A Moment of Reflection on the Past and Future of the Association of Black Cardiologists

The History, Legacy, and Relevance of a Socially Conscious Organization Dedicated to Cardiovascular Health Equity

On April 7, 2015, Elijah Saunders, MD, a pioneer in hypertension and a founding member of the Association of Black Cardiologists (ABC), passed away after a brief illness. Four days later, his close friend and colleague Levi Watkins, Jr., MD, the first physician to implant an automatic defibrillator, and also early member of the ABC, died. Dr. Watkins was scheduled to speak at the services for Dr. Saunders, but he succumbed abruptly to heart disease. More recently, David Bush, MD, a pioneer in cardiac computed tomography, and another early member of the ABC, also died. The loss of these 3 black cardiovascular specialists has been felt deeply by many, particularly the membership of the ABC. All 3 epitomized the “DNA” of the ABC—to strive for cardiovascular health equity. But rather than emote feelings of remorse, it is wiser to eschew epithets and express celebration, as these men, along with several others, established a revolution in cardiovascular medicine. In the present era, where discussions about race are at least awkward if not contentious, it is healthy to pause to consider the history of the ABC, review its legacy, and address its path forward. To wit, what has been the value to the cardiovascular community of the ABC? Why is an organization like the ABC still needed? Does it remain relevant today?

In 1974, at the American Heart Association (AHA) Annual Scientific Sessions, 17 like-minded colleagues—all pioneers as the first generation of U.S. black cardiologists—congregated under the leadership of Richard A. Williams, MD, and served as founding members of the ABC. At its inception, the ABC adopted 9 guiding principles:

• 1. Establish a platform that would focus on the medical problems in the black community.

• 2. Provide camaraderie between providers focused on the special needs of the black community.

• 3. Provide a forum for exchange of ideas and information.

• 4. Provide a forum for documenting and recognizing accomplishments of blacks toward advancement of management of cardiovascular disease (CVD).

• 5. Increase inclusion and participation of blacks in the AHA and American College of Cardiology (ACC).

• 6. Advocate for excellence in research, teaching, and patient care.

• 7. Increase research in CVD in blacks.

• 8. Allow providers focused on these issues to be autonomous and independent but not separate.

• 9. Increase black representation in the cardiovascular workforce.

Over the years, these guiding principles have held firm. The vision and fortitude of the ABC’s founding members allowed this group to overcome segregation, address bias, navigate nearly insurmountable barriers, and blaze a path to be followed by many others. A legacy has been established. Today, those guiding principles are effectuated by hosting annual scholarly meetings; vigorous recruitment and mentoring of cardiology fellows committed to eliminating disparities; supporting inclusiveness in major clinical trials; leading proactive community engagement; and advocating for equitable health care for those whose voices are unheard. We now have >1,000 African-American cardiologists in the practice, discovery, and leadership of cardiovascular medicine and nearly 2,000 members of the ABC. We are clinicians, academic cardiologists, basic scientists, industry leaders, guideline authors, clinical trialists, and clinician educators. We contribute to the published medical data as original investigators, editorialists, reviewers, and editors. We are passionate public health advocates. We have consulted with the National Institutes of Health, U.S. Food and Drug Administration, Centers for Disease Control and Prevention, the U.S. Centers for Medicare & Medicaid Services, and the U.S. Congress. We have directed landmark clinical trials, guided major observational registries, made important discoveries at the bench, and initiated longitudinal cohort studies that are redefining how we understand the science and practice of CVD. We are leaders of academic medicine, including the National Institutes of Health, AHA, and ACC. A member of ABC now serves as Director of the National Heart, Lung, and Blood Institute; 3 members of the ABC have previously served as AHA presidents; and the current ACC president is a member of the ABC.

Now, 41 years since its inception, from the vision of 17 has emerged a legacy that influences and enriches cardiovascular medicine in all of its realms. This palpable presence of physicians of color in cardiovascular medicine must be considered a resounding accomplishment of the ABC and authenticates its origin, as well as validates its guiding principles. However, as an organization so closely aligned with the AHA and the ACC, is the ABC needed today?

The answer is affirmative. The ABC is more relevant now than ever. Over a decade ago, long before disparate care was a cause du jour, the ABC doubled down on driving health equity and articulated a steadfast and deeply held mission statement: the ABC is “dedicated to eliminating the disparities related to cardiovascular disease in all people of color.” This galvanizing mission empowered a compelling and enduring aphorism of the organization: “children should know their grandparents.” For varied populations that perpetually endure the heft of premature mortality due to a disproportionate burden of CVD, this declaration captured the calling of the organization, expanded it to multiple other groups in the population, and addressed an important niche in our collective march to improve the cardiovascular health of all segments of the population. It is because the root causes of these disparities are so deeply interwoven in our social biology and professional workspace that the ABC is especially capable of bringing unique skills, including a critical social consciousness that sets the right tone and identifies the most effective means to reduce and eventually eliminate disparities. Once again, the ABC embraces its legacy as a trailblazer and now welcomes the legion of concerns that are focused on reducing disparities and advancing health equity. The breakthroughs we have experienced in cardiology that have led to stunning reductions in death due to heart disease are vacuous unless all persons at risk for or with established CVD are able to receive equitable care. Today, the ABC operates with an updated mantra: “Championing the elimination of cardiovascular disparities through education, research, and advocacy.”

The ABC has also realized that its reason for being—although established 41 years ago—regrettably remains ever-present today. We all face large and persistent challenges in enhancing the diversity in our institutions, hospitals, offices, and workplaces. Many of us bemoan the thin pipeline of persons of color entering cardiovascular science and medicine. Our angst was highlighted by the recent Association of American Medical Colleges report: over the past 37 years, there has been a zero sum gain in black male medical students (1). And for 2014, disaggregated data from the Association of American Medical Colleges demonstrates that only 1,227 matriculants at U.S. medical schools self-identified as black/African American. In turn, a paltry 4% of the nation’s physicians self-describe as physicians of color. There is a critical need for accomplished role models that are engaged at the community level to inspire young adults, even children, to seek careers in science and medicine and to persevere through today’s challenges of subconscious bias, stereotyping, and residual vestiges of racism. Going forward, ABC will resolutely nurture the careers of those who will add to the diversity of professionals engaged in the study and practice of cardiovascular medicine and, through its nationwide network of passionate professionals, will seek out our future physicians, investigators, and leaders; in so doing, we will build a pipeline of diverse professionals for the future.

Several outstanding organizations in cardiovascular medicine, including the ACC and AHA, are models of leadership with a legacy of accomplishment in science, practice, and advocacy that have profoundly affected many lives. The ABC is among those leading organizations, as it has been the ABC that has uniquely changed the culture of cardiovascular medicine. The face of cardiology would be very different today and the attention on the cardiovascular health of all persons would be less acute without the transformational drive of the ABC. The association’s founding members were the early champions and then custodians of this legacy of health equality and inclusivity. The legacy that was passed from the ACC pioneers onward keeps us aware that differences between patients and among physicians still exist, and perhaps always will. Certainly, the struggle to achieve more equitable representation in medicine for all races is ongoing. However, we are emboldened to seek effective and, as needed, disruptive solutions to overcome disparate care and diversity challenges to lead to a landscape where cardiovascular medicine will be the exemplar among all disciplines of medicine. We will continue to seek to lead the way in the best treatment of illness without hesitancy, regardless of the person affected. This is both the vision and the challenge as we go forward.

• 2015 American College of Cardiology Foundation