ACC.16 Opening Showcase Session Address: Kim Allan Williams Sr., MD, FACC
I want to welcome all of you again to my home town, Chicago! In addition to being known for both its wind and its historically “windy politicians,” this tenacious city has played a starring role in America’s industrial history since its founding in 1833. It was literally reborn from the ashes when nearly one-third of the city was destroyed by The Great Fire of 1871. In 1916, poet Carl Sandburg aptly described the city as, “Hog Butcher, Tool Maker, Stacker of Wheat, Player with Railroads and Freight Handler to the Nation.” Today, Chicago continues to serve as a diverse hub for trade, transportation and commerce.
The Lakefront and McCormick Place – where we are now – has its own history. The World’s Fair was held in this spot in 1933. In 1960, the first McCormick Place was built and named in honor of Colonel Robert R. McCormick, a controversial but charismatic visionary who was editor and publisher of the Chicago Tribune. A fire in 1967 destroyed this first building, but it too was rebuilt from the ashes and is now the largest Convention Center in North America.
Chicago has experienced the intersection of history and change countless times over the years. It has carved its own roads into the history of the United States. As such, I can’t think of a better place to host this meeting. As a profession we too are experiencing an intersection of science and change. Chicago by its very nature sparks innovation and I hope we can all capture a bit of that spark and carry it with us when we leave ACC16.
I’d like to talk with you today about another time period in history and its significance to our profession – 1918 to 1919 – This was the only time in the last century that cardiovascular disease was NOT the leading cause of mortality. On the heels of World War I, the “Spanish” flu pandemic claimed an estimated 20 million lives around the world.
What made the pandemic so different from other outbreaks? Deaths were not limited to just the young and elderly. Healthy men and women between the ages of 20 and 40 also lost their lives in large numbers.
There are a couple theories behind this phenomenon. One being that limited food supplies during the war led to nutrition deficiencies and suppression of immune systems. Another theory is that the immune system was part of the problem, with the virus creating an inflammatory cascade that overwhelmed the healthier host. The stronger your immune response, the more damage occurred.
The virus also spread quickly at a time when many communities were facing shortages in trained medical personnel because of the war.
That crisis is what it took to supplant heart disease from the number 1 cause of death in the US.
Since this time, the US and the rest of the world have come a long way with treating and preventing influenza, including identifying better ways to protect cardiovascular patients. Vaccine research and development, as well as large-scale public education campaigns, did – and continue to – play important roles in prevention and treatment of the disease.
We’ve also made other great strides in reducing cardiovascular mortality.
Unfortunately, however, cardiovascular disease continues to reign as the leading cause of death around the world. In fact, mortality from cardiovascular disease is projected to increase from 17.5 million in 2013 to 23.6 million in 2030 if we don’t gain control.
The good news is that so many deaths from cardiovascular disease are preventable. But success lies in our power to work together as a community.
Up until now, we have been laser focused on treatment of acute conditions and secondary prevention—improving survival in patients already diagnosed with cardiovascular disease … Mopping up the floor, so to speak. But with the cardiovascular disease burden increasing around the world, our focus must expand to include primary prevention and health promotion.
If we are truly to remove cardiovascular disease as the leading cause of mortality worldwide, we must shift the paradigm from treatment to prevention and begin moving toward population health. Population health is not easily defined. Yet, define it we must.
As part of its strategic plan, the College is revving up efforts to lead in this area. We are engaging partners in pursuit of global cardiovascular-related objectives …supporting members in their efforts to improve the health of populations … and encouraging cardiovascular team-facilitated patient education.
One key area in which ACC is building momentum is preventive cardiology. We have, for example, an exemplary nutrition committee, a very dynamic group of staff, scientists and clinicians dedicated to improving lifestyle through education and promoting science. I like to say: “Don't Let Your Culture Hold Your Heart Hostage.”
It’s critical that we take a bigger role in educating our patients and the broader public of the impacts of their lifestyle decisions on their heart – not to mention their overall health. Studies have shown that never smoking, exercising regularly, eating well and maintaining a healthy weight are four criteria that can dramatically reduce the likelihood for chronic disease and early mortality.
Among the highlights of ACC.16 is our intensive series, one of which focuses on lifestyle – diet, physical activity and relieving stress. It has been a thrill to watch this program crystalize into a unique session, unlike any before it. We have also had good results this year helping to craft the 2015- 2020 Dietary Guidelines for the US, getting Americans to reduce their saturated fat, cholesterol and sugar intake. I’m excited about the opportunities to take these successes even further!
Another area where we can make a difference in terms of population health is that of non-communicable diseases. NCDs know no borders, and thus are an issue of global concern. In 2015 alone there was an estimated 42 million deaths from NCDs … with 21 million of these deaths from cardiovascular disease.
