ACC.22 Opening Showcase Remarks: Dipti Itchhaporia, MD, FACC

Dipti Itchhaporia, MD, FACC

Wow, what a journey it has been and today is a momentous day! You may ask why, and I will simply say it’s because we are all here together in person – something we took for granted in the past and will cherish going forward.

I was recently asked to sum up my presidential year with one word or phrase and I chose “GRACE.” The past year brought with it a number of challenges, but we – as a global cardiovascular community – united in creative ways to overcome them all with Gratitude, Resilience, Aspiration, Courage and Empathy.

More than ever, we have to be proud of where we are as a community, a profession and a College. We must be proud of the steps we have taken together to continue to achieve our Mission, our Vision and our strategic goals.

We did not languish this past year, instead we have flourished, and it is with gratitude that I stand before you today. Gratitude for making it through where we were. Gratitude for where we are. And gratitude for where we are going.

We have worked hard, and we have pivoted in ways unimaginable. As a clinical community, we have showcased our resilience.

Early in the pandemic, we quickly embraced digital transformation and adopted telehealth to provide access and care to our patients. We are finally making real headway in our efforts to build a new digital-first infrastructure that will allow us to more quickly and nimbly leverage new technologies and innovations to transform global cardiovascular care and outcomes.

We also discovered that digital transformation comes with challenges like workflow integration, payment models and even the digital divide – challenges that we will need to overcome in order to get it right. However, it’s important to remember that digital transformation, by definition, should improve our patients’ lives and our lives as clinicians, making this a worthwhile goal.

Over the last several years the ACC has built a strong innovation program and developed a roadmap to help overcome some of these challenges. While overcoming these challenges will take perseverance, now is the time for us to continue to lean into innovation. The ACC has been working with many innovation partners to define and implement solutions that will help us answer the call for better quality of care, improved access and outcomes, while also reducing health care inequities and improving clinician well-being.

Our innovation program lays out virtual care, remote patient monitoring and artificial intelligence as ways to prevent and treat heart disease. We, as cardiovascular professionals, must lead the way for digital health development and adoption. We can learn about advances in artificial intelligence, digital health technology, and mobile devices – all of which are on display over the next three days on the ACC.22 Expo Floor and as part of educational sessions during this meeting.

Leonardo Da Vinci said: “I have been impressed with the urgency of doing, knowing is not enough; we must apply. Being willing is not enough, we must do.”

Our resilience was also evident in our actions in the Advocacy arena. Together we came together to urge lawmakers to adopt telehealth provisions, increase funding for cardiovascular research, minimize administrative burden in the midst of the pandemic, and stop harmful Medicare cuts. We didn’t give up and – as a result – we were successful in our efforts to advocate for health policy solutions that advance patient access and equity.

Over the last two years, we have all quickly adopted various digital platforms that allowed us to come together and connect meaningfully in a virtual world. I’m so grateful for the many opportunities I have had as president to connect virtually with so many of you, whether through chapter meetings, international scientific meetings or my monthly Saturday morning “Coffee With the ACC President.”

The philosopher Aristotle wrote: “Man is by nature a social animal.” While this statement, at the time, had more to do with the benefits of a civilized society, the fact remains that social interaction and the desire to connect with others is a fundamental human behavior. The “Coffee With the ACC President” series allowed us to connect and be inspired, allowing our inspiration to be our aspiration.

And we aspired! We aspired to build a better College and a better profession – and we are delivering!

We looked for innovative ways to do science and research by leveraging technology and utilizing patient reported outcomes. We aspired to optimize our NCDR registries and build upon our registry and ACC Accreditation Services to improve patient care and outcomes.

Through our work with our 42 International Chapters and partner cardiovascular societies we have worked hard to grow and accelerate our presence around the world. Programs like our International Conferences in Asia, Latin America and the Middle East; the free, online NCD Academy; and our Global Heart Attack Treatment Initiative (GHATI) are having tangible, on-the-ground impacts in countries around the world.

