Well, folks, another great annual meeting has concluded. I think it’s safe to say we’ve covered all the major CV issues during these three crazy days, along with many not-so-major issues. I personally have enjoyed all the talk of health care reform (if it should ever happen) and of quality of care issues.  I’ve had the opportunity to meet with some true visionaries: U.S. CTO Aneesh Chopra, M.P.P., Anthony Atala, M.D., Richard Satava, M.D., to name a few, plus the many leaders of the international cardiovascular societies who travel great lengths to attend the meeting. I hope you’ve found the meeting to be enjoyable and have some clinical insights you’ll take back to your everyday practice. Make sure to mark your calendars now for ACC.10 and i2 Summit: April 3-5 in New Orleans.

I want to hear from you: What’s been your favorite part of the meeting? Answer the poll below and leave a more detailed response in the comment section below the poll.

There have been a lot of great LBCTs at ACC.10/i2 Summit. Which do you think was the best?

Some post-ACC.10 blog coverage to look forward to: Our ACC member bloggers will be giving their take on the differences in the US & UK health system in the form of two hypothetical CV patients, Thurgood Powell and Mortimer Schnerd. From Dr. Fisher:

We thought it would be interesting to compare and contrast two heart patients - one with insurance and one without insurance - from our two health care systems, to illustrate how these patients obtain health coverage, might be managed, and how things look from the patient's perspective.

...

For the purposes of the exercise, we'll take two patients, Mr. Thurgood Powell, a highly successful 57 year-old businessman making $250,000 (£166,128) per year with his company PoshPosh Entertainment, and Mortimer T. Schnerd, a pleasant 43 year old man who is unemployed but working part-time in the local K-mart, earning $17,400 (£11,562) per year. Both men will experience heart attacks, both men will present to Emergency Rooms in both countries, and both men with require 4-day ICD stays and require the implantation of an automatic defibrillator and follow-up for the first year after the heart attack. Beyond that, heck, who knows. But that will at least give us a starting point to discuss the good, the bad, and the ugly of both health care systems and to compare and contrast the two systems. We will purposely refrain from political commentary in our posts (that's for you to do in the comments section!). We only ask that the commentary discussion be respectful and civil. I would be thrilled to hear what the British think of their health care system/costs/etc. over on Sarah's blog and the U.S. perspectives on this blog.

So there you have it. Look to their blogs (Dr. Clarke and Dr. Fisher) for the full discussion, and I'll be posting my response here as well. 

Other posts from Dr. Clarke today:

• Want to know more about AF??!! See this new website and other trial results from the ACC!: The ACC and Heart Rhythm Society have launched a new website just for AF !!! Take a look!
  
  
• DAT post DES…how long??: The aged debate goes on! How long should we be giving dual anti-platelet therapy (DAT) after DES? Current guidelines suggest 12 months….
  
  
• Cryoablation for PAF: STOP-AF: Whilst anti-arrythmic drugs (AAD) are not without morbidity or mortality, and radiofrequency ablation requires mutliple lesions and can be associated with complications, cryoablation offers PVI with a single continuous cryolesion. But what are the complications?

Last year during ACC.09, I posed this question to blog visitors. Fifty percent said that pocket guides helped you the most in implementing guidelines into your day-to-day practice; 20 percent said it was the guidelines on CD; 15 percent liked wall charts best; and the rest answered “other.” With the TAD guidelines out today, I’m interested in seeing how and if these results have changed over the last year. Answer below!

Actor John Ritter’s sudden death in 2003 from a thoracic aortic aneurysm brought much-needed attention to thoracic aortic disease (TAD). TAD does not have to be fatal, but proper diagnosis and management are critical to allowing TAD patients to live long and healthy lives.  To address the treatment needs for this condition, the ACC and the American Heart Association this morning released new clinical guidelines for the diagnosis and management of TAD. The guidelines arguably deliver a powerful message to physicians and patients: Early diagnosis and treatment can save lives.

One of the most important messages in the guidelines is that TAD often runs in families. As a result, family history is a critical tool for uncovering undiagnosed cases of TAD. Here are other highlights from the guidelines:

• Imaging of the thoracic aorta by computed tomography (CT), magnetic resonance imaging (MRI) or, in some cases, echocardiography is the best way to detect TAD and determine future risk. A chest x-ray alone is not sufficient.
  
