New ACC/AHA/HRS Guideline Addresses Management of SVT To aid clinicians in treating SVT and distinguishing it from other disorders, the ACC, the American Heart Association and the Heart Rhythm Society have released the “2015 Guideline for the Management of Adult Patients With Supraventricular Tachycardia” (SVT). The document, which supersedes the 2003 guideline, contains the most updated consensus of clinicians with broad expertise related to SVT and its treatment. To coincide with the guideline, the ACC developed an SVT Diagnosis and Treatment Tool to help clinicians quickly diagnose the type of SVT and ensure they consistently follow a prescribed algorithm for treatment of the condition. To view all of the SVT resources, including the SVT Diagnosis and Treatment Tool; Slide Set; Key Points to Remember; and CardioSmart Patient Resource, visit ACC.org. On Sept. 23 the ACC/American Heart Association Task Force on Clinical Practice Guidelines also released a report explaining the changes to the latest recommendation classification system, which have been integrated into the 2015 SVT guideline, and better align with the Institute of Medicine’s 2011 recommendations. New Guidance Issued For Multivessel PCI, Thrombectomy in MI Patients A new focused update on primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI) was released Oct. 21 by the ACC, the American Heart Association and the Society for Cardiovascular Angiography and Interventions, in collaboration with the American College of Emergency Physicians, and simultaneously published in the Journal of the American College of Cardiology. The report includes the setting of primary PCI and the relevant considerations for multivessel PCI and thrombus aspiration. To accompany the update, the ACC developed a Primary PCI for STEMI Update Overview Tool designed to educate physicians of the change in class of recommendation for patients with STEMI who are hemodynamically stable. This tool is also intended to inform physicians of the change in the class of recommendation regarding manual aspiration thrombectomy for patients undergoing primary PCI. Societies Release Statement on the Future of Clinical Registries While there has been a rapid increase in the number of clinical registries over the past decade, there are still broad clinical areas and specific procedures that would benefit from the creation of a dedicated registry, according to a “Statement on the Future of Registries and the Performance Measurement Enterprise,” released Oct. 2 by the ACC, the American Heart Association and The Society of Thoracic Surgeons, and simultaneously published in the Journal of the American College of Cardiology. The statement examines the current state of clinical registries while acknowledging their future growth potential. “Registries can support the development, implementation, and evaluation of performance measures as tools for improving patient care and communicating meaningful information to patients regarding quality,” says Deepak L. Bhatt, MD, MPH, FACC, chair of the writing committee. Updated Training Requirements For Clinical EP Released The duration of required training for clinical cardiac electrophysiology will increase to two years, and the volume of procedures trainees should perform prior to completing their fellowship will increase, according to an updated Advanced Training Statement released by the ACC, the American Heart Association and the Heart Rhythm Society, and published in the Journal of the American College of Cardiology. The statement complements the Core Cardiovascular Training Statement (COCATS 4), released earlier this year. ACC Council Addresses Need For Geriatric Cardiology Subspecialty A distinctive geriatric cardiology subspecialty is needed to respond to the complex and unique cardiovascular needs of aging patients, according to a Council Perspective recently published in the Journal of the American College of Cardiology. The recommendation of a more robust geriatric cardiology subspecialty is the result of ACC’s Geriatric Cardiology Member Section’s examination of the future of geriatric cardiology and the evolution of the subspecialty. The authors note that while training for the subspecialty has yet to be defined, competencies would include “improved skills in diagnosis, risk management, disease management and the process of care.” They add that such training would equip providers upon completion with the skills needed to effectively care for older patients. ACC Councils Call For Greater Understanding of CV Effects of Smoking While advancements have been made in the field of tobacco-related research, smoking cessation rates have slowed in recent years, showing that there is still need for greater understanding of the cardiovascular effects of cigarette smoke exposure and electronic cigarettes, according to a Council Perspective from ACC’s Prevention of Cardiovascular Disease Section Leadership Council and Early Career Council published in the Journal