Author + information
- Received January 14, 2011
- Revision received August 11, 2011
- Accepted August 16, 2011
- Published online January 3, 2012.
- Gerard R. Martin, MD⁎,
- Stephanie Mitchell, BPh†,⁎ (, )
- Robert H. Beekman III, MD‡,
- Jeffrey A. Feinstein, MD, MPH§,
- Kathy J. Jenkins, MD, MPH∥,
- Michael Landzberg, MD∥ and
- Gary Webb, MD‡
- ↵⁎Reprint requests and correspondence:
Stephanie Mitchell, American College of Cardiology, 2400 N Street, NW, Washington, DC 20037
The Adult Congenital and Pediatric Cardiology (AC/PC) Section was established to develop a clear voice within the American College of Cardiology and address the myriad issues facing the congenital heart disease profession. The Section is governed by the AC/PC Council, which includes pediatric cardiologists, adult congenital cardiologists, a cardiac care associate, and a fellow-in-training member. The Council is responsible for bidirectional communication between the College's Board of Trustees and the AC/PC Section members. Since its founding in 2004, Section objectives have been defined by the College's mission: to advocate for quality cardiovascular care through education, research promotion, and the development and application of standards and guidelines and to influence health care policy. The pillars of the College—advocacy, quality, education, and member engagement—serve as the defining template for the Section's strategy. The Section has developed work groups in advocacy, clinical practice, education and training, quality, and publications. A separate leadership group has been developed for adult congenital heart disease. Work groups are open to all Section members. Recognition of the importance of lifelong care in congenital heart disease led Section leaders to incorporate pediatric cardiology and adult congenital heart disease content into each of the work groups. There are more than 1,200 Section members, with nearly 400 members actively contributing to Section activities. This article outlines Section efforts to date and highlights significant successes to date.
The American College of Cardiology has a strong and proud tradition of presenting itself as the house of cardiology. Within this context, cardiologists, cardiac surgeons, and cardiac care specialists collaborate in the core mission areas of science, education, advocacy, and membership. The efforts of the College and its members have resulted in great advances in cardiac care. Together, members have decreased mortality associated with atherosclerotic heart disease, the number one cause of death in the United States. The College has also been a consistent supporter of pediatric cardiologists, adult congenital heart disease (CHD) cardiologists, and CHD surgeons, who care for the most common birth defect in children, CHD (1).
Currently, there are an estimated nearly 2 million patients with CHD in the United States (2). Clinical advances have improved the care and management of this complex patient population and led to tremendous gains in survival and quality of life. Unlike our colleagues treating adult atherosclerotic heart disease, our efforts to translate these gains into strong evidence-based guidelines have been limited. This is in large part due to the anatomic and physiologic diversity of CHD. The scope of defects includes mild anomalies requiring no intervention, simple defects corrected by single surgical or catheter-based interventions, and extremely complex cases requiring multiple catheter-based and surgical procedures over the patient's lifetime. Additionally, until the recent development of the Pediatric Heart Network and other registry efforts, pediatric and congenital cardiologists have lacked centralized databases, infrastructure for clinical trials, and resources to coordinate collaborative efforts at multiple sites (3).
To amplify the CHD member voice within the College and address the myriad issues facing the CHD profession, coordination and prioritization of efforts are needed. The Adult Congenital and Pediatric Cardiology (AC/PC) Section was established to identify and advance the professional needs of this minority group within the College. In this article, we detail the structure and guiding principles of the Section and highlight its major accomplishments.
History of the Adult Congenital and Pediatric Cardiology Section
In 2004, the American College of Cardiology established the AC/PC Section as a pilot initiative, to promote the perspective of the CHD community. Developing a dedicated forum for CHD activities was the vision of David Sahn, MD, who recognized the value a dedicated platform for CHD professionals would offer. The Section could coordinate the activities of CHD profession, as well as offer a unified opportunity to advocate for the CHD profession and patients. Section leaders would also be better informed of the College's strategies, align CHD professional objectives accordingly, and serve as a resource to College leaders on CHD issues. The AC/PC Council would govern the AC/PC Section. Council members would represent the interests of pediatric cardiology, congenital heart surgery, adult congenital cardiology, and cardiovascular care team members, in addition to external national and international adult and congenital pediatric societies. The AC/PC Council chair would serve as the AC/PC Section chair. Dr. Sahn served as the first chair, promoting the principles of coordinated lifelong care across CHD specialties and ensuring that Section objectives aligned with the College's strategy. The first meeting was held at the 2005 American College of Cardiology Annual Scientific Session in Orlando, Florida, and had nearly 150 participants.
AC/PC Section membership is open to all College members. Section dues are $35 for fellows and associate fellows, $25 for cardiac care associates, and complimentary for fellows in training (FIT). Specialty representation within the Section is illustrated in Figure 1. With the advent of the Section, CHD professionals within the College have a powerful opportunity to contribute to, support, and advance CHD priorities. In addition to the long-term benefits of supporting and developing the overall strategy of the adult congenital and pediatric cardiology community and specific Section activities, members are invited to the annual Section meeting and reception, both held in conjunction with the American College of Cardiology Annual Scientific Session. Section dues support travel awards for fellows in training, work group activities, the quarterly AC/PC Section e-newsletter, and other alerts directed to CHD issues. Section dues also support the recently established McNamara Lecture at the Annual Scientific Session, in addition to other related activities (Fig. 2).
