American College of Cardiology

Contacts:
kbieg@acc.org
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In this issue:

Practice Updates

ACC News

Question of the Month

ACC’05 Scientific Session!

March 6 – 9, 2005
Orlando, Florida

Patient Education and Compliance Receive Top Focus

In July's CCA Update, we asked what you considered to be your #1 daily patient care issue, and the majority of you identified patient education and communication to increase patient compliance. In responding, many of you expressed some levels of frustration because patient education is so important to prevention of heart failure. To quote one respondent, "So much pathology can be prevented or kept under reasonable control if patients are educated about their particular disease processes, treatments, options, goals, reasonable expectations, and responsibility in their own health."

However, education does not necessarily lead to patient compliance. One respondent references her frustrations with risk factor modification efforts with her overweight patients. "Despite encouragement at every visit to work on very specific goals, exercise programs, and ideas to incorporate changes into their lives, they are making very little progress," she says.

Good two-way communication with the patient and family members seems to be a key to the education process for one respondent. "Patients ask me questions daily about their medicines, low blood pressures, fluid retention, etc. I need to listen to them so I understand what their real concern is and then need to make sure my instructions whether verbal or written are understood by the patient and family."

Kathleen L. Grady*, Ph.D., R.N., F.A.A.N, suggests that no one reason exists for non-compliance. The issue could be finances, cognitive abilities, denial, or simple forgetfulness. Grady, who is nursing director for the Rush Heart Failure and Cardiac Transplant Program at Rush University Medical Center in Chicago, adds that she focuses on why an individual is non-compliant and then individualizes the training to fit that person. For example, if forgetfulness is the problem, then she works with the patient to develop strategies that will help him or her remember.

In addition to patient education and compliance, some respondents raised patient access to affordable medications as an important issue, a topic much in the news today. We would like to follow up on patient education and compliance. If you have found certain methods or tools effective for educating your patients and their families, would you be willing to share them with your peers? Please send your suggestions to CCA Update, click here.

* Look for Kathleen Grady’s comments about heart failure disease team management studies in the September 2004 Cardiology.

Question of the Month
(We’d like to hear from you. So, please take a moment to respond.)

The College is planning specific educational activities for our new category of membership, the Cardiac Care Associate. Please respond to our survey and tell us what your most pressing educational needs are. To respond, click here.

Practice Updates
From FDA MedWatch: Avastin Associated With Increased Risk of Serious Arterial
Thromboembolic Events
The Food and Drug Administration and Genentech, Inc. issued an important drug warning to healthcare providers that there is evidence of an increased risk of serious arterial thromboembolic events, including cerebrovascular accident, myocardial infarctions, transient ischemic attacks, and angina related to Avastin (bevacizumab). The risk of fatal arterial thrombotic events is also increased. In randomized, active-controlled studies conducted in patients with metastatic colorectal cancer, the risks of a serious arterial thrombotic event was approximately two-fold higher in patients receiving infusional 5-FU based chemotherapy plus Avastin, with an estimated overall rate of up to 5%. For more information, click here.

Surge of Atherosclerosis at Menopause Slowed by Diet and Exercise
Thickening of artery walls accelerates as women enter menopause, but these signs of the progression of atherosclerosis can be slowed by a lower-fat diet and increased physical activity, according to a new study, "A Dietary and Exercise Intervention Slows Menopause-Associated Progression of Subclinical Atherosclerosis as Measured by Intima-Media Thickness of the Carotid Arteries" in the Aug. 4, 2004, issue of JACC. Click here for the study.

Revised Guidelines Highlight Importance of Echocardiography in Exercise Testing,
Heart Failure Patients
Rapid advances in the use of ultrasound to diagnose and manage heart disease have prompted the American College of Cardiology (ACC), the American Heart Association (AHA) and the American Society of Echocardiography (ASE) to update guidelines on echocardiography originally published in 1997. The 2003 Guideline Update for the Clinical Application of Echocardiography includes new recommendations for the use of echocardiography during stress or exercise testing, as well as in patients with heart failure or who are critically ill. Click here for guidelines.

