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I read with great interest the editorial by Fuster (1), detailing both expanded recommendations to address the global burden of cardiovascular disease and the necessity for evaluating implemented recommendations by measuring outcomes. These are important steps to address a crisis unappreciated by the majority of U.S.-based cardiologists. However, the American College of Cardiology (ACC) and its members can do more to address current needs.
Cardiovascular disease in the developing world is as much a disease of poverty as newfound affluence. Carbohydrates are cheap and available. Local agriculture is more climate dependent than in the United States and the cost of modern farming practices limits production. Knowledge of a heart healthy diet and the acquisition of that diet are wholly separate. Epidemiologic assessments and disease prevention incompletely addresses existing clinical needs. The treatment of disease at the local level could be augmented by cardiologists from the developed world providing their time, expertise, and interest. There will never be enough local physicians to provide these services due to both emigration and the overwhelming state of third world general medical care. Groups such as doc2doc and Pacemaker International are but 2 examples of small groups making a difference.
The ACC can be a source for regions or communities seeking advanced cardiovascular care. It can identify members with an interest in providing volunteer services in a tangible, sustainable, and local manner. An ACC committee on International Volunteer Cardiology comprising physicians with volunteer experience might address feasibility concerns and individualize a response team based on local needs and available members. Can services such as pacemaker insertion, peripheral revascularization for limb salvage, and even low-risk coronary or valve intervention be offered without full service cardiovascular surgery at acceptable risk by experts in their field? Can telemedicine create a virtual hospital with a team that is known to local physicians from previous missions expediting referrals and optimize the time on the ground by visiting cardiologists? Perhaps a forum at the annual meeting focusing on these issues to chronicle the successes and failures of those involved in provision of volunteer cardiology to the underprivileged and disadvantaged could provide insights. This should highlight not how to do more with more but how to do something with very little.
Confronting the global cardiovascular crisis requires more than education. It requires what cardiologists do best. Rolling up our sleeves and getting our hands dirty.
- American College of Cardiology Foundation