of the American College of Cardiology. According to the authors, in order to further reduce morbidity and mortality from tobacco use, “it is essential to pursue knowledge of the effects of cigarette smoke exposure on the cardiovascular system at a molecular level.” ACC Council Addresses Management of Arrhythmia-Induced Cardiomyopathies Early recognition of arrhythmia-induced cardiomyopathies results in symptom resolution for patients, according to a Council Perspective from ACC’s Electrophysiology Council published in the Journal of the American College of Cardiology. The Council notes that in managing patients with arrhythmia-induced cardiomyopathy, clinicians should focus on eliminating the arrhythmia with catheter ablation and “attempt careful and aggressive control of rate and rhythm.” Long-term survival of the patient is likely following the resolution of the arrhythmia, with a low risk of sudden death. ACC Councils Evaluate the Role of Clinical Pharmacists on the Cardiovascular Care Team Clinical pharmacists play an important role for patients on the cardiovascular care team, according to a joint Council Perspective from ACC’s Cardiovascular Team Section Leadership Council and Prevention of Cardiovascular Disease Section Leadership Council published in the Journal of the American College of Cardiology. In the joint perspective paper, the authors discuss the role of the clinical pharmacist, including training and certifications. They conclude that moving forward, “multidisciplinary organizations … should support efforts to overcome legislative and compensation barriers so that pharmacists may be included in health care delivery models that allow full use of their education and training to provide high-quality patient care.” ACC Council Perspective Offers Advice on NIH Awards The training of cardiovascular physician-scientists, while challenging, is imperative for advancements in health care, according to a Council Perspective from ACC’s Academic Cardiology Section Leadership Council and the Early Career Section Leadership Council, published in the Journal of the American College of Cardiology. In the paper, the authors reflect on the current state of National Institutes of Health career development awards and give guidance to those applying. FDA Updates • The U.S. Food and Drug Administration (FDA) expanded the approval of the Edwards Lifesciences' SAPIEN XT transcatheter heart valve for aortic valve-in-valve procedures. The expanded approval comes from the one-year outcomes of the PARTNER II Valve-in-Valve Registry trial. • The FDA has approved Boston Scientific's Synergy bioabsorbable polymer drug-eluting stent, the first device of its kind to receive approval. • The FDA also recently gave 510(k) clearance for the robotic-assisted CorPath System from Corindus Vascular Robotics, Inc., intended for use during radial access percutaneous coronary interventions. ACC Response to ABIM Report on Vision For Certification and MOC Programs in 2020 The American Board of Internal Medicine (ABIM) recently released a report entitled “A Vision for Certification in Internal Medicine in 2020,” that was drafted to inform the reshaping of ABIM’s Certification and Maintenance of Certification (MOC) programs. The report, developed by the Assessment 2020 Task Force which assembled in 2013, aims to “develop a vision for the future of assessment in internal medicine and associated subspecialties” and to “stimulate discussion” around the future of certification. According to Task Force Chair Harlan Krumholz, MD, SM, FACC, “the group sought to envision what the future could be and considered that what is possible tomorrow may be very different from what can be done today.” With that in mind, the report includes three key recommendations that are similar to those being proposed by the ACC on behalf of its members, as well as the rest of the internal medicine community. Specifically, the report proposes to: 1) replace the 10-year MOC exam with more frequent, less burdensome assessments; 2) focus assessments on cognitive and technical skills; and 3) recognize specialization. The Assessment 2020 Task Force should be commended for its work over the last two years to gather input from stakeholders and develop this report that will no doubt further discussions around the future of MOC. The ACC is also appreciative of ABIM’s continued willingness to listen and learn from the internal medicine community. ACC’s input to date has resulted in the reversal of the double jeopardy provision; decoupling of the initial board exam from MOC participation; streamlining the ability for practitioners to get both CME and MOC Part II credit; and delaying MOC Part IV, etc. As evidenced by the report, there is still much to be done despite the changes over the last several months. The College understands the frustration of its members around the current MOC process and the issue continues to be a top priority for the College. In particular, the ACC strongly