Coronary Artery Bypass Graft Surgery Guidelines Get New Update
The American College of Cardiology (ACC) and the American Heart Association (AHA) have issued a revised set of guidelines for the management of patients undergoing coronary artery bypass grafting (CABG). In contrast to the previous guidelines published in 1999, the new update says no to hormone replacement therapy and yes to aspirin for patients undergoing this common surgical procedure. The new guidelines also stress the importance of statin and beta blocker therapy in all post-CABG patients, as well as anticoagulation with warfarin in patients who develop sustained abnormal heart rhythms after bypass. Click here for the document, which will also appear in the Sept. 1 issue of JACC.

Cardiosource Update
CCA member Suzanne Hughes, M.S.N., R.N., who is an associate editor, nursing and patient education, for Cardiosource, offers this update on activities planned to serve Cardiac Care Associate members better:

We are in the process of making some additions to the Cardiosource website to meet the needs of our non-physician members. Currently, I am working with the editorial staff to add relevant content to the site on a newly designed CCA page, which we hope to have available early this fall. The page will also provide links to other sections of Cardiosource that may be particularly interesting and relevant. We are also exploring the addition of new tools to the patient education section, such as downloadable Power Point files that could be used for giving presentations to patient or community groups. As always, we are interested in your input and hope you will take a moment to respond to the question of the month—Suzanne Hughes

Did You Know?
Cardiac Care Associates can take advantage of a discounted subscription rate of $185 to Cardiosource Premium, the online source for cardiovascular content designed to help you meet the demands of your increasingly complex role in the cardiac care team.

Special Offer: Get an Extra Month Free
Purchase Cardiosource Premium by September 15th and you will receive one month FREE. That's 13 months for the price of 12!

Sign Up For a Free Trial
Try Cardiosource Premium for free until Sept. 15th. To start your free trial right now, call 1-866-898-4801 or 407-345-4300 to speak with a customer service representative. Mention "CCA Free Trial" to take advantage of this offer.

ACC News
ACC Establishes 20 CCA Member Travel Awards for ACC’05
ACC member surveys cite the Annual Scientific Session as one of the most important benefits available to members. ACC considers the educational and professional value to be so important that it is making 20 travel awards available to Cardiac Care Associate members who plan to attend the ACC’05 in Orlando. Each travel award will cover up to $1,250 per person in expenses and includes registration, transport, and hotel. Awardees are reimbursed following the meeting. Interested CCA members should e-mail CCAtravelaward@acc.org and provide their names and contact information. Deadline for applications is Oct. 31, 2004. Winners will be randomly selected on Nov. 1 and notified the same day. The list of winners will be posted on www.acc.org.

Please note: If you plan on attending ACC’05, don’t jeopardize your hotel selection by waiting until November. All award applicants are encouraged to register for the meeting when housing registration opens to members on Sept. 16, 2004.

ACC’s Focus on World Heart Day, September 26
World Heart Day, sponsored by the World Heart Federation in Geneva, Switzerland, focuses on "Children, Adolescents and Heart Disease" for 2004, which coordinates well with ACC’s 2004-2005 theme for community outreach efforts, "Healthy Eating & Activity are the Right Tools©". ACC’s plans for World Heart Day include:

• Promoting a First Families Program by asking all state Governors to proclaim Sept. 26th World Heart Day in their state. To help launch the program in their states, ACC Governors will receive a toolkit that includes a sample letter to the state Governor, a sample proclamation, a sample press release, and a digital poster.

• Planning events surrounding Sept. 26, in collaboration with the Children’s National Medical Center in Washington, D.C., to elevate the profile of children and heart health, with a focus on prevention as opposed to later cure (diet & activity).

For more information about World Heart Day and ACC activities, go to www.acc.org, www.worldheart.org, and www.worldheartday.com.

ACC’05 Reminders
Don’t forget that the abstract submissions deadline is September 8, 2004. Click here for information.

