Tackling Population Health

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

VOL. 64, NO. 10, 2014

ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER INC.

ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2014.07.946

LEADERSHIP PAGE

Tackling Population Health Leaving a Meaningful Mark on the World Patrick T. O’Gara, MD, President, American College of Cardiology

C

ardiovascular diseases know no borders.

grams have failed to make the transition from

Although huge strides have been made in

aspiration to reality.

treating cardiovascular diseases and re-

The American College of Cardiology (ACC) recog-

ducing morbidity and mortality over the last several

nizes these changing times and the inherent oppor-

decades, they remain the number 1 cause of death

tunities that go along with them. We also recognize

around the globe (1). In fact, cardiovascular diseases

the consequences associated with inaction—thus,

constitute the most common form of noncommuni-

our focus has been on development and imple-

cable diseases (NCDs), which now account for nearly

mentation of a strategic plan that re-envisions spe-

2 of every 3 deaths worldwide. NCDs affect both

cialty care with the goal of positioning the ACC as

developed and developing countries without regard

the professional home for the entire cardiovascular

to economic disparities and, if left unchecked, are

care team. Our strategic priorities moving for-

projected to account for nearly 75% of global deaths

ward, including purposeful education, data trans-

by 2020 (2).

parency and use, and a renewed focus on improving

Despite these grim statistics, there are increasing opportunities to fight back. Increasing worldwide

the health of populations, are of particular importance internationally.

access to and use of digital technologies are causing

The ACC recognizes that, in order to maximize its

major shifts in how information is communicated,

mission to transform cardiovascular care and improve

learned, and received at both the healthcare pro-

heart health, education needs to reach practitioners

vider and patient/consumer level. In addition, more

where they live and work. Personalized education,

and more unique global partnerships targeting pre-

e-learning, and specialized live programs focused on

vention and treatment of specific unhealthy behav-

training new leaders or bringing the latest cardio-

iors and risk factors are forming and are being led

vascular research directly to a country are critical

by unique teams made up of medical societies, in-

elements of our purposeful education strategy and

dustry, government agencies, consumer companies,

international outreach.

and others.

A great example of a country that has taken pur-

In a recent editorial page, JACC Editor-in-Chief

poseful education to heart is India, where educa-

Valentin Fuster, MD, PhD, MACC, said it best when

tional programs over the last several years have

he wrote: “There is true momentum to address this

reached thousands of cardiologists and physicians

problem, which cannot be lost to distraction or

treating cardiovascular patients. The ACC Cardio-

apathy. This fight against the burden of cardiovas-

vascular Symposium chaired by Dr. Fuster is 1 of

cular disease, affecting all countries and local corners

the major highlights, providing a comprehensive

of the world, requires many physicians, specialists,

2-day update across all cardiovascular competency

and subspecialists” (3). In his editorial, Dr. Fuster

areas to leading cardiologists across the country. In

emphasized the need for concrete action, measure-

addition to this program, the ACC has extended the

ment, and follow-up, stressing that too many pro-

reach of its Annual Scientific Sessions by showcasing highlights from the meeting in 8 cities across India. Perhaps the most unique offering is an electro-

From the American College of Cardiology, Washington, DC.

cardiogram training program focused on helping

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O’Gara

JACC VOL. 64, NO. 10, 2014 SEPTEMBER 9, 2014:1061–3

Leadership Page

cardiologists and primary care doctors utilize and

smoking and hypertension are alarmingly prevalent.

interpret electrocardiograms.

According to a recent World Health Organization

In addition, the ACC recently teamed up with the

report, 53% of Chinese men smoke and 40% of

Chinese Society of Cardiology on a unique “Train the

Chinese adults age 45 years or older have hyper-

Trainer” program aimed at increasing awareness

tension (4). Moreover, awareness and control of

of atrial fibrillation treatment in China. Ten pilot

these 2 risk factors are limited. Only 40% of hyper-

centers have been established throughout the coun-

tensive patients are aware of their condition, and

try, which offer over 50 lectures and face-to-face

only one-half of these patients receive medication.

exchanges in hospitals with top local and global

In response to the lack of patient awareness re-

experts in atrial fibrillation and embolic stroke

garding such modifiable risk factors, the Chapter

prevention.

has hosted patient education events during the

The use of data is also a hot topic. Integrated

annual Great Wall Congress of Cardiology meeting.

registries have the potential to be used as powerful

The Chapter also translated and distributed to

tools for identifying education and quality improve-

patients several of the ACC’s CardioSmart fact

ment opportunities both globally and at country-

sheets on various cardiovascular disease risk factors.

