Author + information
- Published online August 19, 2019.
- Pamela B. Morris, MD, FACC, Co-Chair, Methodology Writing Committee,
- Richard J. Kovacs, MD, FACC, Co-Chair, Methodology Writing Committee,
- Larry A. Allen, MD, MHS, FACC, Methodology Writing Committee Member,
- Lea G. Binder, MA, Methodology Writing Committee Member,
- Kim K. Birtcher, MS, PharmD, AACC, Methodology Writing Committee Member,
- Ashleigh M. Covington, MA, Methodology Writing Committee Member,
- Ty J. Gluckman, MD, FACC, Methodology Writing Committee Member and
- Kim Allan Williams Sr., MD, MACC, Methodology Writing Committee Member
- Heart House Roundtables Methodology
- clinical meeting
- Heart House
- Heart House Roundtables
- stakeholder meeting
Solution Set Oversight Committee
Ty J. Gluckman, MD, FACC, Chair
Niti R. Aggarwal, MD, FACC
Nicole Martin Bhave, MD, FACC
Gregory J. Dehmer, MD, MACC
Olivia N. Gilbert, MD, MSc, FACC
Dharam J. Kumbhani, MD, SM, FACC
Andrea L. Price , MS, CPHQ, RCIS, AACC
David E. Winchester, MD, FACC
Martha Gulati, MD, MD, FACC–Ex Officio
Table of Contents
Roundtable Background 1118
Table 1. Bethesda Conferences 1965 to 2004 1119
Topic Selection 1120
Guiding Objectives 1120
Table 2. Overview of Roundtable Meetings and Resulting or Related Products 1121
Planning Process: Roundtable Planning Committee 1122
Planning Committee Chair 1122
Planning Committee Members 1122
Roundtable Development Timeline 1122
Figure 1. Heart House Roundtable Materials and Branding 1123
Diversity and Role of Stakeholder Participants 1123
Figure 2. Timeline for Planning a Heart House Roundtable 1124
Planning Process: Roundtable Design 1124
Figure 3. Diversity of Heart House Roundtable Participants 1125
Discussion Questions 1125
Figure 4. Design and Components of Heart House Roundtables 1126
Briefing Books 1126
Table 3: Heart House Roundtable Planning Grid Template 1127
Table 4: Heart House Roundtable Agenda Template 1127
Industry Involvement and Firewalls 1127
Figure 5. Firewall Protecting Roundtable Planning From Industry Influence 1128
Outputs of Roundtables 1128
Examples of Roundtable Outputs 1128
Figure 6. Evolution From Roundtable Topic to Point-of-Care Tool 1129
Relation to Other ACC and Heart House Meetings 1129
Figure 7. Roundtable Outputs and Solution Sets 1130
Future Directions 1130
President and Staff 1131
2016 Anticoagulation Consortium Roundtable Meeting Agenda 1133
2016 Anticoagulation Consortium Roundtable Meeting Discussion Questions 1134
2016 Anticoagulation Consortium Roundtable Meeting Briefing Book Table of Contents 1135
Author Relationships With Industry and Other Entities (Comprehensive)—2019 Methodology for Heart House Roundtables 1136
Peer Reviewer Information—2019 Heart House Roundtables Methodology 1137
The American College of Cardiology (ACC) is the professional home to more than 52,000 cardiovascular professionals dedicated to a mission of transforming cardiovascular care and improving heart health. To promote that mission, the ACC maintains a physical home: the Heart House in Washington, DC. This facility not only houses staff and the College’s operations, but also presents a visible symbol of the ACC’s presence as a global leader and serves as a place to convene important ACC functions.
The ACC is a trusted party in the complex space of health care and a leader in the development of solutions for problems facing cardiovascular professionals in daily clinical care of patients. The College develops guidelines, clinical pathways, health policy statements, appropriate use criteria, mobile applications, clinical data registries, and myriad other tools to support cardiology practice and the ACC mission. To ensure the integrity of its clinical policy, the College maintains a rigorous policy regarding relationships with industry (Writing Committee and peer reviewer relationship with industry [RWI] are disclosed in Appendixes 4 and 5, respectively.). To facilitate problem solving, the ACC interacts with not only its members, but other professional societies, national and local governments, government regulatory agencies, health insurance companies, drug and device manufacturers, patients and patient groups, and medical innovators.