agrees with the report about the need to develop a new, externally-validated process for measuring competence to replace the 10-year exam with all deliberate haste. Additionally, the ACC is committed to continuing work with ABIM to research best practices for the maintenance and demonstration of competence with eventual links to patient outcomes, cost and cost-effectiveness. The College is committed to finding a solution or solutions that best meet the professional needs of clinicians, while also giving patients, the public and other stakeholders confidence that the care provided by their physicians is of the highest quality. Defining Optimal Governance: A Key Priority For ACC’s BOT The ACC has experienced significant growth and change over the last decade. Much of this growth has come in response to changes in the health care environment, as well as changes to member demographics. Further, the trend toward hospital integration for a majority of ACC’s members has required the College to change and tailor its products and services to meet the different needs of members in these institutional environments. Since the development of ACC’s comprehensive five-year Strategic Plan, designed to ensure that the College is doing the right things to fulfill its mission in this changing environment, ACC’s Board of Trustees (BOT) has made it a priority to review its governance and decision-making structures and processes. As a result of this review, the BOT recently approved several key principles of 21st century, optimal governance. They will use these principles to guide the development of performance metrics and a governance-implementation plan to be released by early 2016. Three ACC Members Receive Glorney-Raisbeck Fellowship in Cardiovascular Diseases Joshua M. Lader, MD, a fellow in training at the New York University School of Medicine; Adam Castaño, MD, a fellow in training at Columbia University; and Amy Kontorovich, MD, a fellow at Mount Sinai Medical Center, received the Glorney-Raisbeck Fellowship in Cardiovascular Research from The New York Academy of Medicine. Each fellowship award supports innovative research projects in the field of cardiovascular disease. Below are the fellows’ research topics: Lader: “Mechanisms of K(ATP) Channel Activation in Adrenergically-Mediated Atrial Fibrillation” Castaño: “Technetium Pyrophosphate Cardiac Imaging to Determine if Transthyretin Cardiac Amyloidosis Explains Paradoxical Low-Flow Severe Aortic Stenosis” Kontorovich: “Modeling Myocarditis with Human Induced Pluripotent Stem Cells” In Memoriam: Jack Matloff, MD The founding chair and chair emeritus of Cedars-Sinai’s Department of Cardiothoracic Surgery, Jack Matloff, MD, passed away at the age of 82. During his long and inspirational career, Matloff created heart and lung transplant centers at Cedars-Sinai, served as the president of The Society of Thoracic Surgeons, and co-founded a series of health care executive courses at the Kennedy School of Government at Harvard University. Amongst his many awards for his dedication to service and cardiovascular health, Matloff received the Jerusalem Medal, the highest honor available to a foreign national, for his work at the Jesselson Comprehensive Heart Center at Shaare Zedek Hospital in Jerusalem, Israel. Matloff will be greatly missed by his colleagues, patients, friends and family. ACC Trustee Appointed to Physician-Focused Payment Model Technical Advisory Committee Paul N. Casale, MD, MPH, FACC, a member of ACC’s Board of Trustees (BOT), has been appointed to the new Physician-Focused Payment Model Technical Advisory Committee, created by the Medicare Access and CHIP Reauthorization Act of 2015. Casale was nominated for this position by the ACC. The 11 committee members, which were appointed by Gene L. Dodaro, the Comptroller General of the U.S. and head of the U.S. Government Accountability Office, will provide information and recommendations on physician payment models to the Secretary of Health and Human Services. “This committee will be a critical source of information and advice for the Secretary of Health and Human Services as the department considers new payment approaches for Medicare physician services,” said Dodaro. Casale, an interventional cardiologist, is chief of cardiology at Lancaster General Health. He is also a clinical professor of medicine at the Temple University School of Medicine and senior scholar in the department of health policy at Sidney Kimmel Medical College at Thomas Jefferson University. In addition to serving on ACC’s BOT, he is active on several College committees. Roberto Bolli, MD, FACC, Receives ISHR Lifetime Achievement Award The International Society for Heart Research (ISHR) presented the Peter Harris Distinguished Scientist Award to Roberto Bolli, MD, FACC, for his major discoveries in cardiovascular science. Bolli serves as the chief of the division of cardiovascular medicine, director of the Institute of Molecular Cardiology, director of the