Engaging Section Members
The AC/PC Section model of member engagement is based on the College's Board of Governors. The Board of Governors has established a superb model allowing interested chapter members to participate in relevant ongoing activities. This sustained ability to identify and continuously advance professional priorities is a testament to the opportunity to address the pressing needs of the CHD community, as well our profession's commitment to improving the care, treatment, and management of patients with CHD. Through the efforts of Section members, incredible accomplishments have been realized (Table 1).
At the initial AC/PC Section meeting in 2005, the mandate to Section leadership became clear: enhance activities related to collecting clinical evidence and quality efforts, and strengthen the educational resources available to the CHD community. In response to this direction, the Section established the Quality Metrics Work Group under the leadership of Kathy J. Jenkins, MD, MPH, and Geoffrey L. Rosenthal, MD, PhD. This work group developed teams across the spectrum of clinical areas necessary to care pediatric and adult CHD. Ideal quality metrics assess outcomes that are well defined in terms of numerator, denominator, unit of analysis, and source of data. The metrics are evidence based, span a time that is useful for quality improvement cycles, are actionable, and exist when there are opportunities for improvement. The College has a Web-based portal to facilitate communication among team members, post metrics, host a reference library, and detail the process for approving a metric. Ultimately, the goal is to facilitate data comparisons and drive quality improvement. To date, 14 metrics have been posted.
The Quality Metrics Work Group was also instrumental in demonstrating the need for a procedural-based registry for pediatric and adult patients with CHD. Preliminary work initiated by several groups, including the Mid-Atlantic Group of Interventional Cardiology, the Congenital Cardiac Catheterization Outcomes Project, and the Congenital Cardiovascular Interventional Study Consortium (4), was critical in working with leadership from the National Cardiovascular Data Registry to discuss opportunities for developing a catheter-based registry for all patients with CHD. Section members representing these efforts, as well as the American Academy of Pediatrics and the Society for Cardiovascular Angiography and Interventions, were critical in developing the IMPACT (Improving Pediatric and Adult Congenital Treatment) Registry, which was launched in December 2010. This registry collects data for all pediatric patients and adults with congenital heart defects undergoing procedures. The IMPACT Registry will assess procedural outcomes and establish evidence-based practices, track device utilization, and guide quality improvement activities on the basis of the valuable data collected. For more information on IMPACT and its structure and partners, please visit http://www.ncdr.com/chd.
In an effort to address the increasing number of adult patients with CHD requiring lifelong specialized care, the AC/PC Section is spearheading a multisociety effort to petition the American Board of Internal Medicine and the American Board of Pediatrics to establish a specialty certification in adult CHD. Under the leadership of Tom Graham, MD, Curt Daniels, MD, and Michael Landzberg, MD, of the Education and Training Work Group, petitions have been submitted and approved. An application to the American Board of Medical Subspecialties is now in preparation. The AC/PC Section newsletter will include updates on this important issue.
Joint Council on Congenital Heart Disease
To coordinate key CHD activities, the AC/PC Section participates in the Joint Council on Congenital Heart Disease (JCCHD). The JCCHD's mission is to facilitate communication and collaboration among the leading pediatric cardiac societies. Chairs of the CHD sections of the following organizations are represented on the JCCHD's Executive Committee: the American Academy of Pediatrics, the American College of Cardiology, the American Heart Association, and the American Board of Pediatrics. In addition, liaison members represent the International Society for Adult Congenital Heart Disease, the Society of Thoracic Surgeons, the Congenital Heart Surgeons' Society, and leading patient advocacy groups. Details about the JCCHD's national quality improvement activities are available in recent AC/PC Section newsletters and online at http://www.jcchdqi.org (5).
As the field of CHD continues to emerge against the background of health system reform, the continued extraordinary advances in the fields of cardiology and surgery, and the increased emphasis on patient-centered care, the AC/PC Section is well positioned to respond to the evolution of this profession, as well as advocate for the profession of CHD within the house of cardiology. Section members are committed to addressing CHD as a lifelong illness, from fetus to adult. We invite all American College of Cardiology members to participate in the AC/PC Section and join our expanding campaign against our nation's number one birth defect, CHD. If you are interested in more information about specific Section activities or would like to get involved, please e-mail http://www.cardiosource.org., or post a comment at the AC/PC Section community page at
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Abbreviations and Acronyms
- Adult Congenital and Pediatric Cardiology
- congenital heart disease
- Improving Pediatric and Adult Congenital Treatment
- Joint Council on Congenital Heart Disease
- Received January 14, 2011.
- Revision received August 11, 2011.
- Accepted August 16, 2011.
- American College of Cardiology Foundation
- Hoffman J.I.E.,
- Kaplan S.
- Marelli A.J.,
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