Author + information
- Huon Gray, MD, FACC, Past ACC Board of Trustees member; Past Chair, ACC Assembly of International Governors and
- Mary Norine Walsh, MD, FACC, President, American College of Cardiology∗ ()
- ↵∗Address for correspondence:
Dr. Mary Norine Walsh, American College of Cardiology, 2400 N Street NW, Washington, DC 20037.
The Maseri-Florio International Lecture has become a highlight of the American College of Cardiology (ACC) Annual Scientific Session. The lecture, established by a grant from Professor Attilio Maseri, MD, FACC (1,2), and carrying the names of both Dr. Maseri and his wife, has featured many distinguished individuals on a variety of important topics over the last 16 years (Table 1).
Huon Gray, MD, FACC, joined this distinguished group at ACC’s 2017 Annual Scientific Session (ACC.17) in Washington, DC, as this year’s Maseri-Florio Lecturer. Dr. Gray, who is a past member of the ACC Board of Trustees and a past chair of ACC’s Assembly of International Governors, addressed ACC’s international growth and goals. Over the past decade, Gray has been a key figure in the development and progress of ACC’s international strategy, and his lecture was a fascinating and comprehensive overview, which I have asked him to reprise below.
—Mary Norine Walsh
The ACC is, and should always be, a membership organization principally for cardiovascular professionals working in the United States. I start with this rather blunt personal opinion because the College’s international initiatives require the support of U.S. members and should never be viewed as competing with their interests. After all, members of the College who work outside of the United States have their own national (and regional) societies to which they owe their first allegiance. This paper covers some of the history of the ACC’s international activities and growth, and the benefits these efforts bring to all who work toward achieving its mission globally.
The College’s foundations are rooted internationally. Franz Groedel, MD, MACC (1881–1951), helped establish the German Cardiac Society in 1927, and after escaping from Nazi Germany, settled in New York where he was elected president of the New York Cardiological Society. This later became the ACC in 1949 (3). In the early 1960s, Eliot Corday, MD, MACC, a Canadian by birth and president of the ACC (1965–1966), developed the International Circuit Courses, where U.S. cardiologists would visit other countries to teach and collaborate with colleagues. In addition, many ACC members, both then and now, have ancestral roots in countries outside of the United States and, indeed, many first-generation immigrants are currently working as part of cardiovascular teams.
Given these international dimensions to the College from its earliest days, it is perhaps surprising that it had no defined international strategy until the Board of Trustees established a task force to do this in 2002 (4). An International Associate membership category was created, and further work led to the development of the College’s first international mission statement: “To enhance cardiovascular health through sustained collaboration and the exchange of knowledge and resources for cardiovascular care worldwide.” Five international priorities were also identified:
1. Increase knowledge exchange of cardiovascular science and health care delivery.
2. Increase the ACC’s presence and visibility as a leading cardiovascular organization.
3. Increase goodwill to facilitate ACC’s mission in developing countries.
4. Enhance services to address international member needs.
5. Increase participation in ACC-sponsored programs and services.
These priorities may seem unsurprising when viewed from a current perspective, but when the Board of Trustees approved them it set the College on an international trajectory that, despite its origins, had not previously been articulated. There were understandable concerns about a more global perspective diminishing the importance of domestic priorities, and some members were suspicious that precious College resources could be diverted from, among other things, its national advocacy activities. However, it was not until 2007 that resources were approved to provide staff time (0.5 of a whole staff member’s commitment in the first instance) to help further international activities.
In addition to the vision of College leaders at the time, the ACC’s Annual Scientific Session was increasingly dependent on international support, both in meeting attendance and in submission of abstracts. Roughly 35% to 40% of meeting attendees were international, and more than 50% of abstracts were submitted from outside the United States. This proportion has remained relatively constant over the last 10 years, creating a strong appetite among overseas cardiologists and other members of the cardiovascular team to participate in ACC activities and to join various membership categories (Table 2). Also, the Fellow of the American College of Cardiology (FACC) designation is increasingly seen as a mark of distinction—a recognition of professional achievement—based on surveys of ACC international members.
The years that followed 2007 saw continuous change and development, involving many members serving on task forces and working groups, too many to be named in person but who deserve great recognition for their commitment and determination to see the College widen its horizons. Among the changes:
• The membership application process for non–U.S. cardiologists was simplified.
