Cardiologists continue to see a bright future, full of research, development, advances in diagnosis and new therapies that include devices, drugs and genetics. Judging from the recent American College of Cardiology annual meeting in March, the field is booming, with record attendance by physicians and an energized pool of vendors screaming for attention.
Cardiologists in the U.S. are becoming increasingly concerned, not about new drugs and devices, but an ever-increasing workload, courtesy of the American public. The combination of an aging population and an expected significant increase in coronary heart disease driven by obesity, diabetes and physical inactivity creates the pressure of a much larger cardiology waiting room, very soon. With medical schools turning out just enough graduates to replace the retiring M.D.s, the remaining cardiologists are working harder today on analyzing and “re-engineering” their work (M.D.s seldom appreciate business school jargon, but hey, it looks like some business analysis is called for here). And actually, many M.D.s in the cardiology field are now predicting a shortfall in the number of cardiologists required to treat aging Baby Boomers as they enter their heart-disease prone decades.
The American College of Cardiology President, George A. Beller, M.D., thus opened the recent 50th Annual Scientific Sessions of the ACC (March 18-21, 2001, Orlando) with a focus on … quality of cardiovascular care. “The quality of care is quite variable, and undertreatment … is a problem,” he said. Boom, just like that, he dropped the curtain on the real challenge facing cardiology patients in the U.S. today.
Apparently, both cardiologists and patients have developed bad habits that take some effort to correct. Cardiologists don’t always follow the ACC guidelines and protocols for diagnosis and treatment of cardiovascular disease. Patients find it more challenging than ever to stop smoking, start exercising, change their diet and take their medicine regularly. The net result is that many patients don’t benefit from the treatments that are approved, tested and recommended as optimal care, primarily due to administrative and communication “issues.”
“Cardiac care will never be optimal until we transform, via new technology, our healthcare delivery system, no matter how successful we are in obtaining state-of-the-art knowledge,” Beller continued. He referenced the multiple patient charts stored in multiple locations, completely unlinked, as a major impediment to achieving progress – in effect these data are unavailable and useless to any other physician who requires them on a timely basis. Well, this is not exactly a profound observation, but where is the charge to lead this change? To date, we haven’t seen it coming from the AMA, AHA, ACC, NIH or any other lettered organization associated with physicians. OK, OK, the first step is to recognize the problem. But come on, let’s get moving here before the bridge to the 21st century is ancient history!
To the credit of the ACC organization, many highlights of the meeting focused on information technology items, including cardiovascular data registries, tool-kits that monitor adherence to diagnostic and treatment guidelines, structured reporting of cardiac procedures, loading ACC guidelines onto a Palm Pilot, electronic medical records (at last), and medical errors.
Many of the tools that can quickly help improve patient care are decidedly low-tech, but apparently, just what the doctor ordered – ouch. Kim Eagle, M.D., of the University of Michigan, reported on the Guidelines Applied in Practice (GAP) project results at the ACC in its first trial of monitoring acute myocardial infarction treatment protocols in Michigan. Using a pocket guideline for physicians, a clinical pathway for nurses, standard orders, chart stickers and hospital-specific performance charts (we used to call these good-sticker charts in 3rd grade), adherence to ACC guidelines increased significantly – as measured by beta-blocker usage, aspirin therapy, advice to stop smoking, etc. You can expect more projects in the future from this group, and don’t be surprised to see your cardiologist putting gold stickers on your chart someday either – maybe even electronic ones!
Even with less attention on new devices, drugs and tools, physicians still could not resist wandering the aisles of the ACC meeting looking at all the new toys, just like big kids at an auto show! The items that looked most interesting were related to interventional cardiovascular procedures, with coated stents, brachytherapy, and radial artery-based interventional devices making everyone’s short list. Interventional cardiologists also continue to push the envelope into non-cardiac areas of peripheral vascular disease, as they appear to be leading radiologists in the quest to diagnose and treat these conditions with new tools, devices and procedures.
Cardiac disease remains an epidemic, and the leadership organizations of ACC and AHA appear more willing of late to begin addressing this disease (both diagnosis and treatment) with more focus and discipline. Hurry up, your patients are waiting!
Doug Orr, president of J&M Group (Ridgefield, Conn.), consults with medical device companies in strategy and business development for emerging growth markets, notably radiology and cardiology. Comments and suggestions can be sent to [email protected].
