Through his novels, the British author George Orwell often cautioned us of the perils to which human nature can fall. Here, his message can inform practicing cardiologists and cardiovascular administrators because as ACC President Dr. Ralph Brindis wrote this week in his outgoing president perspective, “When it comes to cardiology, no one has been immune to the changes.”

Among the fast-paced changes, Brindis pointed to the integration of U.S. private cardiology practices with hospitals creating new business models, as well as academic medical centers dealing with new research guidelines, dwindling funding sources and a decreasing number of recruits (J Am Coll Cardiol 2011; 57:1564-1566).

Always on the forefront of the provider’s mind is the evolution of the healthcare delivery model within the U.S. The current fee-for-service model is being examined by government agencies, in the hopes of finding a new way to make providers and payors more accountable for the long-term health of the patient. “New healthcare delivery and physician payment models have everyone scrambling to understand and plan for the inevitable transitions that will occur as we move away from a system focused on volume of services to one that is more focused on quality and outcomes,” Brindis wrote.
 
The 60th annual American College of Cardiology Scientific Sessions & Expo begins this weekend in New Orleans, and many of these practice management considerations will be assessed during the plethora of sessions, including several on the best models for private practice integration, as well as preparing cath labs and departments to exhibit quality outcomes in the leaner times of the future.

Of course, the show-stoppers of the ACC meeting are typically the clinical trials, which reveal potential new therapies in which to treat the various patient populations. For instance, the PARTNER trial will continue to assess the role of transcatheter aortic valve implantation for patients with severe aortic stenosis. The previous results of PARTNER’s cohort B trial only examined patients who were deemed inoperable candidates, but the never-before-seen results of cohort A trial will seek to demonstrate TAVI’s safety and effectiveness in patients with severe aortic stenosis, who are deemed high-risk for surgery, but are not considered inoperable.
 
Also examining new therapies for patients with structural heart disease, the EVEREST II trial will demonstrate the MitraClip’s durability at two years for patients with a leaky mitral valve.

With potential COURAGE-like effects on clinical practice, the STITCH trial will seek to evaluate the benefits of contemporary medical therapy compared with CABG. In another comparison with CABG, the PRECOMBAT trial will compare bypass surgery with Cordis’ Cypher stent in the patients with left main coronary disease—who prove particularly tricky to revascularize due to the complexity of their disease state.

This brief review only touches about the surface of multitude of trials that will be presented at ACC.11 over the next week, and be sure to tune into our daily coverage, beginning on Sunday, April 3.

Despite the ever-evolving environment within healthcare in general, and specifically within cardiology and its varied subspecialties, cardiovascular mortality continues to be driven down, as those patients with heart disease are living longer and healthier lives. Therefore, members of this field are definitely doing their part to “salvage civilization” through their willingness to “evolve,” as Orwell suggested.

Brindis also concluded with a look toward the successes: “As I look back over this past year, I am proud of all of the great things we have done (and continue to do) as a profession to ensure that our patients are getting the best care at both the national and international level,” Brindis wrote. “Whether it is through registries, clinical documents, relationships with lawmakers or educational programs, we are making a difference and paving the way for future generations of cardiovascular professionals and saving the lives of countless patients in the process.”

On these topics, or any others, please feel free to contact me.

Justine Cadet
Executive Editor of Cardiovascular Business
jcadet@cardiovascularbusiness.com