ACCPR 2014 met and exceeded all expectations we set for an event that has become over the years one of the biggest “Points of Pride” of our Chapter. We are pleased to give provide our membership and attendees a summary of some of the meeting highlights.
The planning phase of this event began early in 2013, at which time we chose to incorporate several innovations:
The program began 5 minutes early on Friday 7th with Dr. Roberto Lang from the University of Chicago, who conducted a comprehensive review of contemporary technology to better assess LV systolic function and how to choose the most appropriate measurement tool according to the indication. He described the utility of speckle tracking and strain imaging, especially in the field of cardio-oncology. Dr. Michael Valentine, Treasurer of the ACC, followed with a lively case-based discussion on the latest evidence that should guide decision-making in ACS, including the paradigm shift in the risk-benefit of blood transfusions. He concluded by staging a “middle of the night phone call” to Guidelines author Dr. Patrick O’Gara who was in the audience. A former Board of Governor’s Chairperson and current member of the Board of Trustees, Dr. Dipti Itchhaporia, delivered a worldwide view of CAD and how to impact CV from a public health standpoint. The first tack called “Cardiology Medley” concluded with none other than ACC President-Elect Dr. Patrick O’Gara who lectured in his masterful style on the many aspects of managing hypertension from how to and how low to treat blood pressure to the latest on renal denervation.
On the second “Non-Invasive Track”, fellows-in-training Drs. Mariam Cuoto and Dr. Julio Valentín offered thorough and visually impactful case presentations on acute myocarditis and pnemococcal endocarditis triad for the delight of the audience, which already packed the room. Next we welcomed the Mayo Clinic Echo Lab Director Dr. Patricia Pellikka, who reviewed new echo technologies that included the power of 3D echo to measure LV systolic function and avoid the pitfalls of “geometric assumptions”, the role of TEE-guidance of interventional procedures, using strain imaging and speckle tracking after chemotherapy, and deformation imaging to distinguish HOCM from athlete’s heart. Dr. Lang returned for a detailed review of the echo evaluation of mitral disease with a focus on 3D echo, and Dr. Pellika wrapped up the session with a fascinating review how to diagnose over 8 systemic diseases in the echo lab.
The afternoon tracks on Friday were devoted to Heart Failure. Dr. Itchhaporia gave an overview of strategies to reduce HF readmissions including ACCs Hospital 2 Home program, and how prompt evaluation within a week of discharge is key. Dr. Brian Bruckner from the Methodist DeBakey Heart Center in Houston took us into the advanced world of left ventricular support as a bridge to transplant or “destination therapy”, which raised interest from the audience on how to develop such a program in Puerto Rico. New therapies in heart failure was the topic of Dr. Itchhaporia’s third lecture of the day with an overview of the role of new drugs to the utility of underused old therapies such as hydralazine/nitrates and digoxin (much to the delight of some of our master attendees). Dr. Howard Walpole, member of the ACC Board of Trustees, took us back to the future with a review of the landsape of stent cell therapy and its potential in the not so distant future.
The afternoon went on with ACC’s CardioSmart delegates Arim Karimian and Cherie Black giving us a review of the powertools of CardioSmart to help educate patients and improve health. Next we entered our Invasive/Interventional Track welcoming Dr. Kalon Ho from Harvard’s Beth Israel Deaconess Hospital and creator of the SCAI Quality Improvement Toolkit Application, who updated us on the variety decision and QI tools available to any at our sister Society for Cardiac Angiography and Interventions website. Next, we led an interactive case-based presentation with the help of a distinguished panel of 4 interventionalists, which illustrated in an entertaining way, the complexity of some of the treatment decisions in interventional cardiology. Dr. Ho returned to the podium with an enlightening overview on why and how to choose a drug-eluting vs. a bare metal stent, a management decision that is relevant to all clinicians. Following the ACC Annual Business Meeting led by Dr. Jorge Martinez, chapter secretary/treasurer, and Dr. Orlando Rodríguez Vilá, we closed the day with “Cocktails at the Exhibits” and the welcome reception dinner al fresco.