We also aspired, to optimize our clinical guidelines working closely with the American Heart Association. Our efforts to produce faster, more-nimble, user-friendly guidelines that can provide actionable knowledge at the point of care are already bearing fruit. The new Heart Failure Guideline released yesterday incorporates many of the new changes and recommendations. You can find the guideline, as well as related clinician and patient tools from JACC and CardioSmart here.

We also aspired to continue to work with the American Board of Internal Medicine to make iterative changes in our alternative option for meeting Maintenance of Certification Requirements. The Collaborative Maintenance Pathway, or CMP, delivers our Self-Assessment Products (SAPs) like ACCSAP and allows clinicians to remain 100% certified by focusing on just 20% of the field each year. More than 5,000 clinicians took advantage of the CMP in 2021 and we are excited by its continued growth.

We have also embarked on improving diversity and inclusion in our profession and growing the next generation of cardiovascular clinicians and leaders. Change must start from within and there are important things we must do within the profession to advance high-quality cardiovascular care.

Preventing and treating heart disease requires a workforce that is as diverse as the patients seeking care. We are prioritizing a culture and a profession that is recognized for its diversity and inclusiveness. Bias training and professionalism training in Fellowship and Leadership Programs, targeted programs aimed at middle school, high school and medical students have also been implemented.

From the graduates of our latest Leadership Academy; to the participants in our recent Internal Medicine courses; to the first cohort of the Sandra J. Lewis Mid-Career Women’s Leadership Institute; to the Young Scholars sitting in front of me – I am confident that we are headed in the right direction!

Twenty years ago, on April 16, 2002, the first TAVR was performed by Professor Alain Cribier, opening new horizons in the treatment of structural valve disease.

And as we celebrate 20 years of TAVR as part of this meeting, we have to remember we have had courtside seats to this disruptive transformation as it played out. I am so honored to have Presidential Citation Awardee Dr. Cribier and other pioneers like Drs. Marty Leon, Michael Mack and ACC Past President David Holmes with us today. What they did took courage and commitment, and we can learn so much from their efforts.

They taught us that true transformation of health care sometimes means radical disruption of long-standing practices and getting comfortable with the uncomfortable. I appreciate the Albert Einstein quote that states: “We can’t solve problems by using the same kind of thinking we used when we created them.”

So what’s next? The COVID-19 pandemic has underscored many existing realities of our health care system, including how much health matters, how health and the economy are inextricably linked, and the importance of achieving health equity to realize good health for everyone. It has set the stage for health care transformation with value-based care and health equity as critical pieces of the puzzle and never has there been a better or more important time to actualize our efforts.

Data from the Kaiser Family Foundation and the Centers for Disease Control and Prevention have shown substantially higher rates of infection, hospitalization, and death from COVID-19 in Blacks, Hispanics and Indigenous populations compared with Whites. In addition, vaccine and testing rates also show wide disparities.

These data are sharp reminders of the need for tangible solutions to address health inequities and health disparities to ensure everyone has the opportunity to be as healthy as possible. Doing this right could lead to health improvements that then would translate to tremendous economic growth. But this will require courage.

The Institute of Healthcare Improvement introduced the Triple Aim in 2007, a concept of improved patient experience, better outcomes, and lower costs as keys to health care transformation. A few years later, it was recognized that we could not achieve the triple aim without the clinician and thus the concept evolved to “the Quadruple Aim” to include clinician well-being.

Research shows that decreased clinician engagement and burnout directly correlates to lower patient satisfaction, reduced health outcomes, and higher costs. Today, the concept has evolved further to the “Quintuple Aim,” which incorporates health equity as another key element.

Addressing health equity must start with understanding the social determinants of health. It is known that 20% of a person’s health and well-being is related to access and quality of health care, but that 80% is attributed to the physical environment, health behaviors and socioeconomic factors.

Health inequities are so entrenched that it will require coordinated, multi-sector efforts that can inspire a shared vision, help bridge siloes, and create lasting change. The ACC understands that complex problems simply cannot be solved by one organization. This is especially true when it comes to achieving health equity.

