiologists without borders

In the week following the September 11 attack, I presented a lecture to members of the Japanese College of Cardiology in Hiroshima. But I never left Indianapolis. My flight had been cancelled, so I turned to my information technology guru at Indiana University, who, with the help of his counterpart in Japan, established a videoconferencing link-up. The presentation was live at both ends through a Japanese interpreter, followed by a question-and-answer period. Everything worked quite well and the only downside was that I had to give the lecture at midnight, Indianapolis time, for the 2:00 pmJapanese program!

This story illustrates two themes that I believe will become increasingly important in the post-September 11 world. First, it demonstrates technology’s ability to help us transcend geography and connect with cardiologists almost anywhere on the planet, without leaving home. I suspect we will use such technology more frequently in the coming months and years. Equally significant, it illustrates the importance of reaching out to our colleagues in other nations. Whether they’re in Indianapolis or Hiroshima, London or Cairo, cardiologists around the world are becoming united in defeating the common enemy—cardiovascular disease. And in so doing, we also have the unique opportunity to use cardiology and friendship with our international colleagues as a nonpolitical way to help mend a fractured world.

Long thought of as an outgrowth of our Western lifestyle, cardiovascular disease is now advancing in the developing nations as well. According to the World Heart Federation, cardiovascular diseases are the leading cause of death worldwide and accounted for nearly one-third of the estimated 56 million deaths in 1999.

I believe the American College of Cardiology (ACC) can and should take a leadership role in the international battle against cardiovascular disease. Such an initiative capitalizes on the ACC’s long history of international involvement. In fact, the College is international right down to its very roots. Our founder and first president, Franz M. Groedel, MD, began his cardiology career in Europe but fled to the U.S. after Hitler’s rise to power. The College’s interest in international affairs has continued ever since.

The International Education Committee founded by Eliot Corday, MD, in 1961, is a perfect example. As one of the ACC’s founders described it, the committee was “a sort of medical Peace Corps,” helping to educate cardiovascular specialists around the world for more than three decades on the developments in the field. To accomplish these goals, the International Education Committee sent expert ACC members around the globe to deliver circuit courses, and they used satellite television “telebridges” to enable physicians from the U.S. and other countries to exchange information. These programs reached tens of thousands of physicians in dozens of countries, including the Soviet Union, Iran, and Pakistan. A 1986 teleconference in India reached an estimated one billion viewers in India and the surrounding areas. In the 1970s, I participated in such a trip to South America with three other specialists, Tom James, Floyd Loop, and Sam Kaplan, and we all found it extremely rewarding. We need to revitalize our educational outreach to medically underdeveloped countries in order to make this important contribution to their educational efforts and also for the wonderful goodwill such programs engender. Many of our clinician members have already begun to pave the way by undertaking goodwill missions abroad. Members of the ACC Puerto Rico Chapter, for example, journeyed to South Africa in 2000 to present a cardiac ultrasound machine and explore possible collaborations, while members of the ACC International Committee traveled to Thailand to share their expertise with colleagues there. Many others have undertaken similar trips to places like Tibet and Nicaragua. In other words, the sentiment for activities such as these is already there. Now we must foster it.

In addition to goodwill missions, we must also resolve to work closely with international medical societies. The recently published Guidelines for the Management of Patients with Atrial Fibrillation, for example, was the result of a collaboration among the ACC, the American Heart Association, and the European Society of Cardiology (ESC). The atrial fibrillation guidelines followed by one year the ACC/ESC consensus document on the redefinition of myocardial infarction. “Physicians across the globe should unify through their professional organizations to fight the battle against cardiovascular disease,” wrote ACC Past President George A. Beller, MD, and ESC Past President Lars E. Rydén, MD, at the time of the consensus document’s release. This statement is consistent with the mission of the ACC’s International Committee, which is to enhance cardiovascular health through sustained collaboration and exchange of knowledge and resources with specialists in cardiovascular care. Large multicenter trials, such as the CURE trial, which included more than 12,000 patients from Canada, Europe, and the U.S., also help bind cardiologists internationally.

