Author + information
- Kim Allan Williams Sr., MD, FACC, ACC President∗ ()
- ↵∗Address correspondence to:
Kim Allan Williams, Sr., MD, FACC, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
The influenza pandemic of 1918 was the one and only time in the last century that cardiovascular disease was not the leading cause of mortality in the United States. Although no one knows exactly how many people died from influenza during that year, the total number of global deaths is estimated to be at least 20 million. Of this number, roughly 675,000 were Americans (1).
According to the U.S. Department of Health and Human Services, the influenza pandemic occurred in 3 waves, with the first occurring in the spring and summer of that year as World War I came to an end and soldiers started returning home from Europe. The second wave occurred with an outbreak of severe influenza in the fall of 1918, and the final wave occurred in the spring of 1919 (1).
What made the pandemic so different from other outbreaks is that mortality was not limited to just the young and elderly. Healthy men and women between the ages of 20 and 40 years also succumbed. Perhaps this was because it was a period at the end of war during which limited food supplies had led to nutrition deficiencies and suppression of immune systems. Another theory is that the immune system was part of the problem, with the virus creating an inflammatory cascade that overwhelmed the host.
Men traveling home from Europe brought the illness back to their families. The influenza virus also spread quickly at a time when many communities were facing shortages in trained medical personnel due to the war. The Public Health Service had fewer than 700 officers at the time and was unable to keep up with the number of requests for nurses and doctors. Those medical personnel that were sent to provide aid often became ill themselves or arrived at their destination unprepared to provide meaningful assistance to the large number of people that needed it—many of whom were in makeshift emergency hospitals because of a shortage of hospital beds.
Since then, the United States and the rest of the world have clearly come a long way with treating and preventing influenza, thanks to vaccine research and development and large-scale public education campaigns that were able to spread quickly in later years due to wider use and production of radios and television. Today, the Centers for Disease Control and Prevention can get information into the hands of the public even more quickly (in a matter of minutes, if not seconds) with the widespread use of mobile devices and social media.
Of course, this also means that cardiovascular disease has held steady as the leading cause of death in the United States and around the world in all of the years after the influenza pandemic. Although we have made significant gains over the last 6 decades in reducing cardiovascular mortality and preventing and treating the disease, we have not been successful in taking it down a notch. I think it is time to finally cede this position. The goal of becoming #2 is well within our grasp—more so than ever before. However, if we are serious about doing it, we have to work together and build public trust in our efforts to be successful.
A paper published this past October in the New England Journal of Medicine examined the declining standing of U.S. physician leaders in the public eye since the 1960s. In 1966, 75% of Americans surveyed had great confidence in physicians, but by 2012 only 34% shared this outlook (2). This lack of trust places the United States well behind other developed countries like Turkey, France, Finland, Britain, the Netherlands, Denmark, and Switzerland, where >75% of adults agree that doctors could be trusted (2). The authors, who are affiliated with the Harvard School of Public Health and the Harvard University Program in Health Policy, suggest that this lack of trust may diminish the influence of physicians in decision-making around the next stages of health system reform.
The American College of Cardiology (ACC) is committed to working with its members to improve public trust, whether it is showing that we can and will hold each other accountable for providing appropriate, evidence-based care; involving our patients in their care decisions so that they best understand the best course of treatment and why; or using data from registries like those in the National Cardiovascular Data Registry (NCDR) to improve patient outcomes and close gaps in care. We must own our actions—both good and bad—and be visible to the public and our patients in positive ways that affect their lives.
The Harvard study showed that poor people in the United States have a substantially lower level of trust in the entire health care system. Adults from families earning <$30,000 were significantly less trusting of physicians and less satisfied with their own medical care (2). We can change this by promoting our successes in closing gaps in care, such as reduced door-to-balloon times in hospitals around the globe and reductions in unwarranted hospital readmissions for heart failure patients. Partnering with community groups and other specialty societies and working closely with our own cardiac care team members on patient education and outreach also offers opportunities to build trust on the ground where people live and work. Our CardioSmart online portal and live programs targeted at underserved communities are great examples of on-the-ground, patient-centered efforts.
William Butler Yeats is often quoted as saying: “Education is not the filling of a pail, but the lighting of a fire” (3). Let us light a fire! Let us educate our lawmakers, regulators, payers, professional certification boards, our patients, their families, and the media about what we do and how and when we do it. We have a lot to be proud of—continued declines in mortality from cardiovascular disease; transformational new research, some of which debuted as part of the ACC’s recent Annual Scientific Session in San Diego, California; innovative new global partnerships that are harnessing the power of data; and new digital technologies to reduce disparities in care and provide easy access to clinician and patient tools and resources previously accessible by only a few. The list goes on. We need to do a better job touting these successes.
We also need to tout what it means to be a fellow or associate of the American College of Cardiology (FACC or AACC)—to our patients, our lawmakers, and others in our community. We are best positioned to show by our actions and our words that these 4 letters demonstrate a commitment to providing the best possible care to patients—and we should be trusted because of them.
Finally, and most importantly, ACC members must take advantage of being part of the College. ACC members are the College and are at the core of its mission. The College does not exist for its own sake. Guidelines and appropriate use criteria, educational products, programs, member sections and Chapters around the globe, JACC journals, health policy, and advocacy efforts are all designed to help cardiovascular professionals provide the best care possible throughout their respective careers.
Take advantage of this! We are stronger together than we are working separately. As someone with a passion for tennis as well as cardiology, I always like the following Arthur Ashe quote: “From what we get, we can make a living; what we give, however, makes a life” (4). Each and every member of the ACC has made “giving” their profession—their life choice. We have made a commitment to give back to the community where we live and work, and we are giving back longer, healthier lives. The College and I are here for you on each step of your journey. Use us. Take advantage of our tools and resources. Get involved in committees, sections and councils, chapters, and advocacy. Each of us separately is a spark, but together we are a fire. Let us make cardiovascular disease #2 together.
- American College of Cardiology Foundation
- ↵United States Department of Health and Human Services. The Great Pandemic: The United States in 1918–1919. Available at: http://www.flu.gov/pandemic/history/1918/the_pandemic/index.html. Accessed March 6, 2015.
- ↵BrainyQuote.com. William Butler Yeats quotes. Available at: http://www.brainyquote.com/quotes/quotes/w/williambut101244.html. Accessed March 6, 2015.
- ↵BrainyQuote.com. Arthur Ashe quotes. Available at: http://www.brainyquote.com/quotes/quotes/a/arthurashe105661.html. Accessed March 6, 2015.