Quick Reads Feature | The Pulse of ACC

Transforming Cardiology in Egypt; Investing in Innovation; More.

Transforming Cardiology in Egypt

While Egypt is the most populous country in the Middle East and North Africa, it also has one of the highest rates of the cardiovascular deaths in the region.

Providing clinicians with an understanding of how to best prevent and treat cardiovascular disease throughout the country was an important goal of CardioEgypt in Cairo last month.


Over the course of three days, participants heard from cardiovascular experts from around the region, as well as countries like Germany, Portugal, Canada and the U.S., on topics including imaging, heart failure, prevention, congenital heart disease and more.

ACC Past Presidents C. Michael Valentine, MD, MACC, and Richard Chazal, MD, MACC, as well as Thomas A. Gaziano, MD, MSc, FACC, represented the College and participated in several sessions addressing topics ranging from practice changing trials and guidelines from 2019 to the role of imaging in patients receiving cancer therapies, respectively.

In addition to taking part in CardioEgypt, the ACC has been involved with a number of on-the-ground programs aimed at helping clinicians optimize care and improve patient outcomes in the country.

Egypt is one of the 10 countries involved in ACC's Global Prevention Program, which provides customized education to meet the unique needs of physicians, patient communities and health care systems, and the College's new Global Heart Attack Treatment Initiative (GHATI) and NCD Academy are providing additional opportunities for Egyptian cardiovascular clinicians, hospitals and institutions to stem the rising tide of cardiovascular disease.

Additionally, ACC's Middle East Conference will take place in Cairo, this coming October.


Lifelong Learning Statement For Advanced HF, Transplant Cardiology

The ACC, Heart Failure Society of America and International Society for Heart and Lung Transplantation have released the 2020 ACC/HFSA/ISHLT Lifelong Learning Statement for Advanced Heart Failure and Transplant Cardiology Specialists.

Published in the Journal of the American College of Cardiology, the document provides an outline of the key competencies required of advanced heart failure and transplant cardiology (AHFTC) specialists and complements formal AHFTC fellowship training.


Led by Writing Committee Chair Clyde W. Yancy, MD, MSc, MACC, and Vice Chair Mark H. Drazner, MD, MSc, FACC, the new document is a supplement to the 2017 Advanced Training Statement on AHFTC – which defined the competencies required for Level III training in AHFTC – and specifically addresses the commitment to sustaining and enriching competency over the span of a career.

Of note, the lifelong learning competencies for AHFTC specialists are organized using the six domains promulgated by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties and endorsed by the American Board of Internal Medicine. Clinical competencies and leadership and administrative competencies are also outlined.

According to Yancy and Drazner, "for the advanced heart failure specialist who is no longer actively engaged in transplant medicine or management of mechanical circulatory support, this document is especially useful as there is a discrimination of those lifelong competencies expected of all advanced heart failure specialists and those competencies unique to the specialist with a practice focus in transplant and mechanical circulatory support."

"The breadth of knowledge and skills expected of advanced heart failure/transplant cardiologists is highlighted by the length of competencies applicable to this specialty," Yancy and Drazner conclude.


Updated Guidance For the Management of MR

The ACC has released a Focused Update of the 2017 Expert Consensus Decision Pathway on the Management of Mitral Regurgitation (MR) that addresses newly published trial data related to secondary MR – including the MITRA-FR and COAPT trials – among other developments.


The updated Pathway, led by Writing Committee Chair Robert O. Bonow, MD, MACC, and Vice Chair Patrick T. O'Gara, MD, MACC, and published in the Journal of the American College of Cardiology, provides expert consensus on clinical and echocardiographic assessment; establishment of MR etiology (primary, secondary, mixed) and mechanism; consideration of associated hemodynamic consequences; recognition of the indications for surgical or transcatheter intervention; appreciation of the increasing complexity of surgical mitral valve repair as a function of pathoanatomy; and understanding of the current role for transcatheter mitral valve edge-to-edge repair using a clip device.

In addition, the new document also emphasizes a structured approach to evaluation based on clinical findings, accurate echocardiographic imaging, and, when necessary, adjunctive testing, "[which] can help clarify decision-making."

Bonow and O'Gara further explain that "a highly functional, integrated multidisciplinary heart team is an essential requirement for institutions offering transcatheter mitral valve interventions."

Moving forward, "introduction of novel transcatheter MV repair and replacement systems into clinical practice is anticipated in future years," according to the Writing Committee. In addition to the updated Pathway, the ACC has a number of tools for both clinicians and patients to improve valvular care through appropriate diagnosis, referral and treatment.