  
• Patients with genetic conditions that increase the risk of TAD should have aortic imaging at the time of diagnosis to establish the size of the aorta, with periodic follow-up imaging thereafter.
  
  
• All patients with a bicuspid aortic valve should be evaluated to determine whether the aorta is dilating, or widening.
  
  
• The symptoms of acute aortic dissection, which can mimic those of a heart attack or another cause of chest pain, often make it difficult to arrive at a prompt diagnosis and may delay life-saving treatment. Physicians should keep aortic dissection in mind when asking questions about medical history, family history, and the type and pattern of pain, and when examining the patient.
  
  
• Aortic dissection involving the ascending aorta (the portion nearest the heart) is a life-threatening emergency that should be treated surgically.
  
  
• Aortic dissection involving the descending thoracic aorta may often be managed with medications that control the blood pressure and heart rate, unless life-threatening complications develop. Additional medical therapy may include statins to lower elevated blood cholesterol levels.
  
  
• Minimally invasive endovascular techniques are an option in some patients with aneurysm or dissection of the descending thoracic aorta.
  
  
• All immediate relatives of a patient with thoracic aortic aneurysm or dissection, or a bicuspid aortic valve, should be evaluated by a cardiovascular physician and undergo aortic imaging to measure the size of the aorta and identify asymptomatic disease.

The new guidelines will appear in the April 6 issues of the Journal of American College of Cardiology (JACC) and Circulation: Journal of the American Heart Association, and is available online. They were developed in collaboration with the American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. and the American College of Physicians were also represented on the writing committee.

Yesterday I spoke at a session on practice management called “Practice Innovation: How to Reduce Costs and Increase Quality.” This session offered a high-level look at the many resources the College has available to help practices deliver high quality care while saving money.

The session had an all-star lineup: former (as of convocation last night) ACC President Fred Bove, M.D., M.A.C.C., and now current president Ralph Brindis, M.D., F.A.C.C., were the session chairs. Ralph gave a talk about the role of registries in a reformed health care system and how registries can help measure success, reduce health care disparities and serve as an important tool in comparative effectiveness research (similar to what I wrote about on Sunday).

ACC SVP of Science and Quality Janet Wright, M.D., F.A.C.C., talked about the various quality programs that ACC runs, such as the highly successful Door-to-Balloon campaign, the newly formed Hospital to Home program and medication adherence initiatives. Co-Chair of the Health IT Committee Jimmy Tcheng, M.D., F.AC.C., talked about health IT and the tools necessary to adapt to delivery system change. My presentation at the session covered ways of reducing variations in CV care through tools like appropriate use criteria.

This session goes to show all the different ways that the ACC offers members to improve quality in different areas. That said, CV practices around the country are struggling under the recent payment cuts put into effect by CMS to make fewer practice dollars go farther. It’s understandable that the thought of participating in a quality program might seem impossible at this point. However, even in economically distressing times, the ACC continues to promote quality programs because quality must be the core of what we as health care professionals do. At some point (hopefully!), practices will have the resources to fully commit and expand their participation in quality programming.

*** Image from morgueFile (jdurham). ***

Great day today. Check out these posts by Drs. Fisher and Clarke, and then watch the CVN video below for an additional take on today's science.

From Dr. Fisher:

• Back By Popular Demand: Sex, the Heart, and ED: Today, I proved what I suspected: if you want readership, write or Tweet about sex and the heart.
  
  
• How to Follow the ACC Meeting in Near Real-Time: Both Sarah Clarke, MD (@doctorsarah), pictured above, and I (@doctorwes) will be trying to Twitter (is that a verb?) several of the ACC Sessions while providing running commentary on the meeting today.
  
  
• ACC10 March 14, 2010: A Few Noteable Quotables: "If we're going to count radiation exposure an adverse event, perhaps we should consider sternotomy one, too."

From Dr. Clarke:

• For those sessions you dont get to, and for when you get home!: Just had a look at iScience….highly recommended!
  
  
• The Health Care Reform Debate: Nothing like getting politicians in a room to pull the audience in!
  
  
• Similar to SYNTAX...: 5 year results of a registry comparing left main stem stenting vs. CABG in unprotected left main (MAIN-COMPARE), have been discussed.