To further its mission, the ACC develops new methodologies when none exist that meet current needs (1). These methodologies serve as guidance for the numerous members who compose the task forces, working groups, and committees of the ACC. Methods are developed, refined, and codified, so as to ensure they can be used and reused by the next generations of members. The College’s methodologies are updated on an as-needed basis as practices and needs evolve. ACC methodologies are also looked to by groups outside of the College (2).
In recent years, the ACC has increased the use of a roundtable format to address high-value topics among a broad group of multidisciplinary stakeholders. This format has been highly visible within and outside of the ACC. The methodology for design and conduct of the roundtables has been successful in closing gaps in clinical care, furthering the ACC mission of transforming cardiovascular care, improving heart health, and addressing the challenges of population health and precision medicine. In fact, the success of these programs has led to the development and branding of the ACC Heart House Roundtable series. The purpose of this paper is to describe and offer guidance around Heart House Roundtable methodology for both ACC members and external groups who look to the ACC for trusted solutions in cardiovascular care and heart health.
Throughout its history as a trusted party in health care, the ACC has been asked to opine on topics of interest to its members and other stakeholders. The roundtable format has been well-suited for discussion of these topics through multidisciplinary, multi-stakeholder meetings that foster collaboration with external organizations. Heart House has been chosen as a convenient location by College leaders and has served as a fitting space to convene the roundtables.
The original Heart House was in Bethesda, Maryland, near the National Institutes of Health. In 1965, the Federal Aviation Administration sought expert input from the College concerning the physical fitness of commercial airline pilots. This resulted in the first of the roundtable meetings, at that time named the Bethesda Conferences (3).
While the Bethesda Conferences evolved over the years, 2 fundamental exercises persisted: 1) face-to-face multi-stakeholder discussion; and 2) publication of group deliberations. Task forces were identified to be responsible for developing a draft of recommendations on a specific topic. Conferences would convene up to 70 participants for discussion of current scientific evidence, clinical controversies, and gaps in knowledge, as well as refinement of recommendations to be published as a report of the conference. The Bethesda Conferences addressed high-value topics for 40 years, and the final Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities was held in New Orleans coincident with the 2004 American Heart Association’s Scientific Sessions (4). A list of the Bethesda Conferences and resulting publications can be found in Table 1.
The College moved from Bethesda, Maryland, to its current location in Washington, DC, in 2006 to accommodate a growing staff and expanding scope of operations, and to establish a stronger presence in the nation’s capital. The new Heart House serves as both the symbolic home of the cardiovascular care team and a practical space to conduct multistakeholder meetings. In 2008, James T. Dove, MD, MACC, recognized the power of bringing multiple stakeholders to the Heart House and convened a Health Reform Summit to discuss the changing face of health care. This summit resulted in the development of the ACC’s internal principles for health reform.
Borrowing from Dr. Dove’s playbook, the new ACC Sports and Exercise Cardiology Member Section convened a group of stakeholders at Heart House in 2010, which included the National Collegiate Athletic Association (NCAA), athletic trainers, and team physicians to address important issues such as the need to integrate sports cardiologists into the larger care team for the competitive athlete. This meeting utilized a “think tank” format and allowed wide-ranging, but structured discussions. The recommendations were published and set standards for the field of sports cardiology (48).
Important lessons were learned from these early multistakeholder meetings, including the need to: 1) focus the discussion on a small number of key questions; 2) prepare attendees for active participation by providing relevant pre-meeting briefing materials; and 3) develop a process to guide discussion around the most important questions facing the ACC. The success of these early meetings and the lessons learned spurred a series of subsequent multidisciplinary stakeholder meetings to address important issues facing the cardiovascular care team. Meetings have been focused on high-value topics for ACC members and have produced both practical guidance and clinical tools to be used at the point of care.