Cardiovascular Innovation Institute, and vice chair for research in the department of medicine at the University of Louisville, Kentucky. Bolli’s research includes studying the use of stem cells in treating coronary artery disease patients and the use of ischemic preconditioning. Cardiac Care, A History In his new book, The Heart Healers: The Misfits, Mavericks, and Rebels Who Created the Greatest Medical Breakthrough of Our Lives, James S. Forrester, MD, FACC, co-chair of ACC’s History Work Group, explores the history of cardiac care and how future advances will impact patients and practice. According to the publishers, the new novel is “a compelling chronicle of heart disease and its treatment, as well as a fascinating look at the future of cardiac research and the prevention of heart disease by a man who, himself, has been responsible for hugely significant advances in the field”. Forrester is the recipient of ACC’s Lifetime Achievement Award and serves as an emeritus professor and former chief of the Division of Cardiology at Cedars-Sinai. ACC to Launch Two New Afib-Related Registries The ACC has announced that it will launch two new clinical registry programs to track real world outcomes for the treatment and prevention of stroke in patients with atrial fibrillation (AFib). The two new registries, which will focus on Afib ablation and left atrial appendage occlusion (LAAO), will bring ACC’s total number of hospital and outpatient registries under the NCDR umbrella to 10. The LAAO Registry, will capture data on LAAO procedures to assess patient selection, procedural indications and outcomes, as well as short- and long-term safety. The Afib Ablation Registry will assess the clinical characteristics, acute management, and outcomes of patients undergoing atrial fibrillation ablation procedures. “With a growing prevalence of Afib and a proliferation of options for treatment and stroke prevention in Afib patients, the ACC saw a need for real-world data to track and evaluate the use of these technologies,” said ACC President Kim Allan Williams Sr., MD, FACC. “Data derived from these registries are expected to inform practices and improve patient outcomes.” ACC Announces New Shared Decision Aid The ACC has launched a new decision aid for treating non-valvular atrial fibrillation (AFib) patients with anticoagulation. Blood Thinners For Atrial Fibrillation: A Smart Decision Guide allows cardiovascular care team members to have more effective conversations with their patients about their treatment options for anticoagulation by ensuring that patients have a better understanding of their CHADS2VASC2 stroke risk score and their HAS-BLED bleeding risk. The Shared Decision guide is part of ACC’s Anticoagulation Initiative, a comprehensive quality effort, to help facilitate a greater understanding of Afib treatments and practice patterns, particularly given an increasing number of new anticoagulant treatment options entering the marketplace. Latest Interventional Science From TCT 2015 The ACC was on-site at the 2015 Transcatheter Cardiovascular Therapeutics (TCT) meeting in San Francisco, and provided coverage of the hottest interventional trials and news. Results of the RIVER-PCI trial showed that ranolazine did not reduce the incidences of ischemia-driven revascularization or hospitalization in chronic angina patients with incomplete revascularization following percutaneous coronary intervention. Meanwhile, results of BRAVO 3, which was simultaneously published in the Journal of the American College of Cardiology, found that bivalirudin may be a safe and effective alternative anticoagulant in patients unable to receive heparin while undergoing transcatheter aortic valve replacement. ACC IN TOUCH Follow @ACCinTouch on Twitter for breaking news from all of the top cardiovascular meetings. Stay up to date on the latest news about #ACC16, including registration, featured science and more. Interested in receiving immediate updates from the ACC? "Like" the ACC’s Facebook page to gain access to news, meeting coverage, special promotions, and more. Recent posts on the ACC in Touch Blog include a blog by Richard J. Kovacs, MD, FACC, member of ACC’s Board of Trustees, on the U.S. Food and Drug Administration’s approval of two PCSK9 inhibitors, user fee act reauthorization and off-label marketing. Others topics include a post authored by Kathy Jenkins, MD, MPH, FACC, on pediatric cardiac care and global health, and a post authored by Christie M. Ballantyne, MD, FACC, and Kim Birtcher, MS, PharmD, AACC, on the recent LDL: Address the Risk Think Tank. Check out the ACC in Touch Blog for more insights on the latest in cardiology. For full coverage from the meeting, visit ACC.org/TCT and head to the ACC in Touch Blog for daily wrap-up videos. Look out for ACC coverage from the American Heart Association’s Scientific Sessions at ACC.org/AHA2015. Follow @ACCinTouch for the latest updates.
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