Earlier today I attended an ACC.10 Joint International Lunchtime Symposia as part of ACC’s growing collaboration with international CV societies. There were 15 international lunchtime symposia held at once, representing societies from all across the globe (the Turkish Society of Cardiology, Gulf Heart Association, Chinese Society of Cardiology, to name just three).  The purpose of ACC’s international efforts is to enhance cardiovascular health through the exchange of knowledge and resources for cardiovascular care worldwide. We do this through an ever-growing number of international ACC chapters and partnerships with international societies. A great example of this comes from the U.K., where we have a twinning arrangement between the British Cardiovascular Society and the California Chapter of the ACC (see Dr. Clarke’s post on this for more).

The events inspired by our international ties are not done. Don’t miss tomorrow’s 9th Annual Maseri-Florio International Lecture from 12:15 to 1:15 in Room B206. The event will feature Jean-Pierre Bassand of Besancon Cedex, France, discussing “Improved Outcome without Excess of Bleeding in Acute Coronary Syndromes: A Dream Come True.” Following this, there will be an international lunch in the Omni Hotel International Ballroom from 1:30-3 p.m.

Photo credit: http://visibleearth.nasa.gov/

ACC Central (Booth 2244) is the place to be today. We've got a stellar line up of presentations to help you and your practice. Here are the highlights (check at the booth for the final schedule):

Linking Practice Data and CME to MOC Part IV Credit

9:30 a.m. – 9:45 a.m.

3:30 p.m. – 3:45 p.m.

PINNACLE Registry™: Where Quality and Compensation Meet

10:15 a.m. – 10:30 a.m.

12:15 p.m. – 12:30 p.m.

Navigating 2010 Coding Changes

1:00 p.m. – 1:15 p.m.

E-Prescribing and PQRI: Getting Your Bonus 

1:45 p.m. – 2:00 p.m.

ACC Risk Management Institute: Reducing Your Liability Risk

3:45 p.m. – 4:00 p.m.

While you're there, you can check out some of the great promotions from the ACC, only available to meeting attendees. We'll have more information about lifelong learning, advocacy opportunities, advancing quality in your practice (you know you want your free Guidelines CD!), and be able to answer any questions you have about your membership.

*** Photo by Oscar Einzig. ***

Great coverage of the conference today from our ACC member bloggers, Sarah Clarke, M.D., F.A.C.C., and Wes Fisher, M.D., F.A.C.C.

From Dr. Clarke (who has not only shown herself to be a much more prolific blogger than me, also just joined Twitter -- @doctorsarah):

• Pharmacological treatment of atrial fibrillation. Dronedarone and other anti-arrhythmics: This session (room is packed….about 300 folk!) is focusing on the medical treatment of AF as opposed to the interventional treatment, describing the indication for the various  anti-arrhythmics including new agents.
  
• First impressions!: Nothing can prepare you for the vastness of the place and the programme! The content of the meeting is quite extraordinary with a huge amount available immediately online as sessions start!
  
• Day 1- Late Breaking Clinical Trials 1: An early start for those who made it and remembered to put the clock forward an hour (or rather back 4 hours instead of 5)! This session covered important trials.
  
• Good Morning Atlanta!: So, Dr Wes, your fellow blogging comrade has landed! I suspect the majority of planes landing in Atlanta this weekend have been packed with cardiologists ... Would be interesting to see what happened if the cabin crew requested ‘is there a doctor onboard!?’
  

Dr. Fisher did some detailed tweeting from several of the sessions today. Here are a few of the highlights, but go to his Twitter page for the full coverage. He also has some humorous insights into what makes ACC.10 a bit -- unique, so to speak.

• Richard Anderson,MD from Doctors Co: "legal reform is the only reform that increases pt access while decreasing costs." #acc10  [From today's Health System Reform session]
  
• Ryan: This issue is not about #hc alone - it is the ideology regarding founding principle of this country. #hcreform #acc10  [Also from today's Health System Reform session]
  
• Feldman: 9.6% of pts in Mitraclip w/complications vs 47% in surgery grp #acc10  [From our kick-off LBCT session this morning]
  
• INVEST and ACCORD: stringent control of BP (systolic BP < 130) in diabetics w/CAD w/worse outcomes. imagine: Too many drugs r bad #acc10 [Also from the LBCT session]

Looking forward to the coverage for tomorrow!

