This issue of US Cardiology offers a wide range of topics exploring the current state of cardiovascular science, promoting cardiovascular education, and, most importantly, promoting cardiovascular quality. US Cardiology is truly supporting cardiovascular professionalism, a core value for all of us practicing cardiovascular medicine and those of us involved in leadership roles in this transitional time of healthcare reform. In addition to terrific reviews discussing advanced imaging of mitral valve disease, mechanical circulatory support in heart failure, cardiac transplantation, cardio-cerebral resuscitation, and risk reduction strategies for sudden cardiac death, additional attention is devoted to ensuring that the practice of high-quality cardiovascular care is explored with the Society for Cardiovascular Angiography and Intervention’s (SCAI’s) and the American College of Cardiology’s (ACC’s) Accreditation for Cardiovascular Excellence (ACE) initiative, the ACC’s Practice Innovation and Clinical Excellence (PINNACLE) Network, and making inroads in minimizing cardiovascular disparities.
Cardiovascular professionals across the US are facing ever-increasing demands for quality reporting, maintenance of certification, and adoption of health information technology. We are now also being faced with accusations of practicing cardiovascular medicine in a manner that promotes the waste of valuable resources and, at times, gross abuse or fraud. For example, the issues currently facing Maryland hospitals and cardiovascular professionals related to accusations of overuse of coronary stenting procedures present an opportunity to illustrate how professional societies can take a leadership role in ensuring quality care in the areas of peer review, accreditation, and data management.
As outlined by Bonnie Weiner in this issue, the ACC’s partnership with the SCAI to provide accreditation of hospitals that perform invasive cardiac and endovascular procedures is an area where we are acting as true cardiovascular professionals. The ACE organization reviews hospitals and then accredits those that achieve predetermined benchmarks for quality care that have been shown to improve patient care. ACE is currently providing accreditation for hospitals that perform carotid artery stenting, and is now expanding its oversight to other procedures such as percutaneous coronary intervention (PCI). Both the ACC and SCAI believe that the ACE initiative, combined with ACC’s appropriate use criteria implementation for coronary revascularization and imaging, will be invaluable in addressing the state of Maryland’s concerns about alleged inappropriate PCI. Professional societies have the expertise to best evaluate these concerns and challenges for the profession and to advise stakeholders regarding these issues. Standards have now been established for peer review so that hospital and physician outliers can be assessed in a proactive manner.
The ACC is arming our cardiovascular professionals to reduce racial disparities through our Coalition to Reduce Racial and Ethnic Disparities in Outcomes (CREDO) program, empower patients through the CardioSmart national care initiative, and train the next generation of cardiovascular leaders through the ACC’s Cardiovascular Leadership Institute. Discussions also continue with health plans on the application and use of our National Cardiovascular Data Registry (NCDR) registries, such as the PINNACLE Registry and our PINNACLE Network, as a means of reporting and measuring quality that does not involve relying solely on claims data. ACC initiatives such as FOCUS, which aims to ensure appropriate use of imaging in our practices, coupled with tools embedded in the PINNACLE Registry that can measure long-term outcomes and help assess and ensure the appropriateness and effectiveness of cardiovascular care. These clinical benchmarked data allow our hospitals and cardiovascular professionals the ability to improve the quality and appropriateness of their local care environment. Society should view us as trusted professionals embracing appropriate use of resources and basing our treatments on the latest and best scientific evidence. We must continuously demonstrate professional competence and a commitment to ensuring patient access to high-quality, appropriate care. In addition, we must be honest with patients and maintain trust by effectively and transparently managing conflicts of interest. As true cardiovascular professionals we should always put the interests of patients before personal financial gain. We should be rightfully perceived as champions of patients and respected advisors on healthcare policies that affect cardiovascular public health. With our background of scientific and clinical expertise, we can have the courage to lead and even take a public stance on issues and policies that will affect our patients. As cardiovascular professionals we can take substantial stewardship of the healthcare system into our own hands.