In 2013, the ACC launched the Anticoagulation Initiative as a comprehensive, multidisciplinary quality program to address gaps in care and improve anticoagulation management in patients with atrial fibrillation. This, in part, stemmed from availability of direct oral anticoagulants to reduce stroke risk, along with observations that anticoagulation was significantly underutilized among patients with atrial fibrillation in the ACC’s PINNACLE registry (49).
Recognizing the need for a multidisciplinary, collaborative approach to this issue, the Anticoagulation Initiative held the first Anticoagulation Consortium Roundtable on September 21, 2013. The overarching goal of the Roundtable was to bring together stakeholders who play a role in the care of complex patients. Stakeholders included clinicians, patients and representatives from health care systems, relevant professional societies, regulatory agencies, and pharmaceutical manufacturers. Content experts were invited from many disciplines involved in anticoagulation care, especially in the management of bleeding. Patients and patient advocates were invited to provide their perspectives. The specific objectives of the meeting were to improve the overall quality of anticoagulation care by addressing the issues underlying suboptimal use of anticoagulant therapy, exploring knowledge gaps that needed to be closed to improve patient care, and developing practical frontline tools beyond the guidelines.
Since 2013, the ACC has held an Anticoagulation Consortium Roundtable annually (through 2018), focused on providing solutions for evolving issues in anticoagulation management and to close gaps in care. Each subsequent Roundtable has successfully engaged multidisciplinary content experts, and the stakeholders have been diversified to ensure that experts in all facets of anticoagulation management are represented. The discussions during these meetings have informed the development of tools for anticoagulation management, and outputs have evolved commensurate with changes in care delivery.
As the roundtables have focused on providing recommendations and resources to cardiovascular clinicians for use in clinical care, the ACC has defined these outputs as key components of “solution sets.” The ACC Science and Quality Committee defines the concept of solution sets as groups of closely related activities necessary to transform care and/or improve heart health. Table 2 provides a summary of various content resulting from roundtables that has contributed to the development of solution sets.
Recognizing the need to address gaps and practical issues in other facets of cardiovascular care, the ACC has held over a dozen multidisciplinary stakeholder meetings focused on the areas of anticoagulation, dyslipidemia, valvular heart disease, heart failure, cardio-oncology, cardiovascular disease in diabetic patients, and risk communication. Since their inception in 2013, these meetings have been pivotal to the development of multiple types of outputs as well as fostering societal and organizational relationships.
To demonstrate the organization’s commitment to these high-profile events and provide consistency in methodology and topic prioritization, in 2017 the ACC branded these multidisciplinary stakeholder meetings the “Heart House Roundtables.” Figure 1 depicts the materials developed for each roundtable conducted thus far.
During the first several years that ACC convened the roundtables, criteria for new topic selection were not yet established. The informal criteria used to hold a stakeholder meeting centered on 4 common themes: 1) significant gaps in care and specific dilemmas facing clinicians; 2) high-impact topics in cardiovascular care; 3) topics aligned with established ACC quality programs; and 4) other topics that would benefit from a multidisciplinary roundtable format.
The meetings considered practical issues that clinicians and patients face in daily practice. They sought not only to identify problems and knowledge gaps within important clinical topic areas, but more importantly, to encourage participants to collaboratively brainstorm possible solutions. The anticoagulation, heart failure, cardiovascular risk management in diabetes, and dyslipidemia roundtables were also driven by the need to understand and integrate recently approved medication classes into routine clinical care. These medications included the direct oral anticoagulants; sacubitril-valsartan and ivabradine for use in heart failure with reduced ejection fraction; medications used in diabetes with demonstrated cardiovascular outcomes benefits, including glucagon-like peptide 1 receptor agonists and sodium-glucose transport 2 protein inhibitors; and the proprotein convertase subtilisin/kexin type 9 inhibitors for treatment of hypercholesterolemia. Many of these new pharmacological therapies are costly and prior authorization may be required by payers prior to prescribing these agents. Therefore, the College convened a roundtable focused on 1) strategies to facilitate effective prior authorization of novel and emerging therapies; and 2) identification of high-risk patients who are appropriate candidates for these therapies. Other early roundtables focused on management issues in specific disease states, including heart failure and valvular heart disease, for which multiple recent advances have fundamentally changed the landscape, and thus, our approach to care.
