ACC's October Board of Trustees (BOT) meeting was rich with strategic dialogue and forward-looking initiatives that reflect our shared commitment to advancing cardiovascular care and strengthening the ACC community.

It's been a busy start to fall, and this meeting provided an opportunity to reflect on some of the many accomplishments and activities, including our successful Legislative Conference with over 400 participants and nearly 300 virtual Hill meetings, as well as our ACC Latin America and Middle East conferences bringing localized education to key regions of the world. The annual ACC Quality Summit was also a huge success and a powerful testament to the vibrant mix of clinicians, hospitals, practices and health systems that make up our NCDR and Accreditation Services community.

A number of new clinical guidance documents, as well as new clinician resources, have also been released over the last few months, including an Expert Consensus Decision Pathway on Tricuspid Regurgitation Evaluation and Management, a Scientific Statement on Inflammation and Cardiovascular Disease and Concise Clinical Guidance on Transthyretin Cardiac Amyloidosis Evaluation and Management. A new JACC Focus Issue, providing 24 expert viewpoints on the new ACC/AHA High Blood Pressure Guideline also published in October.

Look for opportunities to dive even deeper into the guidelines as part of ACC.26 in New Orleans in March. Plus, the ACC has just announced a new strategic partnership with OpenEvidence to accelerate the translation of cardiovascular clinical guidance and research into clinical implementation at the point of care. By combining ACC's leadership in cardiovascular science and education with OpenEvidence's advanced generative AI technology, clinicians will have access to relevant, actionable and up-to-date information to support shared decision-making with patients.

Philanthropy, from new gifts to potential opportunities, was also a theme woven throughout the meeting – clearly a sign that our efforts to create a culture of giving are bearing fruit. Newer activities, include the Thad and Gerry Waites Cardiovascular Health Research Fellowship, the Fuster Prevention Forum (a call for applicants for the first cohort was just announced) and a dedicated Benevolence Fund providing one-time financial support for members in need. As we enter the "Season of Giving," you can learn more about ongoing opportunities to give back to the College at ACC.org/Supportand by watching my latest REMARKable Conversations discussion with Philanthropy Committee leaders James Januzzi, MD, FACC, and Pamela Bowe Morris, MD, FACC.

On the ACC global stage, the BOT approved two new International Chapters in Tanzania and Vietnam. As we work towards our Vision of a world where science, knowledge and innovation optimize care and outcomes, it was also inspiring to hear from the Assembly of International Governors on just how much we've accomplished this year. More than 32 participants from 31 countries participated in our Global Leadership Institute and we've received 28 applications from individuals in 12 countries for our Global Digital Health Awards. We also anticipate 12 new sites participating in our Global Heart Attack Treatment Initiative this year. Additionally, programs like Emerging Faculty are increasingly global in nature, attracting applicants from 24 countries this year alone, and this month's issue of Cardiology magazine highlights a number of global collaborations between ACC U.S. and International Chapters, as well as Member Sections.

The Cardiology Workforce Crisiswas also on the agenda, with a review of the key ongoing challenges facing ACC members and ACC's continued College-wide efforts to identify and implement solutions. The BOT engaged in discussions around training requirements, graduate medical education funding and resources like the latest ACC and MedAxiom Care Transformation resources focused on team-based care. For more on this topic, I encourage you to watch a recent REMARKable Conversations where I was joined by ACC Membership Committee Chair Laxmi S. Mehta, MD, FACC, and ACC Board of Trustees Member Thomas M. Maddox, MD, MSc, FACC.

In other highlights:

• The Prevention Task Force, co-chaired by Edward T. A. Fry, MD, MACC, and Dr. Morris, shared thoughts on the importance of upstream public health strategies and primordial prevention, and opportunities for the ACC to leverage its strengths as a leader in advocacy and education. Early recommendations for further consideration include strategic partnerships, programmatic efforts to improve patient access and more. More to come in the coming months.
• We also heard about Section Steering Committee efforts to provide greater engagement opportunities for ACC Member Sections as a whole. Opportunities to leverage the Sections to develop future College leaders and promote the ACC brand were also discussed, with the College's recent Legislative Conference identified as a model for leveraging Section expertise to help educate lawmakers around issues like non-compete agreements, ECG screening for student athletes, aPAD, rural cardiology (access/challenges), guideline implementation at state levels and more.
• The Accreditation Oversight Committee also provided a valuable update on its work, emphasizing that broader policy changes like the One Big Beautiful Bill Act may significantly shape accreditation adoption, making coordination with the Health Affairs Committee critical to align advocacy with value-based care goals. While financial performance has stabilized, external policy risks persist, requiring vigilant monitoring and BOT guidance on risk tolerance for emerging markets on strategically important clinical areas such as cardio-obstetrics. Sustained clinician engagement is also essential to drive long-term adoption and demonstrate both organizational and personal benefits.
• The BOT also engaged in forward-thinking discussions based on major trends shaping both health care and associations, emphasizing strategic relevance and member engagement. Key themes included workforce evolution, digital transformation and nimble governance for associations, alongside patient empowerment, AI-driven care and decentralized delivery in health care. Discussions also focused on clarifying value propositions, defining target audiences and building resilient, innovative models to strengthen community bonds and adapt to market disruptions.

The BOT will meet again next month for its final meeting of the year. Thank you as always for your continued leadership and engagement.