Practice yourself, in little things, and then proceed to greater.
Greek philosopher Epictetus’ words could remind those within clinical cardiology practices that altering patient outcomes and quality measures may not require a massive overhaul. Instead, small process changes could equally allow practices to achieve improved adherence to best practices, if that path is clearly put forth through clinical data.

This coming week, ACC.10 in Atlanta will undoubtedly inform contemporary U.S. clinical practice for numerous patient populations with various acronym constructions. In a media briefing, ACC officials highlighted some of what they thought could be "game-changing" studies. 

They include several trials testing various regimens to halt or reverse the cardiovascular ravages of diabetes. These studies examined different blood pressure control and lipid control. The first transcatheter mitral valve repair trial will be discussed, as will the first genomic response related to warfarin.

Today, the New England Journal Medicine released a study from Duke researchers who found that about one-third of patients without known disease, who underwent elective cardiac cath, had obstructive coronary artery disease. This study may be perceived by some as another example of excessive imaging within clinical practice, and yet, a closer look at the data, may indicate quite the contrary.

Dr. Timothy D. Henry, from Minneapolis Heart Institute, helped Cardiovascular Business News parse the data, suggesting that the study, while important, needs to be taken in the proper context. Specifically, he said the cardiologists followed best practice medicine and that they first approached patients without known coronary artery disease with a noninvasive gatekeeper test.

While protocol adherence seems to be improving many procedures, some disparities still remain. First, the Agency for Healthcare Research and Quality released a brief this week showing that patients admitted to the hospital during the weekend hours are more likely to experience delays in major procedures, be emergency and critical cases and have a higher mortality rate compared to patients admitted during weekday hours.

Also, racial and gender disparities continue to plague healthcare. For instance, Circulation released a study this week that found black men and women experienced a lower decline in AMI hospitalization rates than their white counterparts. Researchers said this "raises the concern that efforts to control coronary artery disease risk factors may be less effective for black patients.”

Epictetus may be accused of cliché with his statement: “Difficulties are things that show a person what they are.” But seeing that he was writing in the first century AD, he may have begun the perpetuation of the concept from which practices can learn how much they can improve when they begin to change because of meeting challenges.

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

Justine Cadet