For clinicians, the ManageMR Toolkit provides guidance from assessment to referral of diagnosed MR patients, while the ManageMR App offers clinicians personalized referral and treatment advice for diagnosed MR patients by verifying the severity and etiology of the MR.

Patient education and shared decision-making tools are available at CardioSmart.org in the Heart Valve Disease Hub.


In Memoriam: A Tribute to David O. Taylor, MD, FACC

This tribute begins with an apology. We would like to apologize to those of you who never had the opportunity to meet David O. Taylor, MD, FACC. A tall, thin man from New Mexico, he had a warm, yet slightly mischievous smile, and a guffaw that will never be forgotten. You could not miss him – he was the man wearing the green scrub shirt, tucked into khaki cargos with dress shoes.

A master clinician, mentor, teacher and role model, Taylor was our idol. We recognize that it is unusual to strive to emulate so many aspects of a single person; however, Taylor was the friend, colleague, physician, parent and spouse we now strive to be.


He was the smartest person in the room, though he went out of his way to hide this. Taylor had a knack for knowing his audience, always answering questions with the wisest, yet simplest and clearest of answers.

He exhibited a striking degree of humility in all aspects of his life, never dominating a conversation and always making you believe your input was valuable. A giant of cardiology, yet he made his trainees feel empowered and in charge.

Among the tributes echoed over and over is that Taylor had an inner peace. Many have remarked that he taught us how to be excellent physicians and consummate educators, but also how to have work-life balance.

It did not really matter for how long you had the honor of knowing Taylor, as he always made you feel recognized and valued. He was a man of unprecedented intelligence, humility and kindness – a calm, soothing and sensible voice who earned the respect and affection of all who knew him.

Taylor saved the lives of countless heart failure patients and brought dignity to those he could not save.

Patients first. Fellows second. Self later.

Thank you, Dr. Taylor, for being an incredible role model. We hope to always honor you by continuing to promote your ideals and values of compassion, humility, integrity, scholarship and mentorship. It is with the deepest admiration that we commit ourselves to carrying on your legacy.


Calling All Sport and Exercise Cardiologists

Registration recently opened for the ACC's Care of the Athletic Heart course taking place from June 18-20 at Heart House in Washington, DC. The meeting, chaired by Jonathan Kim, MD, MSc, FACC, will focus on challenges and best practices in treating elite athletes to exercise enthusiasts.


With an estimated 5 million active athletes at the high school, collegiate, professional and master's levels in the U.S. and recent survey data showing cardiologists see an average of five patient athletes per week, a larger contingent of practice-ready clinicians who understand the contemporary care and practice management strategies for athletes is needed.

The three-day meeting will feature discussions with sports cardiology experts caring for diverse populations of athletes and provide insight into contemporary treatment strategies needed to tailor the cardiovascular care of athletes and exercising individuals.


Investing in Innovation

The ACC and HeartHero have formed an alliance to make a significant impact on survival rates after sudden cardiac arrest (SCA) and further ACC's mission to transform cardiovascular care and improve heart health through HeartHero's innovative portable automated external defibrillator (AED) technology.

While the ACC is involved in other innovation relationships, this is the College's first and only vested relationship with a device company.


HeartHero won the Innovation Challenge at ACC's Annual Scientific Session in New Orleans last year for its miniaturized, portable and user-friendly AED offering a cutting-edge approach to saving lives. With the smaller and lighter AED, people at increased risk of sudden cardiac arrest can store the potentially lifesaving device at home or carry it with them, ensuring instant access to an AED.

"AEDs save lives, but despite their increasing presence in buildings and public spaces, there is no way to guarantee quick enough access to one in cases of sudden cardiac arrest," says John S. Rumsfeld, MD, PhD, FACC, ACC chief science and quality officer and chief innovation officer.

"The ACC recognizes the lifesaving potential for innovative AEDs and is eager to work with HeartHero in making them widely known in the cardiovascular community and widely available to the public."

The HeartHero AED guides the user through the resuscitation process with auditory and visual guides, along with CPR prompts. With integrated technology, recordable and retrievable data from the AED can also be provided to the physician at the time of the incident, thus enhancing patient treatment.

"While CPR has been the tool that buys us time in cardiac arrest, it is clear that electricity is the medicine that saves your life. Increasing awareness around the importance of AEDs and placement into the homes is the driving passion behind HeartHero's mission," says Gary Montague, CEO and founder of HeartHero.

"With current technology and data, we are able to advance the AED industry with the ambition of making the greatest impact to cardiac arrest survivability seen in our time. Our relationship with the ACC will help pave the way for this outcome through research, studying and identifying those at risk and ultimately getting AEDs placed where they need to be."

The device is not approved by the U.S. Food and Drug Administration and not yet available for sale.


Keywords: ACC Publications, Cardiology Magazine

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