The roundtables have been highly productive, and therefore, there is interest in applying the format to a wide range of potential topics. As such, it became increasingly clear that a more formal process for topic identification and selection of meetings branded as Heart House Roundtables was needed.
The Science and Quality Committee is the senior strategic oversight group of ACC’s Science and Quality division and efforts and is responsible for high-value topic selection and prioritization of solution sets. The Committee determines topics by drawing on the expertise and guidance of its members and conducting environmental scans of new scientific developments and member needs. An oversight committee within the Science and Quality Committee determines how each high-value topic should be addressed, which may include convening a Heart House Roundtable as a means of providing appropriate alignment with its strategic goals.
The primary objectives of the Heart House Roundtables are to: 1) identify gaps in knowledge and barriers to care delivery related to common cardiovascular conditions that lend themselves to ACC-driven solutions; 2) provide a forum for multidisciplinary stakeholders to collectively brainstorm about potential practical solutions to knowledge gaps and challenges faced in clinical practice; and 3) inform the development of clinician and patient tools, systems of care tools, and other resources aimed at closing these gaps.
Planning Process: Roundtable Planning Committee
Planning Committee Chair
The planning committee chair for each roundtable is selected by an oversight committee within Science and Quality in consultation with other relevant ACC member groups and based on key competency requirements. The chair should be an expert in the field relevant to the specific roundtable and must have a breadth of content knowledge that makes him/her capable of facilitating discussions among multidisciplinary stakeholders. The chair should also be an ACC member with experience in a variety of domains across the College and should have insight into how the information may subsequently be used to inform future ACC efforts. The roundtables are based on a highly interactive program design, and therefore, the chair should be charismatic and capable of maintaining participant engagement in discussions throughout the meeting. The primary responsibilities of the roundtable chair are to 1) provide input and recommendations for selection of the planning committee; 2) work with the planning committee to identify speakers and participants for the invitation list; 3) lead the planning committee’s creation of the agenda, discussion questions, and briefing book; 4) serve as moderator/facilitator for the roundtable throughout the day; 5) work closely with ACC staff to meet all planning deadlines; and 6) work with ACC staff following the roundtable to prioritize next steps and identify potential outputs, based on participant feedback during discussions. A co-chair of the planning committee may also be selected to work closely with the chair when additional expertise is critical to the planning process.
Planning Committee Members
Planning committee members are selected by an oversight committee within Science and Quality and the planning committee chair. All members of the committee should have recognized expertise relevant to topics that will come up for consideration during the roundtable. The committee should include diverse representation from multiple disciplines, professional societies, and other relevant stakeholder organizations needed to fulfill the goals of the planned roundtable discussion. Planning committee members will work with the chair to refine the agenda, identify introductory speakers for each session, identify stakeholders for participation in the roundtable, draft discussion questions, and submit pertinent materials for inclusion in the briefing book. During the meeting, planning committee members are also assigned to 1 of 6 tables to serve as facilitators during breakout sessions.
Roundtable Development Timeline
Roundtables operate under a compressed timeframe relative to many meetings conducted by professional societies. The timeframe from identification of a high-value topic for a roundtable until the meeting is held is generally in the range of 6-8 months, as depicted in Figure 2. In the period leading up to the roundtable, the planning committee is responsible for identifying and inviting relevant stakeholders for participation; finalizing the agenda, speakers, and discussion questions; as well as creating the briefing book. ACC has dedicated staff who work with the planning committee to execute these activities. All participants receive the briefing materials approximately 2 weeks before the meeting for review and consideration.
Diversity and Role of Stakeholder Participants
The essence of the roundtable format is to engage all relevant stakeholders, including those from outside of the ACC, such as other professional societies, while driving the process toward goals set by the ACC. The mission of the College—to transform cardiovascular care and improve heart health—is the key focus of the roundtables. Stakeholders bring a diversity of perspectives and content expertise that are critical to the discussions and subsequent problem solving. The planning committee is responsible for selection of the stakeholders and for identifying the organizations and the expertise that each stakeholder represents at the roundtable.
