New in Clinical Documents Recommendations For Congenital and Genetic Heart Disease Screenings in Youth Health care professionals should use a 14-element checklist when evaluating healthy, young individuals ages 12-25 for congenital and genetic heart disease vs. initial screening using electrocardiograms (ECGs), according to a new scientific statement released by the ACC and the American Heart Association (AHA) and published in the Journal of the American College of Cardiology. The recommended 14-element screening checklist includes assessing young people for findings on the physical examination, including heart murmurs, and for any history of unexplained fainting, exertional chest pain, or excessive shortness of breath or fatigue during exercise. It also includes questions about family history of premature death or disability due to heart disease or known cardiac conditions involving the heart muscle or heart rhythm before age 50 in one or more family members. The checklist also questions whether an individual has been restricted from participation in sports in the past or has had prior testing for the heart ordered by a health care provider. Perioperative CV Evaluation and Management of Non- Cardiac Surgery Patients The ACC and the AHA have released a new, updated guideline for minimizing the risk of cardiovascular complications before, during and after a patient undergoes non-cardiac surgery. The "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery," was published Aug. 1 in the Journal of the American College of Cardiology, and was accompanied by a systematic review of the guideline on perioperative beta blockade in non-cardiac surgery. The updated guideline was based on a thorough evidence review that analyzed randomized controlled trials, case series, systematic reviews, cohort studies and registries. It puts particular emphasis on preoperative evaluation, offering recommendations on when clinical testing - such as 12-lead ECG, assessment of left ventricular function, coronary angiography and stress testing - may be warranted. Additionally proposed is a new testing algorithm that incorporates a risk calculator while continuing to emphasize that stable patients undergoing low-risk surgery or practice good exercise tolerance rarely need further cardiac studies. New NSTE-ACS Guideline The new ACC/AHA 2014 Guideline for the Management of Patients With Non- ST-Elevation Acute Coronary Syndromes (NSTE-ACS) released on Sept. 23 has a new name and new terminology that reflect current ways of thinking about this frequent and serious cardiac condition. The guideline is the first full revision since the 2007 ACC/AHA Guideline for the Management of Patients with Unstable Angina and Non-ST-Elevation Myocardial Infarction (NSTEMI) and subsequent focused updates. According to Writing Committee Chair Ezra A. Amsterdam, MD, FACC, the new guideline title emphasizes the pathophysiologic continuum of unstable angina and NSTEMI and their frequently indistinguishable clinical presentations. Another significant change is the replacement of the term "initial conservative management" with "ischemia-guided strategy" to more clearly convey the physiologic rationale of this approach. First AUC on Initial Transthoracic Echo in Outpatient Pediatric Cardiology The ACC, in collaboration with eight partnering societies, released new appropriate use criteria (AUC) aimed at helping clinicians determine the reasonable role of initial transthoracic echocardiography in the evaluation of pediatric patients in an outpatient setting. The AUC are the first of their kind focusing on pediatric patients, and govern 113 indications for outpatient pediatric echocardiography based on common clinical scenarios and/or clinical practice guidelines. Previous AUC were published in 2005 for echocardiography in adults. Strategies to Enhance CVD and Comorbid Condition Guidelines With a growing number of U.S. adults with more than one chronic condition, the ACC, AHA and the U.S. Department of Health and Human Services (HHS) have released an analysis aimed at providing guidance around effective management of cardiovascular patients with comorbidities. The "AHA/ACC/HHS Strategies to Enhance Application of Clinical Practice Guidelines in Patients With Cardiovascular Disease and Comorbid Conditions," is based on a review of Medicare claims for 2012 to determine the extent to which cardiovascular patients were filing claims for a range of other conditions such as pulmonary dysfunction, diabetes mellitus, arthritis and mental health disorders. Latest Science from ESC Congress 2014 A number of practice-changing trials presented at this year's ESC Congress in Barcelona, Spain, may have significant implications on current clinical practice