Low-income countries are at great risk. The probability of dying from NCDs – is more than 20 percent in countries in Southeast Asia, Africa and the Eastern Mediterranean region. This is compared with countries like Australia, Israel, Italy, Japan, and Switzerland, where the probability is less than 10 percent.
The global community has come together unlike never before and has made a commitment to reducing premature deaths from NCDs by 25 percent by 2025. The challenge lies with moving from concept to action.
What will it take to get there?
The WHO recommends a treatment approach that addresses total cardiovascular risk rather than an approach based solely on individual risk factor thresholds.The ACC is uniquely poised to lead in this area with more than 52,000 members worldwide … a growing network of domestic and international chapters … and strong partnerships with government agencies and other medical specialty societies – many of whom are represented at this meeting. As a result of our members – including each of you – we can help deliver on community-wide population health programs.
We can be effective advocates for state, national and global policies that make it easier for cardiovascular professionals to provide appropriate, cost-effective care. We can work with regulatory agencies and device and drug manufacturers to make drugs more affordable. Drugs and devices that are life-saving but expensive, threaten to actually widen disparities in care by socioeconomic strata. No one should have to pay half their salary or more for basic medication. “Pay or Pain” or “Buy or Die” policies should not exist. They only serve to increase health care disparities domestically and around the globe.
We can also facilitate the global use and exchange of data through clinical data registries like NCDR, as well as the development and dissemination of clinical guidelines.
Providing easy-to-use tools to help calculate risk or synthesize guidelines is another way that we can improve population health. Currently, less than 50% of low-income countries have tests and procedures in place to screen for cardiovascular risk factors like cholesterol and diabetes. In addition, nearly 25% of countries do not have guidelines for management of cardiovascular disease or the tools to make guidelines effective.
Educating care providers in these countries about the importance of screening and providing them with tools, such as mobile apps that can calculate risk or synthesize key guidelines directly from a phone or computer, is not only feasible, it’s already starting to happen. The College has developed a suite of mobile tools to help determine ASCVD Risk and Statin Intolerance to name a few. The ACC’s Guidelines Clinical App is the mobile home of clinical guideline content and tools for clinicians caring for patients with cardiovascular disease.
In addition to mobile tools, the ACC is also engaged in a number of global programs aimed at reaching cardiovascular professionals where they live and work. For example, the ACC and the Chinese Society of Cardiology are working together on a program that leverages webinars and social media to reach hundreds of cardiologists at hospitals across China.
New this year, the College is also hosting two novel international conferences, the ACC Latin America Conference and the ACC Middle East Conference. These will be the first ever regional ACC conferences in partnership with ACC International Chapters. These conferences present a unique opportunity to reach a targeted group of cardiovascular professionals with locally relevant, interactive education. There will be a special emphasis on educating fellows in training and early career doctors in the latest cardiovascular science and practical techniques for improving cardiovascular patient care.
We need more programs and efforts like these!
Back here in the U.S., we are facing dramatic changes to our health care system. The historic passage of the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, means that the focus on transformation of care from volume to value, often touted as “five years away and always will be,” is now upon us.
We will need to galvanize College resources to craft the value proposition facing our members and their patients. MACRA will undoubtedly have profound impacts on U.S. health care delivery and the ACC is already at the table working to minimize challenges and take advantage of opportunities under the new system to support policies that facilitate evidence-based, cost-effective and high quality care.
Quality improvement efforts, quality reporting, and value-based reimbursement are here to stay, and will undoubtedly be a critical part of provider payment models moving forward, regardless of how the details unfold.
Those of you already participating in programs like the EHR Incentive program and the PQRS are already ahead of the game as MACRA moves to align these programs.
Involvement in NCDR can also help. For example, clinicians currently participating in the PINNACLE or Diabetes Collaborative registries can choose to have the ACC submit PQRS data to CMS on their behalf.
Additional opportunities and practice improvement programs are also under way.
Earlier this year, the Society of Cardiovascular Patient Care merged with the ACC. This allows the College to offer hospitals and health systems a unique, comprehensive suite of quality improvement offerings that includes clinical guidelines, registries and – now – accreditation. SCPC has played a pioneering role in the hospital accreditation space over the past 18 years. The combination of SCPC with ACC brings new perspectives and new expertise to ongoing efforts to reduce the data burden on facilities by providing a streamlined, continuous approach to quality improvement.
We have made significant gains over the last 6 decades in reducing cardiovascular mortality and preventing and treating the disease, but we have not been successful in taking it down a notch to number 2. The goal of becoming #2 is well within our grasp—more so than ever before. But we must own our actions and be visible to the public and our patients in positive ways that affect their lives. We must turn off the faucet instead of just mopping the floor.
Thank you for your dedication and efforts to reduce cardiovascular disease and thank you for coming to ACC16.
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