The topics addressed at roundtables cross over many medical specialty areas; therefore, a diverse group of clinicians is invited to participate at the roundtable from all relevant societies. This may include subspecialties in cardiology (e.g., electrophysiology, heart failure, imaging, interventional, prevention), primary care and internal medicine, other specialties related to the topic at hand (e.g., hematology, neurology, surgery, endocrinology), and broad ranging members of the cardiovascular care team (e.g., nurses, pharmacists, nurse practitioners, and physician assistants). Discussions at the meetings also benefit from participation by other relevant stakeholder groups such as patients, federal agencies, health plans, integrated health systems, and industry. Additionally, ACC staff are seated at tables to help facilitate, take notes, and support translation of the discussion after the meeting has concluded. Figure 3 depicts the diversity of various experts participating at each roundtable.
Participant stakeholders may be invited to serve as speakers at the roundtable to offer their perspectives and insights on a given topic. Both ACC members and outside stakeholders volunteer their time to participate in roundtable meetings.
Stakeholders may also be involved in ACC activities beyond the roundtable and in the outputs developed as a result of the discussions. Durable relationships between attendees and between organizations commonly develop, and it is not uncommon to find prior roundtable stakeholders involved in other College activities such as education and legislative efforts.
Planning Process: Roundtable Design
The interactive program design of the Heart House Roundtables is crucial to cultivate collaboration of multidisciplinary stakeholders and to provide a setting in which robust discussions and problem-solving may readily occur (Figure 4).
The roundtables are conducted in the large conference space at Heart House. The conference room is typically set with 6 large tables, comfortably accommodating 8 participants each. Seating arrangements are carefully selected in advance to intentionally include a mix of stakeholders with diverse expertise and perspectives at each table (Figures 3 and 4). Based on current space availability, the Roundtables include approximately 48 participants representing at least 25 to 30 different professional societies along with other important organizations. Additionally, there are seats on the periphery of the room for invited observers, such as additional relevant ACC staff members or stakeholders.
Table 3 shows the template used by planning committees during the planning process to help shape the agenda, identify speakers and objectives for each session, draft discussion questions for individual groups, and identify relevant materials to include in the briefing book. The agenda is organized into 3 to 4 distinct sessions, with each addressing critical questions, gaps in care, or need for clinical guidance, as identified by the planning committee. Each session is approximately 2 hours in duration. Table 4 provides a detailed overview of the structure for a Heart House Roundtable agenda and Appendix 1 provides an agenda example from the 2016 Anticoagulation Consortium Roundtable.
A typical Roundtable is structured as follows:
1. Welcome to Heart House (5 minutes): The participants in the roundtable are welcomed to Heart House by a recognized member of ACC leadership. This welcome helps to define the meeting as a top priority for ACC leadership and serves as a strong endorsement of the value of multidisciplinary collaboration to achieve meaningful solutions in cardiovascular care. Many roundtable attendees have never been to Heart House, and the welcome reinforces the importance of the location to cardiovascular medicine.
2. Participant Introductions (5 to 10 minutes): Roundtable participants may not have met before the meeting and are a diverse group. Therefore, following the welcome address, members are asked to identify themselves and the organization they represent to create a collaborative environment for discussion.
3. Keynote Address (10 to 20 minutes): Depending upon the topic and needs of the roundtable, the session may begin with either a keynote address or session speakers (see item 4 below). A pre-meeting review of informational materials obviates the need for an extensive didactic program and allows for more discussion time in the single day format.
4. Session Introductions (20 to 30 minutes): Two to three speakers (10 minutes each) will address the topics for consideration to invite discussion as mentioned previously. Speakers should keep comments brief and use minimal slides instead of didactic lecture.
5. Breakout Sessions (1 hour): During the breakout sessions, participants at each table consider discussion questions prepared in advance by the planning committee (see the following text). A member of the planning committee facilitates discussion to ensure that all questions are addressed and that all table participants have an opportunity to provide insight.
6. Group Reports (30 minutes): At the conclusion of the breakout sessions, each group selects 1 member to provide a summary report of the key takeaways from their table’s discussions. Given the multidisciplinary nature of the roundtables, it is important for all participants to consider the unique perspectives of individual members in their group.