• Tiered membership dues were introduced to reflect high-, middle-, and low-income countries.
• An International Lounge was established at the ACC Annual Scientific Session.
• Joint ACC/International sessions are held at the ACC Annual Scientific Sessions (n = 25 at ACC.17).
• CardioSource and subsequently CardioSmart were translated into Spanish (2008).
• Leadership attendance at National Societies’ meetings overseas has gradually increased (n = 52 during 2016).
Two other developments deserve specific mention. Until 2009 the International Committee of the ACC consisted mainly of U.S. members who had an interest in the College’s international affairs. This later transitioned to an International Council of which membership was predominantly made up of overseas members, with wide geographic representation. The second development was the introduction of International Chapters. Their creation followed protracted discussions; protracted not because of significant objection within the College or among its members, but because of the appreciation that other countries, and their national societies, might not welcome the arrival of a large U.S.-based organization with uncertain objectives potentially competing in their area. Much time and discussion was spent in bilateral meetings with the leaderships of national societies. Following positive responses, the first International Chapter was established in Malaysia in 2009.
For a chapter to be inaugurated there has always been a requirement for the written agreement of the relevant national society (or all societies when more than 1 exists), and that there must be at least 20 FACCs working in that country. However, in parts of the world where the number of FACCs falls below 20, there is the option to form a chapter from a consortium of countries. The purpose behind establishing chapters has always been to ensure that those who are elected as members of the College have their views heard and are offered participation in College affairs. By any measure, this development has been successful; the College now has 40 international chapters, each of which is encouraged to raise its performance and involvement each year through the Chapter Recognition Program.
Most will be aware that the College has undergone an extensive governance and organizational restructuring in recent years. As part of this, and the development of chapters, the International Council has become the Assembly of International Governors (AIG) covering 4 regions (Asia, Europe, Middle East/Africa, and non-U.S. Americas) form the AIG Steering Committee. This very much mirrors the organizational structure previously established by the ACC’s U.S. Board of Governors. The chairs of both steering committees now serve together on the recently formed Membership Committee, reporting directly to the Board of Trustees.
The College now has more than 16,000 overseas members (over 4,000 of whom are FACCs) in 137 countries. Since 2005, their presence has been welcomed and supported by successive Boards of Governors in the United States (5), more than 15 presidents and Boards of Trustees, as well as numerous College staff. These members have enjoyed greater participation on College councils and committees, and their hospitals have increasingly collaborated with the National Cardiovascular Data Registry in data gathering and comparative analysis. “Twinning” of International Chapters with U.S. chapters, and now the Chapter Exchange Program, has helped to stimulate discussion and knowledge sharing. In 2016 the College embarked on 2 successful collaborative regional educational meetings in Latin America and the Middle East. These conferences are returning in 2017, with the Latin American Conference already having taken place in Mexico City in June. The Middle East Regional Conference, as well as a new Asia-Pacific Regional Conference, are taking place this fall in Dubai and Shanghai, respectively.
We have long known that the risk factors for cardiovascular disease (CVD) are very similar wherever in the world the patients live (6). CVD is now a major global problem (7) (causing 31% of all deaths worldwide) (8), and has been identified as such in the first ever United Nations declaration on noncommunicable diseases (2012) (9), which called on the World Health Organization and partner organizations to combat it (10). In keeping with its international initiatives, the College has made the reduction of cardiovascular disease worldwide one of its international missions and goals (Figure 1).
The ACC has shown what can be achieved when collaboration is favored over competition, and now has a team of 7 full-time staff pursuing its international goals (Figure 1). In choosing an outward-looking and collegial approach, I believe it has brought benefit to all members, and to the people of the world who have or may develop CVD. Professional connections have been established and nurtured, and long-lasting friendships have been made. As I write, my country is responding to a terrorist atrocity in Manchester, and much is being written and spoken of the need to reach out to others with friendship and in a spirit of collaboration. I, for one, thank the College for the considerable efforts it has made in pursuing these important objectives, a view I believe my overseas colleagues would strongly endorse. As professionals working in the field of CVD we have so much more that unites us than should ever divide us by nationality or beliefs. We should embrace the opportunities given to us in pursuing our common goals.
- 2017 American College of Cardiology Foundation
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