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FLETCHER ET AL., 33RD BETHESDA CONFERENCE: Preventive Cardiology: How Can We Do Better?
J Am Coll Cardiol 2002;40:4:579-651

BETHESDA CONFERENCE REPORT
33rd Bethesda Conference: Preventive Cardiology: How Can We Do Better?
1

Gerald F. Fletcher, MD, FACC, Conference Co-Chair
Gary J. Balady, MD, FACC,
Conference Co-Chair
Robert A. Vogel, MD, FACC,
Conference Co-Chair

This Conference, sponsored by the American College of Cardiology, was held at Heart House, Bethesda, Maryland, December 18, 2001.

Participants/Authors

Philip A. Ades, MD, FACC
Division of Cardiology; Medical Center Hospital Vermont; Burlington, VT 05401

C. Noel Bairey Merz, MD, FACC
Director, Preventive and Rehabilitative; Cardiac Center; Cedars-Sinai Medical Center; 444 S. San Vicente Boulevard, Suite 901; Los Angeles, CA 90048

Gary J. Balady, MD, FACC
Director, Preventive Cardiology; Professor of Medicine; Section of Cardiology; Boston Medical Center; 88 E. Newton Street; Boston, MA 02118

Emelia J. Benjamin, MD, SCM, FACC
Associate Professor of Medicine; Boston University School of Medicine; The Framingham Heart Study; 73 Mount Wayte Avenue; Framingham, MA 01702-5827

W. David Bradford, PHD
Associate Professor of Economics; Department of Health Administration & Policy; Medical University of South Carolina; 19 Hagood Avenue, Suite 408; PO Box 250807; Charleston, SC 29425

Richard S. Cooper, MD, FACC
Chair; Department of Preventive Medicine; Loyola Medical School; 2160 S. First Avenue; Maywood, IL 60153

Jacqueline Dunbar-Jacob, PHD,
RN, FAAN

Professor of Nursing, Epidemiology & Occupational Therapy; Director, Center for Research in Chronic Disorders; University of Pittsburgh; School of Nursing, 415 Victoria Building; 3500 Victoria Street; Pittsburgh, PA 15261

Gerald F. Fletcher, MD, FACC
Professor of Medicine; Mayo Medical School; Coordinator, Preventive Cardiology; Mayo Clinic Jacksonville; 4500 San Pablo Road; Jacksonville, FL 32224-1865

Valentin Fuster, MD, PHD, FACC
Director; Zena & Michael Wiener Cardiology Institute; Mount Sinai Medical Center; One Gustave Levy Place, Box 1030; New York, NY 10029-6500

Philip Greenland, MD, FACC
Professor and Chairman; Department of Preventive Medicine; Northwestern University Medical School; 680 N. Lake Shore Drive, Suite 1102; Chicago, IL 60611-4407

Laura L. Hayman, PHD, RN, FAAN
Professor, Division of Nursing; The Steinhardt School of Education; New York University; 246 Greene Street; New York, NY 10003-6677

Paul A. Heidenreich, MD, MS, FACC
Assistant Professor of Medicine; Stanford University; VA Palo Alto, 111C; 3801 Miranda Avenue; Palo Alto, CA 94303

Martha N. Hill, RN, PHD, FAAN
Director, Center for Nursing Research; Johns Hopkins University School of Nursing; 525 North Wolfe Street, Room 301; Baltimore, MD 21205-2110

Nancy Houston Miller, RN, BSN
Associate Director; Stanford Cardiac Rehabilitation; 780 Welch Road, Suite 106; Palo Alto, CA 94304-1516

Thomas E. Kottke, MD, FACC
Consultant and Associate Professor; Mayo Clinic; 200 First Street, S.W.; Rochester, MN 55905-0001

Harlan M. Krumholz, MD, FACC
Professor of Medicine and Epidemiology
and Public Health; Yale University School of Medicine; 333 Cedar Street, Room I-456 SHM; New Haven, CT 06520

Russell V. Luepker, MD, MS, FACC
Professor and Head; Division of Epidemiology; School of Public Health; University of Minnesota; 1300 South Second Street, Suite 300; Minneapolis, MN 55454-1015