Questions for participants to consider during the breakout sessions are prepared in advance of the meeting by members of the roundtable planning committee. These questions are intended to generate in-depth discussions; to encourage participants to identify, clarify, and prioritize issues; to uncover trends and differences across medical specialties and clinical practice settings; and to support participants as they propose possible solutions to address issues considered during the session (e.g., decision pathways, mobile/online tools, education sessions, patient resource materials). During the breakout sessions, an ACC staff member is included at the table for note-taking to capture responses to questions, multidisciplinary perspectives, proposed solutions, and key top-level takeaways. Appendix 2 provides the discussion questions for the 2016 Anticoagulation Consortium Roundtable.
The discussion questions are critically important for each session as they guide the participants through the process of opportunity identification and subsequent problem-solving. Questions are frequently open-ended to promote free exchange of ideas and should be unique and specific to the topic under consideration during each of the sessions. To encourage robust discussions throughout the roundtable, questions must not be repetitive or have significant overlap with topics addressed during the other sessions. On occasion, some of the tables may consider a different series of discussion questions to broaden the scope of topics considered during the sessions. Questions should relate to the established priorities and objectives of the roundtable and support ACC’s goal of closing practice gaps and improving cardiovascular care. Simply put, questions should be clinically-relevant, practical, solution-oriented, and purposeful.
In advance of the roundtable, the planning committee prepares background information in a briefing book that is sent to all participants. This book includes seminal articles, current scientific literature, and other background materials relevant to the topics being discussed at the meeting, thus providing stakeholders from varying backgrounds with a common knowledge base to inform discussions during the sessions. The briefing book additionally serves as a reference for participants beyond the meeting. A letter from the roundtable chair(s) is also included to define the meeting’s scope and objectives and to describe the format of the meeting, the agenda, and discussion questions for each session. Participants are expected to review all materials in advance, consider issues raised by the discussion questions, and possibly discuss these issues with their colleagues to provide relevant perspectives or insight prior to the meeting. Appendix 3 provides the table of contents for the 2013 Anticoagulation Consortium Roundtable briefing book.
Industry Involvement and Firewalls
Industry support may be part of a successful roundtable by providing funding and a business perspective that can inform future actions. However, a core principle of industry involvement is the absence of any role in content development or tactical execution of the meeting. Industry support for roundtables is treated similar to independent medical grants with a strong firewall between supporters and the planning process. Preferably, there are multiple supporting industry partners to encourage diversity of industry participation, rather than a narrow product line related to a commercial interest.
Topics are approved based on importance to ACC’s membership rather than degree of industry support. While industry supporters are not permitted to influence any part of the planning process, they are invited to select a medical representative to serve as a relevant stakeholder at the meeting. It is important to note that medical representatives selected by industry sponsors are not permitted to serve as planning committee members but may participate in discussions onsite as relevant stakeholders.
Medical representatives from industry are also asked to abstain from giving the report out at the end of each session. Figure 5 provides an overview of the firewall specifications preventing involvement in roundtable planning by industry supporters.
Because the ACC adheres to a very strict conflict of interest policy to prevent any influence by financial supporters, all travel and food for participants is paid for directly by the ACC and is not associated with any industry funding. As a result, participants are not subject to reporting under the Physician Payments Sunshine Act or disclosure of relationships with industry in the ACC’s database. All planning committee members and roundtable participants are volunteers and are not compensated for their time.
The ACC Office of the General Counsel evaluates each roundtable meeting to ensure that the appropriate firewalls are in place to prevent any influence related to industry support.
Outputs of Roundtables
The main strategic purpose of the roundtables is to assemble a diverse group of experts from various clinical disciplines and areas of health care to identify gaps in cardiovascular care and work collaboratively to identify potential solutions. The thoughtfully facilitated discussions during the roundtables are designed to inform subsequent tangible outputs by the ACC. The planning committee places special emphasis on asking questions that can drive not only tangible outputs, but practical solutions that are within the scope of ACC activities and within means at the College’s disposal. Following completion of the roundtable, members of the planning committee and ACC staff review insights gained from the stakeholder discussions to determine which tools and resources should be developed as part of the practical solution sets for specific audiences (e.g., clinician, patient, systems of care) to reduce or close gaps in care. Figure 6 demonstrates how Heart House Roundtable discussions might lead to an actionable point of care tool.
