Author + information
- Richard A. Chazal, MD, FACC, President, American College of Cardiology∗ ()
- ↵∗Address correspondence to:
Richard A. Chazal, MD, FACC, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
In 1987, the American College of Cardiology (ACC) established its first U.S. state-based chapter, in my home state of Florida. Since then, state chapters have grown to represent every state in the union, as well as Washington, DC, and Puerto Rico. Over the last several years, we have built upon this chapter system and expanded our reach by partnering with cardiovascular societies in more than 40 countries and regions around the world to form international chapters.
Our U.S. chapters have been critical resources for cardiovascular professionals in the states and regions where they practice medicine. College leaders, including myself, have risen through the ranks of our local chapters to ultimately serve as governors, standing committee chairs, trustees, officers, and presidents at the national level. ACC state chapters have also played critical roles in identifying and flagging emerging issues and trends that have the potential to affect cardiovascular professionals and their patients—for better or worse. Medical liability reform, in-office imaging and prior authorization, physician reimbursement impacts, hospital integration, and maintenance of certification challenges are just a few of the hot-button issues that have filtered up from the states. Population health-based prevention policies targeting areas like smoking and congenital heart disease screening are also big issues at the state level.
State chapters have proven their value not only in communication and identification of important issues, but also in direct actions affecting patient care. As we celebrate the tenth anniversary of ACC’s Door-to-Balloon (D2B) Alliance this fall, so much of the success of the program is a credit to the efforts of ACC chapters that worked diligently to encourage local hospitals to take part in the program. A decade later, data show that the vast majority of hospitals are now meeting the guideline-recommended D2B time of ≤90 min (1). Similarly, chapter efforts around common national issues like Medicare physician payment have led to critical successes, especially in the policy arena—such as the repeal of the flawed sustainable growth rate formula in 2015. Chapter leaders and activists across the country have also been at the forefront of demonstrable improvement in care for their state’s populations (2). Moving forward, we will all need to continue to be aligned and to speak with 1 voice as the Medicare and CHIP Reauthorization Act is implemented over the coming years. Making certain that the transition from volume to value is truly achievable by practitioners is a key target for advocacy at the national and state levels.
While newer, our international chapters represent a similar opportunity for understanding needs and committing to action around the world. To date, these chapters have aided in efforts to meet the World Health Organization goal of reducing deaths from noncommunicable diseases by 25% by 2025. Our chapters, along with partner societies around the globe, also provide unique opportunities for bilateral transmission of science, at venues such as the ACC Annual Scientific Session, other country-specific scientific meetings, or at regional conferences like those offered by the ACC this fall in Latin America and Saudi Arabia. Chapter exchange programs offer a chance for domestic and international members to share research and best practices and to network with their counterparts in other countries. This networking has led not only to improvement in care, but also has helped forge lasting friendships across international borders, often between individuals who would not otherwise have had the opportunity to interact.
Currently, international membership is the fastest growing population of the College. Thus, these opportunities for learning and collaboration will continue to strengthen and grow. In September, the ACC launched a new program in cardiovascular disease prevention that will provide physicians and hospital systems in 10 countries with access to education, resources, and practical tools needed to stem the rising tide of cardiovascular disease in their countries. It is further designed to equip patients with the knowledge necessary to manage their cardiovascular health. Building on the success of a similar program piloted in China this year, the College will expand the program to reach thousands more doctors in Russia, Saudi Arabia, Egypt, the United Arab Emirates, Mexico, Argentina, Indonesia, Vietnam, and Malaysia. Throughout the program, the ACC will be partnering with its extensive network of international chapters by working with local cardiology societies to customize the education in a way that meets the unique needs of physicians, patient communities, and health care systems in these countries.
This engagement with our international chapters is far from a 1-way relationship. While the College seeks to help disseminate knowledge and expertise gained in the United States, we are also learning from our overseas colleagues. The ACC is fast becoming an importer as well as an exporter of cutting-edge science that is being developed at a rapid pace throughout the world. According to eJournal Press, the submission database for JACC journals, more than one-half of submissions to JACC now come from outside of the United States. Innovative ideas in population health management (a cornerstone of the ACC Strategic Plan) have been developed and tested in countries that have already dealt with medical resource limitations; we have a lot to learn from efforts in China and Latin America!
What our chapter system—both in the United States and internationally—has in common to date is a focus in regions where infrastructure and resources exist to support local efforts on the ground. We are working with colleagues and counterpart organizations that have business plans and goals and who have similar training and science backgrounds that allow for bilateral sharing of research, data, and best practices. By working together, we are stronger and better able to align in the best interests of patients.
Great need exists, however, in areas where there is less infrastructure and less advancement in science. Regions of the world that have been significantly affected by war, poverty, and economic and political turmoil are in need of education and training to care for their populations. Many of these places provide the chance to help the ACC and members to fulfill our mission of transforming cardiovascular care and improving heart health for all people. This is the next challenge and opportunity for our chapter system.
The ACC Board of Trustees recently approved the creation of the Sub-Saharan Africa Chapter. This new chapter represents nearly 20 countries where no single country chapters exist, and where the number of cardiologists in a given country is limited. Helping these countries overcome and/or navigate barriers, such as “lack of resources and health-care systems, non-existent effective preventive strategies at a population level, lack of sustainable drug therapy, and barriers to complete compliance with prescribed medications” (3) will be a challenge, but it will reap significant benefits for all involved if we are successful. Bongani Mayosi, MD, president of the Pan-African Society of Cardiology, and inaugural Chapter Governor Elijah Ogola, MD, from Kenya deserve recognition for bringing this Chapter to fruition and for leading it forward.
Additionally, a group of leaders from the ACC participated in the Seventh Iberoamerican Congress of Nuclear Cardiology and Cardiac Imaging in Havana, Cuba, in April. Prior to and subsequent to that congress, we have had a number of meetings with leaders in Cuban cardiology, including Eduardo Rivas-Estany, MD, FACC, president of the Cuban Society of Cardiology. These encounters have made it clear that there is a tremendous opportunity to participate with our colleagues in that country toward the goal of improving heart health for their patients. Currently, plans are under way to have a joint scientific session of the ACC and Cuban Society of Cardiology in May 2017 in Havana.
The need for the expertise and wisdom of ACC members worldwide is increasing at the same time that we are experiencing a global epidemic in cardiovascular disease. In an era when American cardiovascular specialists are stressed with rapidly evolving changes in our own health care system, we are also presented with the challenge to share the benefits that have been afforded us by our education and experience. When physicians graduate from medical school, we take an oath that in part says we will “respect the hard-won scientific gains of those physicians in whose steps [we] walk, and gladly share such knowledge … with those who are to follow.” It goes on to say that we “will prevent disease whenever [we] can” and will “remember that [we] remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm” (4). In addition to our daily jobs of treating our own patients, the ACC’s chapters around the world provide us all with additional opportunities to fulfill this oath (and the College’s mission) on a much broader and increasingly global level.
- American College of Cardiology Foundation
- Krumholz H.M.,
- Herrin J.,
- Miller L.E.,
- et al.
- Shor R.
- Cappuccio F.P.,
- Miller M.A.
- ↵Lasagna L. Modern Hippocratic Oath. 1964.