The ACC media team earlier today hosted a pen-and-pad session with major media outlets to discuss the importance of the National Cardiovascular Data Registry (NCDR). NCDR has been a major presence at ACC.10 and i2 Summit: 22 abstracts using its data were presented in oral presentations and poster presentations (for more information on NCDR abstracts, go to ACC Central, Booth 2244, and ask for the NCDR Guide to Research Posters and Presentations, which has complete information on the time and location of the NCDR presentations).

I think this focus on NCDR highlights an important point: while we currently base our most rigorous clinical documents, guidelines, on clinical trials, there’s a real need to understand real-world, in-the-trenches patient data and use that to improve care and inform clinical science.

This is, of course, easier said than done. Right now, we have the data from the hospitals that participate in the suite of NCDR registries. In the ambulatory setting, we continue to enroll and extract data from practices participating in the PINNACLE Registry. But we are still are missing data from the minority of CV hospitals and practices without the resources to participate in NCDR … yet! Even for the data we do have, we are challenged to link the outpatient and inpatient data without a better national interoperability infrastructure.

At the event today, health IT was brought up as a crucial component to understanding real-world patient data. Without health IT, practitioners lack the ability to more easily understand trends in their patient population and clinical habits. The data mining made possible by an electronic health record is not possible with a paper health record without a crippling amount of administrative hassle. To continuously take our quality of care to the next level, advanced health IT will be necessary. (Learn more about ACC’s health IT efforts here.)

What do you think? How important is using real-world patient data to inform clinical documents? Take the poll below and leave your comments on the blog by clicking the “comment” link under the poll.

*** Image from Flickr (Sir Twilight King). ***

Tonight night from 7-8:30 in the Omni Hotel's International Ballroom North, the ACC is hosting ACC’s 61st Anniversary Party, which we’ve renamed “ACC in Touch Reception: LIVE in Atlanta.” Okay, okay, you got me. It’s not actually a 61^st anniversary party but rather a networking reception. And like every good networking reception, it will feature a great band, hors d'oeuvres and your favorite beverage. If you're part of an ACC chapter, you can start at your chapter reception and move over the ACC in Touch networking reception directly after. If you're not part of a chapter, that’s okay, just come over around 7 to take this opportunity to network with your peers and have some genuine fun.

The event is themed for our new social media campaign, ACC in Touch, which helps you to network online currently, through Facebook, LinkedIn, Twitter and this blog. ACC in Touch has a huge presence at the meeting (which you’ll be able to learn more about at the reception), and this networking event is just one of them.

The ACC.10/i2 Summit photo contest is officially open! Submit your best photo through our Facebook app for a chance to win an Amazon Kindle loaded with a year's subscription to JACC. You can also click on the "contest" in red on the right for access. The photos will be voted on by Facebook fans of the ACC. Pictures can be submitted until March 21, so get snapping!

As I've mentioned previously on this blog, tomorrow I'm participating in the special session at ACC.10 about health system reform. The event features House Republican leader Paul Ryan, Democratic strategist and former Clinton White House adviser Chris Jennings, CEO of the Doctors Company Richard Anderson, MD, along with ACC President Fred Bove, M.D., F.A.C.C., ACC SVP of Advocacy Jim Fasules, M.D., F.A.C.C., and the events’ moderator, Scott Wright, M.D., F.A.C.C., of Mayo.

The event, tomorrow from 12:15 to 1:45 p.m. in Hall B100, promises to be a lively discussion on the promise and dilemma’s related to health care reform. I hope to see you there! Meanwhile, if you missed it in the last post, check out our ad that ran in major Washington, D.C., newspapers this week. I think it outlines the College’s positions quite well.

Shortly before the CV world descended upon Atlanta, the city hosted a different conference: the Healthcare Information and Management Systems Society (HIMSS). This conference was dedicated to conveying information about health information technology (IT). While many ACC members are perhaps unlikely to attend a four-day conference exclusively devoted to health IT, HIMSS and ACC have come together to offer something even better: a one-day track at ACC.10 devoted to health IT and how it relates to cardiology.

The spotlight session, tomorrow from 8 am to 6 pm in B405, features not only the visionaries in the field – National Health IT Coordinator David Blumenthal, M.D; U.S. CTO Aneesh Chopra, M.P.P.; and Marc Overhage, M.D., Ph.D., of the Indiana Health Information Exchange – but also ACC members who have implemented health IT into their practice offering practical advice on how to implement and how to maximize your health IT use. Check out the full schedule here and make sure on Sunday to attend this useful session.