Examples of Roundtable Outputs
The first session of the 2014 Anticoagulation Consortium Roundtable featured a presentation on bridging of anticoagulant therapy and a discussion question inquiring about bridging strategies at various institutions. The discussions that followed demonstrated a clear gap in consistent bridging strategies, likely the result of a lack of guidance for managing interruption of anticoagulation for patients with atrial fibrillation. As a result, the ACC developed and published an Expert Consensus Decision Pathway on Periprocedural Management of Anticoagulation in Patients with Atrial Fibrillation (50). This clinical policy document was translated into the mobile tool BridgeAnticoag, which has been downloaded by nearly 9,000 individuals. BridgeAnticoag guides clinicians in assessing individual patient and procedural risk to better allow for risk assessment and thus determine whether interruption and/or bridging is appropriate for an individual patient. This tool has been updated to incorporate guidance from the 2017 Expert Consensus Decision Pathway on the Management of Bleeding in Patients on Oral Anticoagulants, and was renamed ManageAnticoag (Figure 6).
During the “2013 LDL: Address the Risk Think Tank” meetings, participants identified perceived statin intolerance as a major barrier to statin adherence and a contributor to the underutilization of statin therapy. Clinicians needed support tools that would enable them to carry out systematic and rigorous evaluation and management of high-risk patients with muscle symptoms. The ACC subsequently developed the Statin Intolerance App to facilitate and guide the process of evaluation of muscle symptoms and characteristics consistent with true statin intolerance, identification of secondary causes of muscle symptoms, consideration of statin-drug interactions that may cause muscle symptoms, differences in statin metabolism and pharmacokinetics, and strategies to optimize statin adherence. In addition to the app, a state-of-the-art paper, which reviewed contemporary clinical practice guidelines for managing LDL-cholesterol–related atherosclerotic cardiovascular disease risk, was published to improve clinician awareness and implementation of lipid guidelines (51). A patient educational resource guide, which may be used during live educational programs for patients, was added to the CardioSmart library.
These represent just a few of the outputs from previous roundtables. A comprehensive list is provided for review in Table 2. Figure 7 shows the outputs in the context of a solution set including the different tools and resources developed for the clinician, patient, and systems of care that have emerged from Heart House Roundtables.
Relation to Other ACC and Heart House Meetings
Heart House Roundtables are one of several types of face-to-face meetings branded by the ACC. The ACC is a recognized leader in the development and conduct of important educational, science and quality, advocacy, and practice management meetings for both cardiovascular and other medical professionals. Certainly, the ACC Annual Scientific Session has set the standard for educational programming for the cardiovascular community. A list of other live educational meetings offered throughout the year can be found online. The annual ACC Legislative Conference brings together ACC members from across the country to advocate for cardiovascular professionals and their patients. The ACC Cardiovascular Summit addresses business, operational, quality, and leadership issues related to the practice of cardiology.
When addressing complex issues in cardiovascular care, gaps in current guidelines or evolving scientific evidence often exist, and interactive in-person meetings have demonstrated increasing value to the ACC as a format for problem solving and development of consensus recommendations. These in-person meetings are becoming more common at Heart House. While other meetings may leverage aspects of the Heart House Roundtable methodology, as outlined in this document, it is important to note that for a meeting to be branded as an official Heart House Roundtable, it must be overseen by a committee within Science and Quality. Proposals for topics not identified as an official Heart House Roundtable may pursue other staffing and funding resources and may leverage the Heart House Roundtable methodology, but will not be officially branded. This has been the case with previously convened meetings including both the Innovation and Appropriate Use Criteria Summits as well as forums on Optimizing Cardiovascular Care: ACC and Health Systems, Right Measure for the Right Care of Heart Failure Patients, the Integration of Patient-Reported Outcomes into Cardiovascular Care, and Antithrombotic Therapy for the Management of PAD and CAD. Similarly, member groups, such as the ACC Section Leadership Councils, may conduct think tank sessions or other live meetings. As ACC’s Heart House includes a state-of-the-art conference center, there are also several non-ACC meetings held at Heart House when space is available (e.g., Cedars Sinai Women’s Heart Conference, U.S. Food and Drug Administration Advisory Meetings, MedStar Health, The Advisory Board Company meetings). These meetings are not part of the Heart House Roundtable series, and do not follow the format outlined in this paper.