Daniel B. Mark, MD, MPH, FACC
Professor of Medicine; Duke Clinical Research Institute; PO Box 17969; Durham, NC 27715

John C. Mcgrath, PHD
Chief; Public Information Communications Branch; National Institute of Child Health and Human Development; Building 31-Claude D. Pepper Building; 31 Center Drive, Room 2A32
Bethesda, MD 20892

George A. Mensah, MD, FACC
Chief, Cardiovascular Health Branch; Centers for Disease Control & Prevention; 4770 Buford Highway, NE, MS K-47; Atlanta, GA 30341-3717

Ira S. Ockene, MD, FACC
Director, Preventive Cardiology Program; University of Massachusetts Medical School
University Campus; 55 Lake Avenue North Worcester, MA 01655-0002

A. David Paltiel, MBA, PHD
Associate Professor; Yale School of Medicine; 60 College Street, Room 305; New Haven, CT 06520

Richard C. Pasternak, MD, FACC
Director, Preventive Cardiology &
Cardiac Rehabilitation; Massachusetts General Hospital; 55 Fruit Street; Boston, MA 02114-2620

N. Burgess Record, MD, FACP
Medical Director; Western Maine Center for Heart Health; Franklin Memorial Hospital; 111 Franklin Health Commons; Farmington, ME 04938

Sandra S. Record, RN
Program Director; Western Maine Center for Heart Health; Franklin Memorial Hospital; 111 Franklin Health Commons; Farmington, ME 04938

Eleanor Schron, MS, RN, FAAN
Nurse Director; USPHS Commissioned Corps; National Institutes of Health/NHLBI/DECA; II Rockledge Center; 6701 Rockledge Drive, MSC 7936, Room 8144; Bethesda, MD 20892

Sidney C. Smith, JR, MD, FACC
Professor of Medicine; University of North Carolina; Chief of Cardiology; 132 Donegal Drive; Chapel Hill, NC 27514-6560

Paul D. Thompson, MD, FACC
Director of Preventive Cardiology and
Cholesterol Management Center; Hartford Hospital; 80 Seymour Street; Hartford, CT 06102-8000

Robert A. Vogel, MD, FACC
Professor of Medicine; Director, Clinical Vascular Biology; University of Maryland Hospital; 22 S. Greene Street, Room S3B06; Baltimore, MD 21201-1544

William S. Weintraub, MD, FACC
Department of Medicine, Emory University; Professor of Medicine/Cardiology; Emory Center for Outcomes Research; 1256 Briarcliff Road, Suite 1 North; Atlanta, GA 30306-2636


Participants/Reviewers
EZRA A. AMSTERDAM, MD, FACC
KATHY BERRA, MSN, ANP, FAAN
JAMES A. BLUMENTHAL, PHD, ABPP
MARCIA BRITT, PHD
LORA E. BURKE, PHD, MPH, RN
JOSEPH CHINN, MD
JEFFREY A. CUTLER, MD, MPH
BARBARA J. FLETCHER, RN, MN, FAAN
GREGG C. FONAROW, MD, FACC
GOTTLIEB C. FRIESINGER II, MD, MACP, MACC
HEATHER E. GANTZER, MD, FACP
NEIL F. GORDON, MD, PHD, MPH
JESSIE GRUMAN, PHD
KENNETH A. LABRESH, MD, FACC
CINDY LAMENDOLA, MSN, ANP
ASH LULLA, BS
DAVID J. MALENKA, MD
DEAN ORNISH, MD
ROBERT A. PHILLIPS, MD, PHD, FACC
NICO P. PRONK, PHD
DAVID B. PRYOR, MD, FACC
BRUCE M. PSATY, MD, PHD
RITA F. REDBERG, MD, MSC, FACC
WILLIAM C. ROBERTS, MD, FACC
ROBERT E. SAFFORD, MD, PHD, FACC
DENISE SIMONS-MORTON, MD, PHD
DENNIS L. SPRECHER, MD
DANIEL STRYER, MD
MARY N. WALSH, MD, FACC
HOWARD WEITZ, MD, FACP, FACC
GAYLE R. WHITMAN, PHD, RN, FAAN
RANDOLPH F. WYKOFF, MD, MPH & TM

