We are at a considerable crossroads in medicine and cardiology. The Affordable Care Act may provide us with more coverage for needed preventive services and provide 35 million people with some form of healthcare coverage, but the overall ‘pie’ of healthcare dollars will be shrinking, in an attempt to forestall the failure of Medicare and the further debt spending of the US. A call for a balanced budget, pursued by both Republicans and Democrats, will undoubtably be the mantra of this election year and thereafter, and ‘prudent’ government spending will mean at least some form of containment (the ‘sustainable growth rate’ [SGR] Medicare physician payment formula) of healthcare expenditures. Thus, important advancements, such as those described in this edition of US Cardiology, may be hard to fund without matching cuts elsewhere. So far, we have avoided the SGR, which has been deferred year after year, but sooner or later it may be enacted, resulting in an immediate 27 % cut in Medicare physician fee reimbursements. Each year, the Congress has acted to ‘kick the can down the road’ and defer any decision related to enacting the SGR, but each year, the debt grows bigger and the cuts, if they come, will be harder to swallow. This last Congress deferred the SGR for only two months, so we are in a point of limbo as to whether there will be enactment or further deferral.
Articles in this edition of US Cardiology cover some of the most important advances in cardiology, and we cannot let dysfunction in Washington undo our progress. This edition discusses improvements in hypertension (including baroreflex sensitivity assessment), in implantable cardiac devices (that may very well further improve the management of arrhythmias and heart failure), in echocardiography for heart failure, and in the assessment of sleep apnea—among others. New developments in the understanding of the relationships between inflammation and atherosclerosis, routes of transcatheter aortic valve implantation, and use of cardiac rehabilitation are just some of the other topics covered. Even completely new approaches to existing problems, such as using remote magnetic navigation for atrial fibrillation ablation, are presented.