Sports Cardiology: Core Curriculum for Providing Cardiovascular Care to Competitive Athletes and Highly Active People.

The last few decades have seen substantial growth in the populations of competitive athletes and highly active people (CAHAP). Although vigorous physical exercise is an effective way to reduce the risk of cardiovascular (CV) disease, CAHAP remain susceptible to inherited and acquired CV disease, and may be most at risk for adverse CV outcomes during intense physical activity. Traditionally, multidisciplinary teams comprising athletic trainers, physical therapists, primary care sports medicine physicians, and orthopedic surgeons have provided clinical care for CAHAP. However, there is increasing recognition that a care team including qualified CV specialists optimizes care delivery for CAHAP. In recognition of the increasing demand for CV specialists competent in the care of CAHAP, the American College of Cardiology has recently established a Sports and Exercise Council. An important primary objective of this council is to define the essential skills necessary to practice effective sports cardiology.

2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers.

The mission of the American College of Cardiology is "to transform cardiovascular care and improve heart health." Cardiovascular team-based care is a paradigm for practice that can transform care, improve heart health, and help meet the demands of the future. One strategic goal of the College is to help members successfully transition their clinical practices to the future, with all its complexity, challenges, and opportunities. The ACC's strategic plan is aligned with the triple aim of improved care, improved population health, and lower costs per capita. The traditional understanding of quality, access, and cost is that you cannot improve one component without diminishing the others. With cardiovascular team-based care, it is possible to achieve the triple aim of improving quality, access, and cost simultaneously to also improve cardiovascular health. Striving to serve the best interests of patients is the true north of our guiding principles. Cardiovascular team-based care is a model that can improve care coordination and communication and allow each team member to focus more on the quality of care. In addition, the cardiovascular team-based care model increases access to cardiovascular care and allows expansion of services to populations and geographic areas that are currently underserved. This document will increase awareness of the important components of cardiovascular team-based care and create an opportunity for more discussion about the most creative and effective means of implementing it. We hope that this document will stimulate further discussions and activities within the ACC and beyond about team-based care. We have identified areas that need improvement, specifically in APP education and state regulation. The document encourages the exploration of collaborative care models that should enable team members to optimize their education, training, experience, and talent. Improved team leadership, coordination, collaboration, engagement, and efficiency will enable the delivery of higher-value care to the betterment of our patients and society.

Comparative outcomes of catheter-directed thrombolysis plus anticoagulation vs anticoagulation alone to treat lower-extremity proximal deep vein thrombosis.

IMPORTANCE: The role of catheter-directed thrombolysis (CDT) in the treatment of acute proximal deep vein thrombosis (DVT) is controversial, and the nationwide safety outcomes are unknown. OBJECTIVES: The primary objective was to compare in-hospital outcomes of CDT plus anticoagulation with those of anticoagulation alone. The secondary objective was to evaluate the temporal trends in the utilization and outcomes of CDT in the treatment of proximal DVT. DESIGN, SETTING, AND PARTICIPANTS: Observational study of patients with a principal discharge diagnosis of proximal or caval DVT from 2005 to 2010 in the Nationwide Inpatient Sample (NIS) database. We compared patients treated with CDT plus anticoagulation with the patients treated with anticoagulation alone. We used propensity scores to construct 2 matched groups of 3594 patients in each group for comparative outcomes analysis. MAIN OUTCOMES AND MEASURES: The primary study outcome was in-hospital mortality. The secondary outcomes included bleeding complications, length of stay, and hospital charges. RESULTS: Among a total of 90,618 patients hospitalized for DVT (national estimate of 449,200 hospitalizations), 3649 (4.1%) underwent CDT. The CDT utilization rates increased from 2.3% in 2005 to 5.9% in 2010. Based on the propensity-matched comparison, the in-hospital mortality was not significantly different between the CDT and the anticoagulation groups (1.2% vs 0.9%) (OR, 1.40 [95% CI, 0.88-2.25]) (P = .15). The rates of blood transfusion (11.1% vs 6.5%) (OR, 1.85 [95% CI, 1.57-2.20]) (P < .001), pulmonary embolism (17.9% vs 11.4%) (OR, 1.69 [95% CI, 1.49-1.94]) (P < .001), intracranial hemorrhage (0.9% vs 0.3%) (OR, 2.72 [95% CI, 1.40-5.30]) (P = .03), and vena cava filter placement (34.8% vs 15.6%) (OR, 2.89 [95% CI, 2.58-3.23]) (P < .001) were significantly higher in the CDT group. The CDT group had longer mean (SD) length of stay (7.2 [5.8] vs 5.0 [4.7] days) (OR, 2.27 [95% CI, 1.49-1.94]) (P < .001) and higher hospital charges ($85,094 [$69,121] vs $28,164 [$42,067]) (P < .001) compared with the anticoagulation group. CONCLUSIONS AND RELEVANCE: In this study, we did not find any difference in the mortality between the CDT and the anticoagulation groups, but evidence of higher adverse events was noted in the CDT group. In the context of this observational data and continued improvements in technology, a randomized trial with outcomes such as mortality and postthrombotic syndrome is needed to definitively address this comparative effectiveness.

Web-based Internet telemedicine management of patients with heart failure.

An Internet-based store-and-retrieval telemedicine system to communicate between patients and their healthcare provider was tested. The system requires no specialized equipment, is Web-based, and allows frequent surveillance of the health status of the patients with heart failure (HF). Thirty six patients were recruited to evaluate a Web-based telemedicine system for reducing care encounters. Eighteen patients were randomized to the telemedicine arm (group T), and 18 were given usual clinical care (group C) in our HF center. Patients in group T reported three times weekly via a secure Internet site for telemedicine intervention. We studied patients with HF with New York Heart Association (NYHA) class 2 to 4 with hospitalization within past 6 months. Mean age was 56.1 +/- 12.6 years (66.7% male; 66.7% Caucasian, 27.8% African American, and 5.6% Hispanic). Mean ejection fraction (EF) was 23.9% +/- 17.6% in group T and 26.6% +/- 16.4% in group C. Over an 8-month period, unscheduled (group T-3; group C-5), and scheduled clinic visits (group T-11, group C-7) were similar (p = NS); one group T patient was transplanted, one group C patient died. Total hospital days were lower with group T (44 days) compared to group C (133 days), p < 0.05. An Internet-based telemedicine system was able to closely monitor patients with HF. Surveillance through Internet-based telemedicine resulted in less hospitalization compared to control patients. This system may be helpful in reducing the cost of HF patient care.

Management of heart failure patients using telemedicine communication systems.

Heart failure (HF) continues to place significant demands on health care resources because of the large number of hospital admissions for HF, the growth of the elderly population with HF, and the improved survival of patients with chronic heart disease who develop HF that requires continuous care. Because HF is best managed using a disease management approach, frequent communication is an important component of care. A variety of studies using the telephone to maintain communication have demonstrated reduced hospital admissions and improved morbidity rate. Hardware monitoring systems that can record vital signs and transmit information from the home to a data center have also demonstrated their value in HF care, but such systems become expensive when considered for large populations of HF patients. Most HF patients can transmit their vital signs, weight, and symptoms to a practice data center using the Internet with no specialized hardware other than a sphygmomanometer and a scale. We have used such a system to monitor HF patients and have provided care instructions using the same system. With use of an Internet communication system, it is possible to reduce hospitalizations and maintain a stable HF status without frequent office visits.