Now, I’m hoping that the College can coordinate these international efforts and help members have an even bigger impact abroad. As I write, the ACC Task Force on Developing an International Strategy, chaired by Robert Jones, MD, is creating a series of recommendations to present to the Board of Trustees for approval. I would like to see the College make even greater use of technology than we already are. With Internet and satellite technology, we could transmit our Annual Scientific Session and other educational offerings worldwide. In addition to increasing our audience internationally, such electronic transmissions would also serve cardiologists at home who are unable to travel to the meeting. We could also schedule a kind of Virtual Grand Rounds that could be delivered on a regular basis, using experts gathered for ACC symposia at almost any site. For example, cardiovascular specialists in the U.S. and abroad could participate in live interactive programs from the Snowmass Conference, the New York Cardiovascular Symposium, or anywhere else in the world. In addition, that conference could be archived on our Web site and accessed later at the user’s convenience. Telemedicine could be used in other ways as well. Various types of communication technologies could allow cardiologists around the world to share clinical information or scientific interests. The College could identify members with certain expertise or interests and pair them with colleagues abroad. Many of these link-ups could be made using our new Web site, ACCardio, which I mentioned in a previous President’s Page. We might also offer clinical care opinions. For example, if a cardiologist here or abroad had a complex patient and wanted an opinion from one of our ACC experts, the history, physical, and pertinent laboratory data could be transmitted via the Internet and be evaluated by an ACC leader in the patient’s problem area.

In discussions about future endeavors, I think we would miss out by not including a very important workforce, our ACC retirees. Many of our retired members are vigorous and well tuned to modern cardiology. The College could establish a program that would link retired cardiologists to international communities. Retirees who meet certain requirements could travel abroad for short or long time periods to serve as role models, teachers, or practicing cardiologists. We might consider establishing programs to share expertise, training, and resources, possibly in conjunction with the World Heart Federation or the American Association of Thoracic Surgeons, and create “centers of excellence” in developing countries. The College could also serve as a clearinghouse for donated journals, textbooks, computers, and medical supplies from individuals and industry. These items could be of tremendous benefit to physicians in countries with limited resources for technological advancements.

One initiative that is already providing vital international links and service is Heartbeat International. Begun by Henry McIntosh, MD, in 1984, this organization works with Rotary International to provide pacemakers to needy patients in developing countries. The ACC has made contributions to support this organization, and I think the College’s participation in this wonderful humanitarian initiative could greatly enhance the good it does.

Efforts like these benefit us as well as our peers abroad. For one thing, international involvement helps keep us from becoming parochial in our outlook. International scientists play a vital role in research. Meetings of foreign societies abroad are becoming increasingly important, and more and more international physicians participate in our own Annual Scientific Session. While international physicians make up about 12% of the College’s membership, they represented more than 40% of the attendees at this year’s annual meeting. More than 60% of the articles submitted to this Journal in 2001 came from international scientists. We would highlight international participation in two ways. First, we will recognize the contributions of an individual dedicated to benevolent efforts in medically underdeveloped countries with an International Service Award, and we will recognize international scientists and clinicians with an International Lectureship at our Annual Scientific Session. We could also establish a membership category for international ACC members and fellows in training.

All Americans—not just physicians—stand to benefit from the improved international relations that such collaborations engender. America’s leaders have long recognized that our humanitarian efforts have diplomatic as well as clinical goals. As President Ronald Reagan told the College in 1983, “By sharing your knowledge and skills with physicians of other countries, you have not only helped to improve medical care… you have also served as an ambassador of goodwill.” A landmark 1985 teleconference between American and Soviet physicians, for instance, helped ease years of Cold War tension. The early circuit courses were actually cosponsored by the U.S. State Department.

In today’s turbulent times, creating bonds of friendship across cultures is especially important. While borders facilitate cartographers in making maps, in medicine they serve no practical use and must be spanned by human bridges that keep us connected to our common goal of better prevention and treatment of heart disease. Expanding on the “internationality” of the College can contribute to that effort.

• American College of Cardiology