The long-awaited PR Summit-Practice Solutions in a Time of Change, started early on Saturday. Both attendees and speakers were equally excited about the program. Dr. Walpole opened the session with a provocative keynote speech on the 5 most important trends in cardiovascular healthcare delivery, healthcare reform and “Why We Must Change”. Ms. Cathleen Biga offered a “rude-awakening” to the upcoming and ongoing transformation of care from fee for service to value-based. RVU, AUC, PQRS, and Meaningful Use were a few of the concepts covered. With an “off the podium” approach, Dr. Valentine got “up close and personal” with the audience as he offered insights into how to survive as a solo or small practice. The use of NPs and PAs, seeking new revenues sources, improving workflow efficiency, and exploring integration models were some of the items on the list. Part II of the Summit began with Dr. Itchhaporia giving a fantastic overview of the applications of quality data and its essential role in D2B, AUC, TAVR, and anticoagulation standards, finishing up with the fundamentally important National Cardiovascular Data Registry (NCDR) and all of its sub-registries, currently under-represented in Puerto Rico. Dr. Valentine came back to expose the audience to the power of co-management agreements with hospitals and the key concept that neither physicians nor hospital can tackle the challenges ahead by themselves. In closing, Cathleen Biga gave a “shock and awe” bone-chilling presentation on issues of regulatory compliance and how to prepare for audits.
In representation of the National ACC, Dr. Patrick O’Gara, President-Elect, offered his “Presidential Address” to a “standing-room only” audience as he briefed us on the College’s Strategic Plan, on the importance of leadership and on our duty to “be an agent for good, for patients, and for change”.
Saturday afternoon began with concurrent sessions. The track on “EP/Arrythmias” was led by none other than Heart Rhythm Society President Dr. Richard Fogel with lectures on the impact of the Sunshine Act and his thoughts on public access defibrillation. Between his lectures, Dr. Fogel participated with the audience in the ever-challenging ECG “From Basic to Complex”, led by Dr. Juan Carlos Sotomonte, and thereafter known as “From Complex to More Complex!” In the nearby El Caribe room, administrator representatives from Centro Cardiovascular and Pavia, San Pablo, Auxilio, San Lucas, and Damas hospitals joined Ms. Cathleen Biga in the “PR Summit Extended Session”, a detailed and practical discussion of a variety of issues that affect our local cardiovascular healthcare delivery, from compliance, to workflow, to quality data and the NCDR.
Saturday finished up with the “Structural/Pediatrics” track by welcoming Dr. Leo Lopez from New York who reviewed the challenges of 2D vs. 3D echo evaluations of the increasingly more common adult congenital heart disease. Fellows in Training Dr. Edinson Camargo and Dr. Ricardo Perez eloquently presented their cases on recurrent pulmonary embolism and Takotsubo cardiomyopathy. Aortic stenosis from “A to Z” could have been another title for Dr. Pellika’s wonderful review of this condition from the echo perspective, while Dr. Leo Lopez finished the session with a good audience of late-afternoon followers who learned about how to follow up adult patients with Tetralogy of Fallot. Interesting notes on his lecture included the initial description by Stensen and suggesting a “Tetralogy of Stensen”, and the fact that a single anatomical septal shift is responsible for the 4 elements of the anomaly, thus “Monagamy of Fallot”.
The highlight of our Annual Dinner was hosting most past governors and showing the premiere of “ACC Puerto Rico Chapter-The First 25 years”, produced by our chapter and championed in part by Fellows in Training Dr. Helder Hernandez and Dr. Pedro Garcia.
Sunday was “Quality” day, starting with quality measurement and improvement strategies in the echo lab and the cath lab by Drs. Lopez and Ho, respectively, with a heavy emphasis of NCDR. Dr. Walpole provided a reality-check on the essential role of quality data and quoted: “A goal without metrics is not a goal, it’s an illusion”. Dr. Fogel then offered a superb keynote speech on the “disconnect between guidelines, AUC, and payments”, illustrative of the complex interactions between clinicians, professional organizations, and payers. We closed our 25th Scientific Sessions with Dr. Bruckner and a review of LV support in acute heart failure along with practical and ethical implications.
We thank the ACC board and staff, the event organizers, industry sponsors, attendees, and our guest faculty for being an essential part of the remarkable educational, networking, and quality-improvement sessions our ACC Puerto Rico Chapter just hosted. See you all in our 26th Scientific Sessions May 1-2, 2015.
1051 Calle 3 SE Ste. LC10
San Juan, PR 00921-3003
President & Governor
Juan C. Sotomonte, MD, FACC
Héctor Martínez-González, MD, FACC
Jorge L. Martínez-Díaz, MD, FACC
President Scientific Committee
Francisco Lefebre-Llavona, MD, FACC