American College of Cardiology

Contacts:
kbieg@acc.org
commlias@acc.org

In this issue:

Question of the
Month

ACC ’05 Update

ACC News

ACC’05 Scientific Session!

March 6 – 9, 2005
Orlando, Florida

General
Admission and
Housing Opened
Sept. 30

A Brief Look at Cardiac Care Teams: Their Structures and Strengths

James T. Dove, M.D., F.A.C.C., a strong proponent of Cardiac Care teams, speaks frankly about the physician/ nurse team culture that has been the core of his Springfield, Ill., practice for 30 years. Says Dr. Dove, "We have always viewed the physician/nurse relationship as a partnership, which means there is a mutual respect for each other’s skills and knowledge. The culture that we have here is one of the things that we stress to any new members of the practice." Over the years, says Dove, teams were expanded to meet the disease management needs of patients, and PAs and NPs were added to the teams.

Kathleen L. Grady, Ph.D., R.N. and nursing director of the Rush Heart Failure and Cardiac Transplant Program at Rush University Medical Center in Chicago attributes the growth of the disease management team culture at Rush to their earlier heart transplant programs. "When our HF patients were transplanted, nobody knew anything about transplants at that time, so we really became the total caregivers for these patients. When we evolved to heart failure/heart transplant, our social worker, our psychologist – everyone moved into the HF care team as well," explains Grady. Rush’s heart failure disease management teams were formally established in 1994.

(Click here to read more on Grady’s study: "HF Disease Management Teams: Varied Approaches Find Success." Cardiology. Sept. 2004; 1 and 4.

Who’s on the Team?
As the team culture grew, team structures to support it evolved. Facility capabilities and patient needs tend to guide an individual patient’s cardiac care team. At minimum, teams include physicians and N.P.s, R.N.s, A.P.N.s or P.A.s. Depending on a patient’s needs, other team members might include social workers, pharmacists, dietitians, exercise physiologists, endocrinologists, pulmonologists, nephrologists, other specialists, and psychologists or psychiatrists.

What Do They Accomplish?
It’s important to note that the coordinated efforts of cardiac care teams improve outcomes for patients, says Dove. In a presentation at the Chicago Cardiovascular Symposium, Grady reported on a study of two team approaches. One is nurse-directed/managed with a consulting physician; the other is nurse coordinated/facilitated as assisting the physician. Both contained common components, the most important being that team-managed patients experienced an increase in positive outcomes.

At the VA Medical Center in Northport, N.Y., Colleen Walsh-Irwin, R.N., M.S., C.C.R.N., A.N.P., reports that the cardiology division’s data show a decrease in hospitalizations with their NP- run CHF clinics. "I think N.P.s have the advantage of nursing backgrounds that emphasize the importance of patient education, which combines with the clinical knowledge needed to make changes in treatment. We also tend to work closely with nutritionists, social workers and cardiac rehab to provide the patient with the array of resources needed to manage this complex disease," says Walsh-Irwin.

With cardiac care teams, patients are able to receive better, more comprehensive care because the team is able to check on patient status more frequently and identify any potential pitfalls in the overall management, comments Dove. Cardiac care teams also enable the cardiologists to focus on the guidelines and variations in practice that apply to an individual patient’s condition.

If there is a weakness to disease management teams, it is cost and a lack of knowledge about possible long term savings versus short term costs. Balancing short-term costs with long term gains for individual patients and population health remains a challenge, says Grady.

Question of the Month
(We’d like to hear from you. Please take a moment to respond.)

What ethical challenges do you face most often on a day-to-day basis and how do you respond to them?

Click here to respond

ACC ’05 Update

Practice Updates

Cholesterol Management Clinical Collection Now on Cardiosource
Now available on Cardiosource is an exciting new site that provides the most up-to-date information on cholesterol management. The following samples of categories and titles are included:

What’s new?: "Role of Supplements/Herbs for Cholesterol Lowering – When to Use and When Not to Use"
Basic Review: "Coronary Heart Disease Prevention: Will More Stringent Lipid Guidelines Produce Better Outcomes?"
Current Controversies: "Combination Therapies for Cholesterol Management"
Clinical Trials: "Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) Case Studies"
Journal articles and abstracts: "Lipid-Lowering Therapy With Statins in High-Risk Elderly Patients: The Treatment-Risk Paradox". Click here to access site.

Study: Pay for Performance Programs Can Improve Quality of Care
The National Committee for Quality Assurance (NCQA) released their study, "State of Health Care Quality 2004," which shows that "quality gaps" lead to as many as 79,000 avoidable deaths each year. NCQA defines quality gaps as discrepancies between the type of care received by average Americans and patients enrolled in the top performing health plans. Researchers estimate that the variations in care lead to thousands of avoidable deaths and $1.8 billion in medical costs. The report concludes that requiring physicians and hospitals to report quality data and providing financial incentives for high quality care would create more equitable standards of care. Click here for more information.

Noncardiac Surgery Risky for Older Heart Failure Patients
This first national analysis shows surgeons face risky unknowns when treating older HF patients. When HF patients undergo surgery for other health problems, they are much more likely to die or suffer complications than similar patients who have coronary artery disease, according to a new study in the Oct. 6, 2004, of JACC. Click here for more information.

ACC News

Online Membership Renewal Now Available!
Take advantage of ACC’s new membership renewal process for your 2005 membership dues. To access the site, go to www.acc.org and click the red box on the right of the screen.