guidelines. One of the biggest new trials - the PARADIGM-HF trial - generated the most buzz about the future of heart failure treatment. The study, which compared the combination angiotensin receptor-neprilysin inhibitor, LCZ696, an investigational new heart failure drug, to enalapril in patients with heart failure and reduced ejection fraction, was stopped early because of overwhelming benefit with LCZ696. Results from the CvLPRIT trial found that patients with ST-elevation myocardial infarction (STEMI) undergoing complete revascularization had better outcomes and experienced fewer major adverse cardiac events compared with those who had only "culprit" artery revascularization. These results reinforce data from another trial, the PRAMI trial published in 2013, which showed percutaneous coronary intervention (PCI) of all coronary arteries with major stenoses (i.e. > 50 percent angiographic narrowing) may improve outcomes. While questions remain about the exact timing of non-culprit artery PCI, whether certain patients benefit versus others; whether fractional flow reserve might guide decisions; and the role of patient complexity and hemodynamic stability; the results have raised enough concern that the College recently withdrew its recommendation that non-culprit artery PCI not be performed at time of primary PCI from the ABIM Foundation's Choosing Wisely campaign until the issue can be settled. The ACC is working with the American Heart Association and its other partners on the guidelines for management of patients with STEMI to address these findings. Changes to the PCI guidelines and appropriate use criteria for revascularization are also under advisement. The one-year results of the TASTE Trial may also alter clinical practice. Investigators assessed the benefit of routine thrombus aspiration at time of primary PCI for STEMI patients. In contrast to a previous study, they reported no survival benefit with routine thrombus aspiration or any reduction in a combined endpoint of death, re-hospitalization for myocardial infarction, or stent thrombosis. "These and other trials underscore the fact that science is not static, but rather constantly evolving," says ACC President Patrick T. O'Gara, MD, FACC. "The College and others need to be responsive to these dynamic changes and ensure that cardiovascular professionals are providing the most appropriate, evidence-based care. However, there is also a need to maintain the rigorous processes and methodologies associated with clinical practice guideline development." For complete ACC coverage of ESC Congress 2014, visit the Meeting Coverage page on CardioSource.org. TCT 2014 Brings Intervention to Washington, DC Transcatheter Cardiovascular Therapeutics (TCT) 2014 brought the latest in interventional cardiology to Washington, DC, in September. Among the hot trials making headlines, the ABSORB II trial found that an everolimus-eluting bioresorbable scaffold produces a comparable success rate to an everolimus-eluting metallic stent in aiding patients with coronary artery disease. Investigators presenting the PRIMA trial noted that patent foramen ovale closure may significantly reduce migraine headaches in patients, as well as in patients who have migraines with aura refractory as compared to medical therapy. Another hot trial, SECURITY, found that dual antiplatelet therapy following second-generation drug-eluting stent implantation appears to be acceptable at 12 months in regards to incidences of cardiac death, myocardial infarction, stroke, definite/probable sent thrombosis, and Bleeding Academic Research Consortium type three or five bleeding. Look out for ACC coverage from the American Heart Association's Scientific Sessions on CardioSource.org. Follow @ACCinTouch on Twitter for the latest updates. ACC Names Editor in Chief of New JACC: Clinical Electrophysiology Journal David J. Wilber, MD, FACC, will serve as editor-in-chief of the new JACC: Clinical Electrophysiology. The new journal, which will begin publishing in March 2015 on a bimonthly basis, will feature original research and review articles regarding cardiac rhythm disorders. Dr. Wilber currently serves as the George M. Eisenberg Professor of Cardiovascular Sciences, Loyola University Chicago Stritch School of Medicine and has been the director of the Division of Cardiology and the Cardiovascular Institute at Loyola University Medical Center since 2001. He also holds the position of director of Clinical Electrophysiology. "We hope this new journal will be a major addition to the medical literature on electrophysiology, and a forum for new advances," he said. ACC Updates Choosing Wisely Heart Attack Recommendation In response to new science showing that complete revascularization of all