Education Opportunities
MGMA/ACC Audio Conferences: A Conversation with CCA Member Janet Long
Janet B. Long, M.S.N., A.P.R.N., B.C., A.C.N.P., spoke recently in a Medical Group Management Association /ACC audio conference, "Physician Extenders in the Cardiovascular Practice: How to Use Effectively and Bill Appropriately." Ms. Long is a Nurse Practitioner at University Cardiology Foundation in Providence, Rhode Island. Ms. Long, who has spent her nursing career in cardiology ranging from the acute care hospital setting to outpatient care, currently manages various cardiovascular diseases in a cardiology practice and is co-director of the Cardiovascular Risk Reduction Program. We asked her to take a few minutes out of her busy schedule to discuss the presentation.

Q: Can you give us an idea of what was covered in this audio conference?

Long: Dennis Grindle, C.P.A., gave an overview of Medicare's "incident to" rule; reviewed Medicare's shared/split E/M services; and other issues, such as supervision of diagnostic tests; hPSA 10% quarterly bonus payments, and reassignments issues. I spoke on outpatient practice models for the Nurse Practitioner and also on methods of billing to receive reimbursement for time spent educating and treating a patient when it is beyond the normal time allotted for a CPT code. Marc Shelton, M.D., discussed how he utilizes Physician Assistants in the hospital setting in his practice.

Q: What information in this session do you think was most important and relevant to CCA members?

Long: I think the most important points were how to bill maximally for the visits and the types of roles that Nurse Practitioners and PA's can perform in a cardiology practice.

Q: Overall, what could you say about your experience with the audio conference format?

Long: As a format, it was comfortable to work in, and I think the audience responded to it well. Also, it does allow a person to share information from several experienced sources without the expense of going someplace and you can participate either in the office or at home.

The next ACC/MGMA audio conference is scheduled for December 2004. Click here for more information about the audio conferences.

Listen Online—ACC Conversations with Experts
Free to all ACC members! 20 – 30 minutes fast-paced discussions between experts. Sessions are archived. Go to www.conversations.acc.org for more information. Upcoming conversations include: Aug. 25, "Low Molecular Weight Heparin in At Risk Pregnant Patients". Sept. 1, "Antihypertensive Therapy in African-American Diabetic/Renal Patients." Listen to or read these recent discussions online at www.conversations.acc.org: "Sleep and Cardiovascular Disease in Women Watch Program," and "Cardiac Medications in the Patient with Renal Disease Watch Program."

30th Annual Tutorials in the Tetons 2004: Update in Cardiovascular Disease
1600). Aug. 30 – Sept. 1, 2004, Jackson Lake Lodge, Jackson Hole, Wyo. Directed by Timothy Fleming, M.D., F.A.C.C.; Gordon A. Ewy, M.D., F.A.C.C.; Hugh C Smith, M.D., F.A.C.C.; and H. Robert Superko, M.D., F.A.C.C.. For more information, click here.

Now available and free to all ACC members! The Diabetes-Cardiovascular Disease Toolkit, a part of the Make the Link! Diabetes, Heart Disease and Stroke campaign! Available on CD-Rom, hard copy, and online, through the partnership of ACC, the American Diabetes Association (ADA), and the Preventive Cardiovascular Nurses Association (PCNA). Click here for more details.

Make the Link! Webcasts
ACC, ADA, and PCNA also have an ongoing continuing education series of free live Webcasts. Archives are available.

ACCSAP5 Now Available for $215
If your clinic or program doesn’t have a copy of ACCSAP5 now, perhaps it’s time to buy one at this discounted price. ACCSAP5, the fifth edition of the Adult Clinical Cardiology Self-Assessment Program, is the most comprehensive, state-of-the-art medical resource covering the field of adult clinical cardiology. It is a definitive information source that supports day-to-day clinical practice or serves as a useful tool for Board preparation studies. Editor-in-Chief: Richard P. Lewis, M.D., M.A.C.C. ACCSAP5 is available in print, CD-Rom and online formats. Supplies are limited. Click here for more information.

We Welcome Your Suggestions for CCA Update
To comment on topics covered in this issue or to offer ideas for future issues, please click here.

Start Planning Now for the
ACC’05 Scientific Session!
March 6 – 9, 2005
Orlando, Florida

Important Dates To Remember:
Aug. 2–Sept. 8, 2004
ACC’05 Abstract Submission Web Site Open

September 16, 2004
ACC’05 Preferred Registration and Housing
Opens for ACC Members Only
Click here for information.