Preparing for November, National Diabetes Month
Cardiovascular disease is the leading cause of death among people with diabetes, accounting for at least two out of three diabetes-related deaths. If you haven’t done so already, take advantage of the free education materials available from the American Diabetes Asssociation and ACC through Make the Link!. The program’s goal is to educate physicians and health care providers about the link between diabetes and cardiovascular disease, and the toolkits and other materials include patient education materials, too. ACC Governors will be receiving a Make the Link! toolkit soon for use by their state chapters.

Cardiovascular MRI Self Assessment Tool Now Available
More and more, magnetic resonance imaging is being used as a diagnostic tool in cardiovascular care. In response to member needs, ACCF worked with the Society for Cardiovascular Magnetic Resonance to develop the Cardiovascular Magnetic Resonance Self Assessment Program (CMRSAP). ACCF’s self-assessment programs, such as CMRSAP, are designed to help all members of cardiac care teams stay current with new tools and techniques in cardiovascular care. CMRSAP, which includes a wealth of CMR knowledge from more than 70 world-renowned experts, was edited by Gregory W. Hundley, M.D., F.A.C.C. CMRSAP is available online now with a CD-ROM version available in late October. The price for CCA members is only $99, substantially less than the cost for physician ACC members.

CathSAP2 Now Available for 50% Off!
Buy a copy of CathSAP2 now for 50% off and receive EPSAP2 (Electrophysiology Self-Assessment Program) and ECGSAP3 (Electrocardiography Self-Assessment Program) with your purchase for no additional cost. Take advantage of this special opportunity to stock your professional library. With the CCA member discount, you would receive these three products for only $162.50.

CMS Proposes Expansion of Coverage for ICDs
The Centers for Medicare and Medicaid Services (CMS) announced last week that the agency plans to expand coverage for implantable cardioverter defibrillators (ICDs). The decision follows the release of data from the Sudden Cardiac Death in Heart Failure Trial, which shows that heart failure patients who never experienced a heart attack could benefit from the electrical shock delivered by ICDs when a life-threatening arrhythmia is detected. The 30-day comment period began September 28. CMS’ final decision is expected by the end of 2004. Click here for more information.

American Nurses Association Launches BP Education Plan
The American Nurses Association launched a 10-city bus tour in September to increase public awareness of the dangers of high blood pressure and to screen, educate, and encourage them to make changes needed to achieve good health. The Tour started in New York City. ACC members are invited to help when the Tour comes to their city. For locations and dates, click here.

Education Opportunities

The 37th Annual New York Cardiovascular Symposium: Major Topics in Cardiology Today
Directed by Valentin Fuster, M.D., Ph.D., F.A.C.C., in co-sponsorship with the New York Cardiological Society of the New York State Chapter of the ACC, Dec. 10-12, 2004, Hilton New York, New York. This renowned New York Cardiovascular Symposium presents a comprehensive view of major topics in cardiology today. Click here for more information.

The 34th Interpretation and Treatment of Cardiac Arrhythmias: Arrhythmia Management for the Clinician—A Practical Approach
Offered in co-sponsorship with the Heart Rhythm Society and in cooperation with Main Line Health HEART CENTER: Lankenau, Bryn Mawr and Paoli Hospitals, Wynnewood, Penn., and the Pennsylvania Chapter of the ACC. Directed by Peter R. Kowey, M.D., F.A.C.C., and Dusan Z. Kocovic, M.D. Dec. 2–4, 2004, Four Seasons Hotel, Philadelphia. Click here.

The 24th Annual Perspectives on New Diagnostic and Therapeutic Techniques in Clinical Cardiology
Directed by C. Richard Conti, M.D., M.A.C.C. and Jamie B. Conti, M.D., F.A.C.C. In co-sponsorship with the Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Fla., Jan. 28–30, 2005, Disney’s Contemporary Resort Walt Disney World® Resort, Lake Buena Vista, Fla.

The 24th Annual Cardiovascular Conference at Snowshoe
Directed by William H. Carter, M.D., F.A.C.C. and Christopher Granger, M.D., F.A.C.C. In co-sponsorship with Charleston Area Medical Center Health Education and Research Institute and Duke University Division of Cardiology, Jan. 31–Feb. 2, 2005, Mountain Lodge Conference Center, Snowshoe, W.Va.

Listen Online—ACC Conversations with Experts
Free to all ACC members, 20 – 30 minute fast-paced discussions between experts. Sessions are archived; you may read or listen to the past conversations online. For more information, go to www.conversations.acc.org.
Check out these recent conversations:
"Left Atrial Enlargement: Clinical Implications"..........................9/22/04
"How Many Drugs Does a Heart Failure Patient Need?"..............9/29/04
Look for These Upcoming Conversations:
"Treating NSTEMI When Emergency PCI Is Not an Option......10/20/04
"The Effects of Anti-Hypertensives in New-Onset Diabetes:
Metabolic, Renal and Lipids"……………….................................11/17/04

ACCSAP5 Now Available for $215
If your clinic or program doesn’t have a copy of ACCSAP5 now, perhaps it’s time to buy one at this discounted price. ACCSAP5, the fifth edition of the Adult Clinical Cardiology Self-Assessment Program, is the most comprehensive, state-of-the-art medical resource covering the field of adult clinical cardiology. It is a definitive information source that supports day-to-day clinical practice or serves as a useful tool for Board preparation studies. Editor-in-Chief: Richard P. Lewis, M.D., M.A.C.C. ACCSAP5 is available in print, CD-Rom and online formats. Supplies are limited. Click for more information.

Changes Taking Place

This is the last issue of CCA Update that you will receive. Starting in November, Cardiac Care Associate members will receive a print copy of the Cardiology newsletter with the Cardiac Care newsletter inserted, a renamed variation of CCA Update. Please continue to send your thoughts and ideas to ACC as your newsletter evolves.