significantly blocked arteries leads to better outcomes in some heart attack patients, the ACC has withdrawn its Choosing Wisely recommendation that patients and caregivers examine whether this practice is truly necessary. As part of its American Board of Internal Medicine Foundation Choosing Wisely list of five things providers and patients should question released in April 2012, the ACC recommended questioning any intervention beyond unblocking just the "culprit" artery responsible for the heart attack in a hemodynamically stable patient. At the time the list was released, there were several nonrandomized studies demonstrating harm to patients when treating all significantly blocked arteries. However, over the past two years, new science has emerged showing potential improvements for some patients in their overall outcomes as a result of complete revascularization. ACC Launches New Disclosure Management Portal The ACC launched a new and enhanced web portal to streamline the disclosure management process. The new system allows users to disclose all cardiovascular and health care-related relationships, and sign off on all appropriate user agreements, such as confidentially, embargo, attestation, and ongoing obligation, in one place. Users will be able to capture all data on one page relevant to the ACC activity in which they participate, and enter and exit the system as needed with single sign on. Additionally, the system has been fully modernized and optimized for use on computer, tablet or smartphone. Update your records and check out the new portal at disclosures.acc.org. Notable News New Book: Houston Hearts Houston Hearts - a new book that explores the remarkable history of Houston Methodist Hospital and Baylor University College of Medicine, from 1944 until now - was recently published by William L. Winters, Jr., MD, MACC. The book describes how in a matter of years, the program built up a reputation as one of the best cardiovascular surgical centers, in addition to their renowned cardiology department. Winters observed the premier hospital first-hand, beginning in 1968 and reflects on these memories in the text. W. Bruce Fye, MD, MA, MACC, remarks, "the authors achieved their goal of producing a richly documented history that will be of value to anyone seeking to understand the origins, evolution, and impact of The Methodist Hospital." In Memoriam: Joseph K. Perloff, MD, FACC Joseph K. Perloff, MD, FACC, passed away Aug. 17 at his home in Los Angeles at age 89 due to complications from coronary artery disease. He was a cardiologist at UCLA who helped establish the study of adult congenital heart disease and became the founding director of one of the first clinics dedicated to its treatment. "These are complex patients, and they are not going to thrive if they don't see specialists," he recalled in a 2003 Los Angeles Times article. In addition to his many successes, Perloff is remembered for receiving the first ACC Lifetime Achievement Award in 2008. In Memoriam: Arthur Hollman, MD, FRCP, FLS Arthur Hollman, MD, FRCP, FLS, an archivist and historian for the British Cardiovascular Society (BCS) and honorary member of the California Chapter of the ACC passed away Aug. 20. He once said that he would like to be remembered as the man who saved the "millimeter of mercury." In 1975, he founded "the Committee for the Protection of the mmHg" after the European Union (EEC) directed that blood pressure should be measured in kilopascals, and not in millimeters of mercury. He persuaded other European countries, including the Soviet Union, to get the EEC to reverse its decision and persuaded the World Health Organization to state in 1980 that the "mmHg would be retained for the time being." Hollman was an icon in the BCS and a much valued strategic partner to the ACC. ACC BOT Member Receives Friendship Award Congratulations to Harlan Krumholz, MD, SM, FACC, a member of the ACC's Board of Trustees, for receiving China's Friendship Award, the nation's highest honor for achievement by a foreigner. The award nationally recognizes those who are driving forces in economic and social development. Foreigners are only eligible to win the award once, making the achievement even more momentous. FACC Named Dean of UT College of Medicine and Life Sciences Christopher Cooper, MD, FACC, governor of the Ohio Chapter of the ACC, has been named dean of the University of Toledo's (UT) College of Medicine and Life Sciences. "I'm honored to accept this role because I know first-hand the hard-working and talented faculty and staff that make this College of Medicine a place that I have been proud to serve for the past two decades," said Cooper. "I am looking forward to working with the students, faculty and staff of the