Achieving the Quintuple Aim will require rethinking our approach to health care, with an eye towards the following elements: digital transformation, data, community partnerships, value-based care, teamwork and shared decision-making, social determinants of health and health equity, and clinician well-being. As always, the patient must be at the center! Health care has a long way to go to effectively address health inequity, but there are evidence-based approaches that can be used to start or continue the battle.

Besides shining a light on the issue of health equity, the pandemic has placed science under the public microscope, showcasing its strengths, as well as its limitations. We learned that scientists and health care professionals need to learn to effectively communicate the risks, benefits, and latest scientific findings beyond the academic and scientific arena. As I wrote in a recent JACC Leadership Page, I wonder: “How will history judge our performance during the pandemic, will we be commended for the rapid development of vaccines and our quick pivot to leverage innovative technologies to allow for remote monitoring and telehealth, or will we be criticized for a breakdown in communication that perpetuated false narratives.”

Restoring public faith in science is then an imperative in the coming years. Scientists, health care professionals, and societies like the ACC have an opportunity to shape history. There is no doubt that historians will look back on this time and form judgments regarding the relationship between science and society. We must make sure that when historians look back at this time of uncertainly and turmoil, they see how trust between science and society was actively strengthened and that it led to solutions that enriched our lives as well as provided lasting benefits for the public good.

In his book The Demon-Haunted World: Science as a Candle in the Dark, Carl Sagan wrote: “Science is an attempt, largely successful, to understand the world, to get a grip on things, to get a hold of ourselves ... to steer a safe course.” 

Doing this well and steering the course starts with communication, and it starts with us! ACC’s continued work to remain “OutFront” for our member with ongoing work to provide clinicians with timely and trusted guidance through clinical guidelines, expert consensus decision pathways, health policy statements and more, is vital to our efforts to advance high-quality care.

A great example of clinical guidance was our COVID-19 Hub, which continues to be a trusted source of the latest research and science published in our JACC Journals, as well as education and expert commentary. Similarly, our CardioSmart work to provide patients with the tools to understand heart disease and engage in their care is integral to achieving our Vision.

Our 10 JACC Journals, including our newest additions of JACC: Asia and JACC: Advances, are also part of these efforts. These globally recognized journals, led by Dr. Valentin Fuster and an incredible roster of women and men who truly represent the best in their respective fields, are changing how we not only disseminate science, but also incorporate it at the point of care. From Dr. Fuster’s weekly podcasts, to central illustrations used on social media, to interactive guideline tools, to the new Patient Care Pathways initiative – the list of innovations goes on!

Last, but certainly not least, we understand more than at any time in history that to achieve high-quality cardiovascular care and the Quintuple Aim we must have empathy – empathy for our patients, families, care teams, colleagues and for ourselves. In the past year, we honed our ability to understand and share the feelings of others, coming to the aid of colleagues around the world to underscore the importance of clinician well-being.

The College has a longstanding history of working across borders to improve heart health. We rallied our members across the globe to help provide much-needed, on-the-ground COVID-19 relief funding in countries like Brazil and India. Most recently the College provided support for UN Refugee efforts in the Ukraine. We are also translating CardioSmart materials into Ukrainian to help clinicians working at the borders to help the millions of people caught in the war. Our hearts go out to Ukraine.

When I reflect on this past year, I know that the silver lining from the pandemic is that it has brought together the profession and the ACC community in ways never imagined and inspired creativity, innovation and strengthened bonds around the world. It has also revealed an enduring truth – that it’s the people, the colleagues, the teams, the ACC, the members, the staff, it’s you who discover, disrupt, innovate and create. Together we have built a strong foundation this past year – a foundation on which we can grow and rise up to meet the challenges and opportunities, known and unknown, that await us in the future.

I am confident that together we can truly transform cardiovascular care and improve heart health around the world! This starts with us and we will do it with GRACE! Thank you very much.

Keywords: ACC International, ACC Annual Scientific Session, ACC22

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