Conference Steering Committee
GERALD F. FLETCHER, MD, FACC, CONFERENCE CO-CHAIR
GARY J. BALADY, MD, FACC, CONFERENCE CO-CHAIR
ROBERT A. VOGEL, MD, FACC, CONFERENCE CO-CHAIR
PHILIP A. ADES, MD, FACC
C. NOEL BAIREY MERZ, MD, FACC
EMELIA J. BENJAMIN, MD, FACC
LAURA L. HAYMAN, PHD, RN, FAAN
THOMAS E. KOTTKE, MD, FACC
HARLAN M. KRUMHOLZ, MD, FACC
GEORGE A. MENSAH, MD, FACC
IRA S. OCKENE, MD, FACC
SIDNEY C. SMITH, JR, MD, FACC
WILLIAM S. WEINTRAUB, MD, FACC

Staff
American College of Cardiology
CHRISTINE W. MCENTEE, CHIEF EXECUTIVE OFFICER
CARY SENNETT, MD, PHD, SENIOR ASSOCIATE EXECUTIVE VICE PRESIDENT
CAROLYN CARNEY LANHAM, DIRECTOR, SCIENTIFIC COMMITTEE MANAGEMENT
EVA MARIE GRACE, PROJECT COORDINATOR, SCIENTIFIC COMMITTEE MANAGEMENT
SYLVIA POLK-BURRISS, PROJECT COORDINATOR, SCIENTIFIC COMMITTEE MANAGEMENT

TABLE OF CONTENTS

Introduction
  References

Summary Recommendations
  Research
  Funding
  Policy
  Clinical-Educational

Task Force #1—Magnitude of the Prevention Problem: Opportunities and Challenges
  Epidemiology of CVD
  Cardiovascular Risk Factors: Distribution and Impact of Treatment
  CVD Prevention
  Barriers to Achieving Risk-Factor Reduction
  Approaches to Barriers in CVD Prevention
  Summary
  References

Task Force #2—The Cost of Prevention: Can We Afford It? Can We Afford Not to Do It?
  
Cost-Effectiveness Analysis of Preventive Strategies: Brief Overview
  Issues in Cost-Effectiveness Analyses
  Cost Effectiveness Versus Public Policy
  Cost Effectiveness Versus Total System Costs
  Conclusions
  References

Task Force #3Getting Results: Who, Where, and How?
  
Programs of Governmental and Non-Governmental Organizations
  Community Programs
  Clinical Interventions
  Media and Communications
  Summary—Getting Results: Who, Where, and How
  References

Task Force #4Adherence Issues and Behavior Changes: Achieving a Long-Term Solution
  
Introduction: The Challenge of Adherence
  Adherence: A Problem That Must be Addressed on Multiple Levels
  Counseling and Theoretical Models
  General Strategies for Increasing Adherence
  Risk-Factor-Specific Strategies and Resources for Increasing Adherence
  Summary and Future Directions
  References

Task Force #5The Role of Cardiovascular Specialists as Leaders in Prevention: From Training to Champion
  
How Much Training in Prevention?
  What Type of Practitioner Training is Needed?
  How Should Preventive Services Be Integrated Into Daily CV Specialty Practice?
  Can CV Specialists be Champions of Prevention?
  What is the Role of Academic Preventive CV Specialists?
  References

Appendix: Resource Guide

The recommendations set forth in this report are those of the conference participants and do not necessarily reflect the official position of the American College of Cardiology Foundation.

When citing this document, the American College of Cardiology Foundation would appreciate the following citation format: Preventive cardiology: how can we do better? Presented at the 33rd Bethesda Conference, Bethesda, Maryland, December 18, 2001. J Am Coll Cardiol 2002;40:579-651.

This document is available on the American College of Cardiology Web site at www.acc.org. Copies of this document are available for $5.00 each by calling 800-253-4636 (U.S. only) or by writing the Resource Center, American College of Cardiology Foundation, 9111 Old Georgetown Road, Bethesda, Maryland 20814.

 

Copyright © 2002 by the American College of Cardiology

 

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