College of Medicine and Life Sciences to continue elevating this college, the UT Medical Center and the University." A cardiologist who has been working at the UT Medical Center for 20 years, Cooper has established himself as engaging educator and prolific researcher throughout his career. Most recently he served as the principal investigator on a $20 million grant from the National Institutes of Health, Cooper and his team announced results in late 2013 that could lead to fewer procedures and lower costs for patients suffering from kidney related high blood pressure. In Memoriam: Mario Rubén García Palmieri, MD, MACC Mario Rubén García Palmieri, MD, MACC, passed away on Sept. 16. He was governor of the ACC Puerto Rico Chapter from 1966 through 1969 and a devoted contributor to the organization and its mission. Notably, his long ACC career peaked when in 2008 he was designated Master of the ACC. In recent years, he continued to participate enthusiastically in the Puerto Rico Chapter's Annual Scientific Session and its organizing scientific committee, always promoting the participation and scientific engagement of cardiology fellows. ACC Partners With 1776 to Identify, Support Innovative Health Startups The ACC is partnering with 1776, the global incubator and investment fund, as an association partner in addition to supporting 1776's Challenge Cup - a global competition spanning 16 cities in 11 countries to identify the most promising health startups solving some of the health care industry's biggest challenges. "Forward-thinking, innovative startups can play a pivotal role in developing new ideas and technologies to help stimulate advances in medicine and science," said ACC CEO Shal Jacobovitz. "We are proud to partner with 1776 and Challenge Cup because these new companies have the potential to help us fulfill our mission to transform cardiovascular care and improve health." As a Challenge Cup partner, the ACC will provide this year's regional winners with an unparalleled opportunity: an all-expense paid trip to the 64th Annual Scientific Session in San Diego, CA. "At Challenge Cup, making connections and finding the right mentors to help navigate regulated industries is just as important as connecting with the right investors - and we're proud that ACC recognizes the tremendous potential these startups have to strengthen healthcare for people around the world," said Donna Harris, co-founder of 1776. Candidates for the Challenge Cup competition are startups that are compelling, world changing, highly scalable, and aim to make tangible differences in peoples' lives, not just build the hottest new app. Through Challenge Cup, entrepreneurs are not only connected to the investors and mentors they need to succeed, but sponsors and venture partners are introduced to these innovators' fresh ideas that have the potential to solve big, difficult challenges. Challenge Cup 2015 events are being held in 16 cities, including Washington, DC, Chicago, Sydney, New York City, Tel Aviv, Amman, Santiago, Nairobi, Mumbai, Austin, Toronto, Boston, Berlin, Dublin, San Francisco, and China. Each city will produce four regional winners in four categories - education, energy, health and cities. The 64 regional winners will further compete at 1776's Challenge Festival in May, a week long event in Washington, DC, that gives these startups an opportunity to forge deeper connections with the partners that can help them navigate regulation and quickly scale their businesses. ACC in Touch Follow @ACCinTouch on Twitter for breaking news from all of the top cardiovascular meetings including #AHA14, #CVSummit and #ACC15. Interested in action from Capitol Hill? Check out @Cardiology for the latest cardiovascular-related advocacy news. Connect with ACC CEO Shal Jacobovitz on LinkedIn. Search for Shal on LinkedIn.com and be sure to join the American College of Cardiology group to stay up-to-date on the latest news from the College. Recent posts on the ACC in Touch Blog include Patrick T. O’Gara, MD, FACC, president of the ACC, who explains the importance of regulating e-cigarettes. Recent guest posts include William A. Zoghbi, MD, MACC, past president of the ACC, who examines cardiovascular disease around the globe through heart-healthy environments in celebration of World Heart Day; Kim Birtcher, MS, PharmD, AACC, chair of the ACC’s LDL: Address the Risk Oversight Workgroup, who explores how to work collaboratively to help patients and clinicians address low-density lipoprotein risks; and Kim Williams, Sr., MD, FACC, president-elect of the ACC, who recaps the recent anticoagulation consortium roundtable that continued important discussions around anticoagulation therapy.
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