ACC NEWS
President’s Page: The American College of Cardiology’s Continuing Support for Interventional Cardiology
James T. Dove, MD, FACC, ACC President* and
W. Douglas Weaver, MD, FACC, ACC President-Elect
* Address correspondence to: James T. Dove, MD, FACC, American College of Cardiology, c/o Padmini G. Rajagopal-Moorehead, 2400 N Street NW, Washington, DC 20037
In the past few months interventional cardiologists have felt under fire with late-breaking clinical trial results and various studies at scientific meetings—including the European Society of Cardiology (ESC) in September 2006 and the ACC.07 in March 2007—challenging percutaneous coronary intervention (PCI) and the use of stents. The negative feedback during these few months is especially difficult after several years in which interventional cardiologists have received extensive positive recognition for the extraordinary achievements and contributions they have made in saving lives with their new techniques and innovative approaches.
Perhaps because some of the seemingly negative information was presented at an American College of Cardiology (ACC) meeting, some interventional cardiologists have expressed concerns about the value of ACC membership and have claimed that the ACC is no longer interested in representing interventional cardiology. Nothing could be further from the truth.
Approximately 25% of the ACC’s members describe themselves as interventional cardiologists. Clearly, they are an important segment of the ACC cardiovascular team. The ACC has numerous strategies in place to increase value to all its members and in recent years, those strategies have focused extensively on interventional cardiologists.
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Investing in Intervention: i2 Summit
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Three years ago, after commissioning an intensive study of how to add better value for our interventional members, the ACC Board of Trustees voted, at significant risk, to invest in a new interventional meeting—the Innovation in Intervention: i2 Summit 2006. The study revealed a clear need for a well-planned meeting that presented information in a fair and balanced fashion with quality live case demonstrations. The i2 Summit revitalized more than the former ACC Interventional Spotlight portion of the ACC Scientific Session. With its innovative approaches, it has been the catalyst for bringing the annual meeting’s educational processes in step with what other organizations had been doing.
Both i2 Summit 2006 and 2007 have been extraordinarily successful, and Drs. David Holmes, Bill Knopf, and Barry Uretsky are in the midst of planning i2 Summit 2008 and will once again provide the best possible educational program for interventional cardiology.
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Providing External and Internal Support
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Given the public confusion generated by the results of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation) trial presented at ACC.07 in March, the ACC issued a statement in early April that expressed the ACC’s support for interventional cardiology and the important advances that interventional cardiology provides for patients. The statement was developed so that members could print and distribute it to their patients who had questions about PCI and stents for their particular conditions.
At Food and Drug Administration hearings in December 2006, official ACC testimony called for a longitudinal database and unique patient identifiers to link patient records across all health care facilities in part to help clarify possible issues regarding stents and other implanted devices. We also addressed the need to avoid "data hysteria"—the taking of small numbers and using them to project how they might affect hundreds of thousands of patients. We stressed that it is our job to put the significance of research data into perspective for our patients.
In January 2008, the ACC will launch JACC: Cardiovascular Interventions to facilitate publication of important interventional articles. The Journal of the American College of Cardiology (JACC) has been unable to print all the excellent interventional articles it has received due to space limitations. This new journal, under Spencer King as editor-in-chief, will provide a larger venue for important articles from the interventional community—not in competition with, but in addition to—Catheterization and Cardiovascular Interventions, the journal of the Society for Angiography and Cardiovascular Interventions (SCAI).
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Building Recognition and Partnerships
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The ACC plans to hold a commemorative Gruentzig meeting in September 2007 at Heart House to highlight the 30th anniversary of Gruentzig’s first interventional procedure. It will highlight the tremendous value that interventional cardiology has contributed to advancing our knowledge base and patient care. The ACC has invited the SCAI to assist in the planning of this meeting, which will be scheduled so as to not conflict with the ESC or Transcatheter Cardiovascular Therapeutics (TCT).
The ACC Board of Trustees is also entertaining the idea of an interventional scientific council within the College, similar to the two recently piloted sections for Women in Cardiology and Adult Congenital Heart Disease and Pediatric Cardiology, both of which are flourishing. If the Board decides to move forward on a section for interventional cardiology, we will invite the SCAI to be involved.
The ACC also believes that collaboration is important to the cardiovascular profession and to the patients that we serve. To that end, we have continued to make significant strides in building bridges with the leadership of SCAI. The ACC supports the work of SCAI and has recently discussed joint operational issues and better transparency of any planned interventional-related activities of the College. Communication between our two organizations is headed in a direction that we both want. We face some huge battles for both imaging and interventional cardiology, and we must fight them with a common voice and pooled resources to have the force needed to win.
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Revisiting the COURAGE Issue
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Earlier we mentioned the COURAGE trial results at ACC.07. We would be remiss if we did not take this space to correct misinformation about the ACC’s handling of an embargo break with regard to the COURAGE results. ACC bylaws require that embargo breaks and other issues concerning professionalism be reviewed by the ACC Ethics Committee. When the embargo on releasing the trial results was broken by a couple of members, the following occurred:- • immediately following ACC.07, those involved communicated their lack of intent for the break and their contrition for the problems it created;
- • the ACC’s Ethics Committee, which includes interventional cardiologists, reviewed all available information and unanimously concluded that the embargo had been broken and recommended sanctions;
- • the Board of Trustees also discussed the Committee’s recommendations and unanimously approved them.
The process by which the decision was achieved by our committee volunteers was thoughtful and deliberate. Our embargo policies have been in place for a long time and because of some concerns raised during this process, we have asked the Ethics Committee to review our current policy. However, we also realize that it is more important than ever to provide balanced discussion of late-breaking clinical trial results that are likely to attract media and public attention, and we have put in place a means to accomplish this.
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Moving Forward
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President-Elect Doug Weaver, ACC CEO Jack Lewin, and I have spoken to several prominent interventionalists to get their opinions and counsel on how we might improve and help interventional cardiologists with their current concerns. These calls have been warm, informative for all parties, and productive in helping us modify procedures and protocols in the College.
We can continue to spend time putting out fires, or we can work together to build better and stronger programs that benefit us all. ACC leadership knows your issues and concerns well and is working in every way possible to address them.
To that point, we are concerned about the most significant risk to the profession and our patients, which is health care reform. We need to commit our energy and resources to address this issue and not the past. The ACC is using the credibility we have built on Capitol Hill to take a place at the table in health care redesign. At this crucial time, all cardiovascular organizations and members need to stand together in proposing reform based on access, quality, and appropriate care. Divided, we will have less influence and effect on the outcome.
The leadership of the ACC does not portend to suggest that we have been or always will be perfectly correct and that there is no room for improvement. We will always welcome legitimate constructive criticism and recommendations on how to do better because doing so is part of what makes a stronger team.
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Investing in Intervention: i2...
Providing External and Internal...