specific levels. The ACC’s National Cardiovascular

Building on these successes, the ACC and the

Data Registry (NCDR) has made considerable contri-

Chinese Society of Cardiology are launching a major

butions toward improving the quality of cardiac care

new initiative to combat hypertension in China

in the United States, and there is tremendous po-

this fall with the release of a Mandarin language

tential internationally to use registries to inform

website, distribution of essential educational mate-

clinical research, identify gaps in local care, and help

rials for nurses and patients, and a public health

providers develop best practices related to cardio-

event

vascular outcomes.

conducted to raise awareness around hypertension

In 2010, the ACC’s registries were deployed inter-

where

blood pressure

screening

will be

management.

nationally when the Sheikh Khalifa Medical City in

Over the last several years, the ACC also has

Abu Dhabi implemented the ACC’s ACTION (Acute

actively advised the United Nations (UN) on its ef-

Coronary Treatment and Intervention Outcomes

forts to combat the NCD epidemic since the 2011 Po-

Network)–GWTG (Get With The Guidelines) registry.

litical Declaration of the UN High-Level Meeting on

Since then, additional international facilities have

NCDs. In fact, ACC Past President John Gordon Har-

adopted NCDR registries, including the outpatient

old, MD, MACC, and I both recently took part in UN

PINNACLE registry. Current international NCDR par-

hearings focused on moving from discussion to ac-

ticipants include facilities in Brazil, Canada, India,

tion around the global target of a 25% reduction in

Saudi Arabia, and the United Arab Emirates. The ACC

premature mortality from NCDs by 2025. As a proud

is also starting to roll out its International Centers of

member of the NCD Alliance, the ACC is working to

Excellence program that recognizes hospitals outside

support this global target, as well as corresponding

of the United States for high performance standards

NCD targets focused on high blood pressure, smoking

and the provision of quality cardiovascular care.

cessation, diabetes, obesity, and reliable access to

Among other criteria, pilot institutions are asked to

medicines. These goals are embedded in the World

demonstrate their commitment to quality services by

Health Organization’s global action plan against

actively tracking their performance and closing per-

NCDs (5). They mirror several of the efforts spear-

formance gaps based on registry data. In addition, a

headed by Dr. Fuster and the Institute of Medicine

new program for international hospitals is rolling out

committee he chaired in 2010.

this fall to enable greater adoption and use of clinical data registries.

There is still much to learn about the treatment of cardiovascular disease. Disease type, occurrence,

Last, but certainly not least, whether it is providing

and treatment vary with many factors. Yet, if we can

support for global efforts to address NCDs or part-

work together to increase international participation

nering with local health systems and/or governments

in educational activities, encourage global use and

on campaigns addressing major cardiovascular risk

exchange

factors like hypertension, obesity, and smoking, there

about cardiovascular diseases and its risk factors,

is a clear mandate that the College continue to work

progress is well within our grasp. Witnessing the

alongside its international chapters to improve pop-

passion to take on global cardiovascular health

ulation health.

among our international members and the dedication

of

data,

and

raise

public

awareness

The ACC’s China Chapter has done an exemp-

of our International Governors, more than 30 Inter-

lary job in the patient education space. In China,

national Chapters, and our partnering societies both

O’Gara

JACC VOL. 64, NO. 10, 2014 SEPTEMBER 9, 2014:1061–3

Leadership Page

in the United States (e.g., American Heart Association) and abroad (e.g., World Heart Federation),

ADDRESS CORRESPONDENCE TO: Dr. Patrick T.

there is no doubt that we can accomplish these steps

O’Gara,

in a way that will leave a meaningful mark on

N

the world.

[email protected].

Street

American NW,

College

Washington,

of

Cardiology, DC

20037.

2400

E-mail:

REFERENCES 1. Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in

All. Geneva, Switzerland: World Health Organization, 1998.

ment and control: data from the China Health and Retirement Longitudinal Study. Bull World Health

the United States: a policy statement from the American Heart Association. Circulation 2011;123: 933–44.

3. Fuster V. Global burden of cardiovascular dis-

Organ 2014;92:29–41.

2. World Health Organization. The World Health Report 1998. Life in the 21st Century: A Vision for

4. Feng XL, Pang M, Beard J. Health system strengthening and hypertension awareness, treat-

ease: time to implement feasible strategies and to monitor results. J Am Coll Cardiol 2014;64:520–2.

5. O’Gara PT, Harold JG, Zoghbi WA. Thinking globally to transform cardiovascular care. Lancet 2014;384:379–80.

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