Cardiovascular care continues to be complex, rapidly evolving, and ever-expanding. The ACC’s international presence is also increasing substantially. New collaboration with other medical specialties that impact cardiovascular care, such as endocrinology and oncology, are similarly evolving. The challenges of population health, personalized care, and improving the value of health care, as well as the well-being of health care professionals, are accelerating. Concurrent with these trends, new drugs and devices are brought to the bedside every year. To improve heart health and innovate, the ACC increasingly will look outside of its walls for collaboration and guidance. Convening roundtables within the walls of Heart House has proven to be a valuable tool for developing the solutions that our professional members need.
We expect that the successes of the first years will continue, with enthusiasm for more roundtables. The Board of Trustees of the College is in the process of implementing a 5-year strategic plan. Certainly, roundtables will be included in our strategy to advance our mission. Convening stakeholders to address the new challenges will be important; however, not every challenge will require a roundtable. Many challenges will be met by evolving research initiatives, education, or advocacy. Nonetheless, there will continue to be a need for the College to convene important, focused discussions and to produce the solutions needed every day in the clinical care of patients. The methodology presented in this document reflects the College’s current practices and will evolve as the landscape changes. The ACC and Heart House will continue long into the future as a trusted place to foster these discussions.
President and Staff
Richard J. Kovacs, MD, FACC, President
Timothy W. Attebery, DSc, MBA, FACHE, Chief Executive Officer
William J. Oetgen, MD, MBA, FACC, FACP, Executive Vice President, Science, Education, Quality, and Publishing
Joseph M. Allen, MA, Team Leader, Clinical Policy and Pathways
Amy Dearborn, Team Leader, Clinical Content Development
Ashleigh Covington, MA, Team Leader, Clinical Pathways and Heart House Roundtables
Amelia Scholtz, PhD, Publications Manager, Science, Education, Quality, and Publishing
Appendix 1 2016 Anticoagulation Consortium Roundtable Meeting Agenda
Anticoagulation Consortium Roundtable Agenda
Appendix 4 Author Relationships With Industry and Other Entities (COMPREHENSIVE)—2019 Methodology for Heart House Roundtables
Appendix 5 Peer Reviewer Information—2019 Heart House Roundtables Methodology
This table represents the individuals, organizations, and groups that peer reviewed this document. A list of corresponding comprehensive healthcare-related disclosures for each reviewer is available online.
This document was approved by the American College of Cardiology Clinical Policy Approval Committee in June 2019.
The American College of Cardiology requests that this document be cited as follows: Morris PB, Kovacs RJ, Allen LA, Binder LG, Birtcher KK, Covington AM, Gluckman TJ, Williams KA Sr. 2019 methodology for Heart House Roundtables: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2019;74:1116–37.
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- Solution Set Oversight Committee
- Table of Contents
- Roundtable Background
- Topic Selection
- Planning Process: Roundtable Planning Committee
- Diversity and Role of Stakeholder Participants
- Planning Process: Roundtable Design
- Industry Involvement and Firewalls
- Outputs of Roundtables
- Relation to Other ACC and Heart House Meetings
- Future Directions
- President and Staff
- Appendix 1 2016 Anticoagulation Consortium Roundtable Meeting Agenda
- Appendix 2 2016 Anticoagulation Consortium Roundtable Meeting Discussion Questions
- Appendix 3 2016 Anticoagulation Consortium Roundtable Meeting Briefing Book Table of Contents
- Appendix 4 Author Relationships With Industry and Other Entities (COMPREHENSIVE)—2019 Methodology for Heart House Roundtables
- Appendix 5 Peer Reviewer Information—2019 Heart House Roundtables Methodology