Foreword

I am writing this note at an interesting time. I have just watched the inauguration of our newest US President and there is an air of refreshed enthusiasm across the country. At the same time, we are facing a continued downturn in our economy and the predictions for the near term are pessimistic. Thus, there is a paradoxical state of optimism mixed with fear.

Healthcare reform has moved to the forefront on the wish-list of many. While much of the discussion has focused on proposals to more efficiently provide healthcare for more people at a lower cost to the country, we must look at the many elements that fuel the rising cost of healthcare. This issue of US Cardiology contains reviews of the current state of our knowledge of several cardiovascular diseases, updates readers about evolving diagnostic modalities, and evaluates new treatments. Within these articles are discussions of new and expensive technologies. An outsider might be perplexed that, on the one hand, it is critical now more than ever to look at our discipline and find ways to cut costs, but, on the other hand, it remains crucial to continue to allocate new resources to advance our understanding of diseases so that we can develop new methods for better and earlier diagnosis and more effective treatments.

So, how should physicians and others in this field balance our professional goals, which might appear to push for more spending or less regulation to allow us to develop and use new technologies, while meeting society™s current need to reign in healthcare expenditure? The answer of course is that we need to find a way to support both. So, as we leave an era where healthcare and its technologies have expanded more than ever before, we enter an era where we must continue to advance knowledge and support new technology but with a more critical eye. As always, we must make evidence-based decisions in our evaluations of new healthcare technologies, identifying the winners and weeding out the losers, but now we must be even more selective.

As cardiology advances in this paradigm of optimism in the face of diminished resources, our integration of new technologies to better understand disease processes and diagnose and treat them must also incorporate the realities of our time. With that, we are all called upon to achieve a balance between enthusiasm for technological advances and maintaining an objective view of the value of each of these technologies so that we can ensure that only those that are truly cost-effective are put into practice. In addition, we need to identify what can be replaced so that these advances are truly beneficial rather than duplicative at an added cost. Effectiveness will be measured in many ways, including patient safety and the ability to make faster diagnoses or improved diagnoses, where treatment can not only enhance hard outcomes but also improve quality of life and the quality and appropriateness of care. With a concerted push by all of us, the prospects can be bright├óÔé¼ÔÇØdespite many challenges.