Cardiovascular Excellence

We are so fortunate for cardiovascular medicine. 

Cardiology professionals have organized the division so well. From cardiovascular surgeons to tomography and imaging professionals to electrocardiogram technicians, the education, certification and professional associations are not only ordered, they are organized to patient needs. The cardiovascular field demonstrates true excellence in organized professionalism. It is encouraging to know that guidelines and recommendations from specific cardiovascular fields continue, and it will be awesome to observe certification standards align across borders. There are over 100,000 publications from 2021-present on Google Scholar and there are over 20,000 on PubMed related to "heart disease". Here are a select few highlights that inspire our future.

Cardiovascular epidemiology is sharp [1]. This is a result of multidisciplinary attention and prioritization of the statistics, quality to epidemiology and dedication of healthcare professionals. Opportunities to secure epidemiological quality across international borders and opportunities to enhance the gaps identified are exciting.

Cardiovascular imaging groups, like the Society of Cardiovascular Computed Tomography, continue to develop guidelines[2]-[4]. Opportunities to develop the profession across the world, and opportunities to align standards across the world, remain with competent hands. 

Cardiovascular publications remain professional, and they update evidence-based work [5]. How the specialty creates an international gameplan around research gaps, research priorities [6], strategies for limitation avoidance, and funding strategies tied to quality of trial design will be exciting to see. With over 20,000 PubMed results and over 100,000 Google Scholar results from 2021-present, there are many professionals to entrust aligned research organization,

Tools for heart disease prediction continue to be created and assessed, and this work enhances the professionalism of the division [7].

Healthcare delivery continues to assess and improve, including with potential unnecessary electrocardiogram use [8]. Better patient care, efficient delivery and cost reduction strategies are valued, and it is good to know these are priorities for the cardiovascular field.

Cardiovascular professionals anticipate trends, such as the effects of aging [9]. Anticipation helps healthcare delivery and coverage payers prepare for disease increases, including for endocarditis. Planning and preparedness, for high, middle and low income countries, benefits the public.

Cardiovascular specialists have detailed disease differences in low and middle income countries (LMIC). If rheumatic heart disease is primarily encountered in middle-income and low-income countries, with indigenous groups of high income countries also primarily affected [9], targeted assistance to LMIC and the groups can be applied. Additionally, work can be organized through an international gameplan that aligns with international guidelines [10], and the work progress can be tracked.

 

Strategic plans from public health partners continue, particularly as lifestyle modifications can be game changers for heart disease. The WHO mention of “access to noncommunicable disease medicines and basic health technologies” for better cardiovascular care is crucial. Cessation of tobacco use, reduction of salt in the diet, eating more fruit and vegetables, regular physical activity and avoiding harmful use of alcohol [11] is also important. As the CDC [12] and international peers align with WHO, opportunities such as labor recommendations, professional standards, and evaluation of hospital response in rural areas will present. Opportunities to include first response assurance for countries, including basic life support (BLS/CPR), AED basics and paramedic first response in LMIC, would also be exciting additions. Enhancing pharmaceutical oversight could be considered. Additionally, accounting for heart disease not modifiable by lifestyle changes by identifying country measures for healthcare delivery will present incredible potential. Updates to the 2014 CDC strategic plan will be compelling.

Cardiovascular research traditions, such as the use of dogs in atrial fibrillation research, have identified gaps between animal models and human application [13]. Researchers are not shy when publishing limitations. Changes and reduction to animal model use, including through innovative model development [14] and mapping strategies [15], are truly awesome. And, this inspires hope.

[1] C. W. Tsao et al., “Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association,” Circulation, vol. 145, no. 8, pp. e153–e639, Feb. 2022.

[2] Writing Group et al., “The role of cardiovascular CT in occupational health assessment for coronary heart disease: An expert consensus document from the Society of Cardiovascular Computed Tomography (SCCT),” J. Cardiovasc. Comput. Tomogr., vol. 15, no. 4, pp. 290–303, Jul. 2021.

[3] S. S. Pickard et al., “Abstract 10063: Implementation of Appropriate Use Criteria for Cardiac Computed Tomography and Magnetic Resonance Imaging in the Follow-Up Care of Patients with Conotruncal Congenital Heart Disease,” Circulation, vol. 144, no. Suppl_1, pp. A10063–A10063, Nov. 2021.

[4] Caruso and Farruggio, “Impact of computerized tomography scan and three-dimensional printing model for surgical procedure in complex congenital heart disease,” J. At. Mol. Phys., [Online]. Available: https://www.researchgate.net/profile/Elio-Caruso-2/publication/350166748_Impact_of_computerized_tomography_scan_and_three-dimensional_printing_model_for_surgical_procedure_in_complex_congenital_heart_disease/links/60625311299bf1736779402a/Impact-of-computerized-tomography-scan-and-three-dimensional-printing-model-for-surgical-procedure-in-complex-congenital-heart-disease.pdf

[5] G. Dibben et al., “Exercise-based cardiac rehabilitation for coronary heart disease,” Cochrane Database Syst. Rev., vol. 11, p. CD001800, Nov. 2021.

[6] H. Korpela et al., “Gene therapy for ischaemic heart disease and heart failure,” J. Intern. Med., vol. 290, no. 3, pp. 567–582, Sep. 2021.

[7] M. Diwakar, A. Tripathi, K. Joshi, M. Memoria, P. Singh, and N. Kumar, “Latest trends on heart disease prediction using machine learning and image fusion,” Mater. Today, vol. 37, pp. 3213–3218, 2021.

[8] B. Appold et al., “Reining in Unnecessary Admission EKGs: A Successful Interdepartmental High-Value Care Initiative,” Cureus, vol. 13, no. 9, p. e18351, Sep. 2021

[9] S. Coffey et al., “Global epidemiology of valvular heart disease,” Nat. Rev. Cardiol., vol. 18, no. 12, pp. 853–864, Jun. 2021.

[10] A. P. Ralph, S. Noonan, V. Wade, and B. J. Currie, “The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease,” Med. J. Aust., vol. 214, no. 5, pp. 220–227, Mar. 2021.

[11] “Cardiovascular Diseases,” World Health Organisation, 2022. https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1

[12] Centers for Disease Control and Prevention, “DHDSP Strategic Plan.” Mar. 14, 2014. [Online]. Available: https://www.cdc.gov/dhdsp/strategic_plan.htm

[13] M. E. Czick, C. L. Shapter, and D. I. Silverman, “Atrial Fibrillation: The Science behind Its Defiance,” Aging Dis., vol. 7, no. 5, pp. 635–656, Oct. 2016.

[14] Y. R. Lewis-Israeli et al., “Self-assembling human heart organoids for the modeling of cardiac development and congenital heart disease,” Nat. Commun., vol. 12, no. 1, pp. 1–16, Aug. 2021.

[15] D. H. Lau, D. Linz, and P. Sanders, “New Findings in Atrial Fibrillation Mechanisms,” Card. Electrophysiol. Clin., vol. 11, no. 4, pp. 563–571, Dec. 2019.