Conquering cardiovascular disease around the globe

When we think about overall cardiovascular care, we need to consider all the elements. Certainly, first and foremost is the care of the patient with heart disease. Of course there are many other factors that we must consider and dedicate our efforts to, starting with early detection of disease, raising awareness about the impact of obesity, inculcating healthy behaviors and considering the contributions of genetic factors and, importantly, ethnic backgrounds. We aim for better care, better population health and affordable care from the perspective of both the patient and society. The ACCs answer to achieving this triple aim has emphasized quality, value and professionalism. The college has also focused on patient-centered care and is seeking collaborations among organizations for the development of guidelines, quality tools and health policies. Key ACC initiatives to help advance cardiovascular health include data registries and their impact, appropriate use of diagnostic modalities and interventions, strategies to empower patients with knowledge, and approaches to deal with public health challenges, both locally and globally. National data registries provide important data on practice of medicine and patient outcomes. The ACCs National Cardiovascular Data Registry, or NCDR, celebrates its 15th year this year and it has become the flagship of registries, growing to a total of seven registries. These cover most areas of cardiology, including interventional cardiology, implantable cardioverter defibrillator therapy, management of acute myocardial infarction, congenital heart disease and, most recently, transcatheter valve therapy. These continually enrolling registries have more than 24 million records. What is also exciting is that some of these registries have gone global, with presence in Asia, the Middle East and South America. This enables sharing and comparing of cardiovascular care quality between nations worldwide with the goal of improving cardiovascular care. Our most recent partnership with the Society for Thoracic Surgery, as well as regulatory agencies, payers and industry, ushers in a new registry paradigm this one for patients with advanced aortic stenosis mandating participation for reimbursement while monitoring quality, patient outcome and supporting research and innovation. The power of data reporting can change clinical practice and improve quality of care. Before reporting door-to-balloon data for treatment of acute heart attack, most hospitals and physicians believed they were doing a great job in this type of care. With the data, the percent of patients achieving a door-toballoon time of less than 90 minutes improved. Such data also lowered the rate of inappropriate angioplasties in favor of medical treatment. Reflecting on the application of knowledge, while science tells us what we can do, guidelines tell us what we should do, and registries show us what we are actually doing and will likely be doing in the future. A key component of high-quality care places an emphasis on the patient. This is where we need to be spreading the word about healthy living and healthy choices in the community. On one hand, looking back on the impact of cardiovascular interventions and outcomes, it is really gratifying to see the significant decline in cardiovascular mortality in the US over the past 40 years, thanks to advances in research, medications, devices and catheter-based and surgical interventions. However, many challenges remain. In the US, many patients who need to take aspirin are not. And many are in need of better blood pressure control and cholesterol management. Smoking rates, although better than in other countries, are still far from optimal. Even more urgent are challenges looming globally. Death from cardiovascular disease exceeds that from any other disease and accounts for about one-third of total deaths worldwide. It is higher than cancer, respiratory disease and diabetes, the other main non-communicable diseases (NCDs), combined.

The projected trends are alarming as they gradually increase for both cardiovascular disease and cancer. There are 10 highest risk factors for cause of total death worldwide. The most important is high blood pressure followed by tobacco use, high glucose, physical inactivity, overweight and obesity, and high cholesterol. Many of these risk factors are the same for other NCDs. Therefore, addressing them will have a major impact on global health, not only cardiovascular health. Prompted by the NCD Alliance, the United Nations had its first ever high-level meeting on NCDs in September 2011. The outcome of the summit was a political declaration that called on the World Health Organization to establish global targets for curbing NCDs. Indeed, the World Health Assembly met in Geneva in May 2012 and approved a monumental goal: a 25 percent reduction in premature mortality from NCDs by the year 2025. To achieve that overall goal, the following targets were adopted: reductions in tobacco smoking, physical inactivity, excessive alcohol use, salt intake, raised blood pressure, diabetes and obesity. Availability of essential medications to prevent heart attack and stroke was also emphasized. Going forward, there are challenges but great opportunities to reach this ultimate goal. As risk factors are so prevalent and traditional treatments are affordable, there is no need for new inventions globally. A big challenge is implementing the resolutions of various targets, knowing these may vary by nation. It is crucial to establish better funding for the NCD movement currently NCDs cause about 60 percent of global deaths yet receive about one percent of health funding. So the time is now for us to act and work collaboratively. Cardiovascular disease is a global problem. We can protect population health by taking a global perspective and working together with ACC chapters and national and international organizations to reach this noble goal.