Cardiovascular disease is the leading cause of death globally. Although two thirds of patients with cardiovascular disease are in low-middle income countries, the leading centers for innovation in cardiovascular care are concentrated in North America and Europe¹. To bridge this disparity, the ACC, with its 42 international chapters and over 16,000 members outside the U.S., strives to connect global clinicians through several formal as well as informal initiatives².

Amongst ACC's longest running international endeavors is the Chapter Exchange Program. This program was initially piloted in 2008 through a partnership between the California and the Great Britain and Ireland chapters. More chapters have subsequently been added, and the initiative was formally launched at ACC.16 in Chicago.

In 2017, several paired chapters initiated their efforts to achieve the above goals. One pair that has been extremely successful at launching their partnership is the New York and Argentina duo. This relationship, originally conceived under the leadership of Timothy J. Malins, MD, FACC, and implemented by John Chad Teeters, MD, FACC, and Norma M. Keller, MD, FACC, gained renewed momentum in 2020 thanks to the efforts of the leaders of the ACC New York Chapter, Srihari S. Naidu, MD, FACC, and Himabindu Vidula, MD, FACC; and the ACC Argentina Chapter leaders Ana Maria Salvati, MD, FACC, Past Governor; Alberto Juan Lorenzatti, MD, FACC, Past Governor and member of the Assembly of International Governors Steering Committee; and José Luis Navarro Estrada, MD, FACC, Immediate Past Governor. The program has not only resumed scholarly exchange by sending representative speakers to in-person scientific meetings but has also successfully expanded to the digital domain.

Julio A. Panza, MD, FACC, director of the Department of Cardiology at Westchester Medical Center in New York, has been chairing the program since its inception. Having completed his medical school and early cardiology training in Argentina, he places great value in the program's educational as well as cultural enrichment of trainees in both countries. Panza recently moderated a case-based webinar organized by the chapter partnership, titled "A Tale of Two Chapters," which was attended by nearly 100 participants from both chapters. It featured trainees presenting cases from their respective regions; highlighting the similarity and differences in the management of cardiogenic shock and acute coronary syndrome, followed by a robust conversation between a panel of eminent faculty from both countries discussing nuances of care within the resources available.

In 2021, the two chapters signed a memorandum of understanding setting up an observership program for Argentine cardiology residents to rotate in sub-specialties of their interest across teaching sites in New York. The program currently invites applications from Argentine cardiology residents in their last year of clinical training and selects two trainees a year to rotate in participating hospitals in New York State for one to two months. The ACC New York Chapter provides the selected trainee with a $2,500 USD scholarship to help offset the cost of living during the rotations, while the ACC Argentina Chapter sponsors their travel arrangements. At present, participating cardiovascular programs in New York include Westchester Medical Center, North Shore University Hospital, Lenox Hill Hospital and Montefiore Medical Center.

Pilar Domenech, MD, who rotated at Westchester Medical Center in the fall of 2023, structured her observership to include cardiac intensive care, advanced imaging and heart failure services, and called her experience "truly enriching." While this was her first time observing the use of durable ventricular assist devices, currently not available in Argentina, it was the innovative repurposing of treatments like axillary insertion of intra-aortic balloon pump, a therapy widely utilized at her institution through femoral access, that she found the most fascinating. She saw it as an easy adaptation in her future practice to increase patient comfort and mobilization while waiting for heart transplant. She also appreciated the use of multimodality imaging in supplementing, and in some cases replacing, invasive diagnostics. She now wishes to pursue advanced imaging as a sub-specialty after completing her training.

The program is completing its second year in 2024; its fourth visiting trainee set began rotating in March at Montefiore Medical Center in New York. Over a short period of time, this reciprocal relationship has achieved its goal of exchanging ideas and experiences to advance cardiovascular education across national borders. The program aims to expand in the coming years with more frequent webinars and digital education initiatives. International exchanges and collaboration serve as an opportunity for education, cultural enrichment and innovation. The program also contributes to the education of the next generation of cardiovascular physicians with the aim of bridging the gap in cardiovascular care across the world.

References

1. World Health Organization's statement on cardiovascular diseases. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Accessed on December 30, 2023.
2. A. Allen Seals. ACC International Outreach and the Global Cardiovascular Community. Journal of the American College of Cardiology, 2016; 67: 3011-3013. https://doi.org/10.1016/j.jacc.2016.05.007.