The Indiana-ACC recently held its annual Legislative Day on February 22nd in Indianapolis, advocating for cardiology issues that impact both clinicians and patients across the state. We joined with both Tobacco-Free Indiana and the Indiana Department of Health Public Health Day. Additionally, our group had a photo opportunity in the House Chamber to showcase House Resolution 4, sponsored by State Representative Victoria Garcia Wilburn, designating February 2024 as American Heart Month and to raise awareness about cardiovascular disease and the importance of knowing one's cholesterol. See more photos here.

Among the key issues addressed during the Legislative Day were prior authorization and Senate Bill 10. Members of the Indiana-ACC provided insights, enabling legislators to make informed decisions that prioritize the well-being of patients and the efficient delivery of high-quality care.

By building strong relationships with state lawmakers, the Indiana-ACC continues to play a pivotal role in shaping policies and regulations that affect the cardiovascular community. This proactive approach ensures that the voices of our members and patients are heard.

Prior authorization continues to delay patient care and treatment, impact outcomes, and drive up health care costs for all Hoosiers. Physician offices advocate for their patients but are forced to waste valuable time and resources on these burdens.

Your stories about how prior authorization impacts patients are a powerful way to help put Patients Over Prior Auth.

Please participate in ISMA’s newest advocacy initiative by sending your latest example(s) of payors inappropriately putting prior auth over patients.

A plenary session at the Cardiovascular Summit featured an update and overview of the College’s work in collaboration with AHA, HFSA, HRS, and SCAI to create a new Board of Cardiovascular Medicine. The application review process is underway with the American Board of Medical Specialties and more details on the ways members can support this effort should be available in the coming weeks and months. In the meantime, an updated FAQ has been posted to a revamped CVBoard.org (http://cvboard.org/) site. Additionally, the site includes a direct link to the joint society webinar describing the process and answering some of the biggest questions about the new Board as well as an overview video.

If Gwen Goldfarb, our chapter executive, or I can be of assistance to you, please let us know.

The Indiana-ACC is delighted to bring you a series of brief, accessible & impactful videos to provide you with knowledge beyond traditional clinical content. Take a look at the two videos below, and let us know what you think.

Host: Amit Patel, MD, FACC

Guests: Rohan Dharmakumar, PhD & Andreas Kumar, MD, MSc

Panelists: Ankur Kalra, MD, FACP, FACC, FSCAI & Edward Fry, MD, MACC

Host: Amit Patel, MD, FACC

Panelists: Ryan Daly, MD, FACC and Mary Norine Walsh, MD, FACC

Patients diagnosed with heart failure with reduced ejection fraction (HFrEF) [LVEF ≤ 40%] are at significant morbidity and mortality risk compared to the general population. Those diagnosed with heart failure have a 5-year mortality of approximately 40-50% compared to the general population at 15%. Those with advanced heart failure have an even worse prognosis with a 1-year mortality of 80-90%. In the United States, the annual direct cost of heart failure is estimated at over $30 billion, which is driven primarily by over 1 million heart failure related hospitalizations (1,2).

While guideline-directed medical therapy (GDMT) has been proven to reduce morbidity and mortality, many eligible patients with HFrEF are not receiving one or more of the recommended therapies, which is often due to clinical inertia in the outpatient setting. The latest AHA/ACC/HFSA guidelines strongly recommend quadruple therapy consisting of four pillars of GDMT management: beta-blockers (BB), renin-angiotensin-aldosterone system inhibitors (ACEi/ARB, ARNI preferred), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT2i) (3). Initiation of these four pillars have demonstrated an overwhelming benefit, preventing one death for every four patients treated over 2 years (4). The inpatient setting provides the opportunity to have a multidisciplinary approach to ensure patients can tolerate and adhere to GDMT in order to achieve the full benefits.

Clinical inertia is defined as the lack of treatment intensification in a patient not on evidence-based goals of care (5). During hospitalization, the patient’s acute issue is typically the primary focus while more chronic condition management is deferred to a patient’s outpatient provider. However, when it comes to initiation and titration of GDMT, it can be more difficult to start or adjust these agents based on a single vital sign or lab draw. The inpatient setting provides the opportunity for multidisciplinary teams to closely monitor heart rate, blood pressure, renal function, and electrolytes in order to ensure tolerability. In addition, any affordability or insurance coverage barriers can be addressed during the hospitalization.

Data continues to be published demonstrating that simultaneous or rapid sequence initiation of quadruple medical therapy for heart failure confers early benefits for patients within 30-60 days of initiation. Greene SJ, et al demonstrated an early relative risk reduction between 25% and 58% for each pillar of GDMT for outcomes including cardiovascular death, heart failure hospitalization, worsening heart failure, and all-cause death. These authors concluded that quadruple therapy may reduce the risk of death by 73% over 2 years (6).

So why initiate GDMT in the inpatient setting? Patients who are started on GDMT in the inpatient setting are more likely to be treated, to tolerate each agent, fill their prescription and adhere to therapy long term, and are more likely to feel better, stay out of the hospital, and live longer.

1)    Dixit NM, et al. Optimizing Guideline-directed Medical Therapies for Heart Failure with Reduced Ejection Fraction During Hospitalization. US Cardiology Review 2021; 15:e07.

2)    Jones NR, et al. Prognosis following a diagnosis of heart failure and the role of primary care: a review of ther literature. BJGP Open 2017; 1(3):bjpopen17X101013.

3)    Heidenreich PA, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022;79:e263-e421.

4)    Bassi NS, et al. Association of optimal implementation of sodium-glucose cotransporter 2 inhibitor therapy with outcome for patients with heart failure. JAMA Cardiol 2020;5:948–51.

5)    Verhestraeten C, et al. Clinical inertia in the treatment of heart failure: a major issue to tackle. Heart Fail Rev 2021; 26(6): 1359-1370.

6)    Greene SJ, et a. Simultaneous or Rapid Sequence Initiation of Quadruple Medical Therapy for Heart Failure - Optimizing Therapy With the Need for Speed. JAMA Cardiol. 2021;6(7):743-744.

Be on the lookout for the AMA’s Relative Value Scale Update Committee (RUC) Surveys on PCI and left atrial appendage (LAA) closure services. You could be randomly selected to complete the survey, in which case participants will be asked to estimate the typical time, intensity, and complexity of their work and the Relative Value Unit (RVU) for the procedure in comparison to a list of reference services with established RVUs. Feedback from these surveys are used to create AMA recommendations to the Centers for Medicare and Medicaid Services. This cycle, the PCI family of codes is being surveyed, following the recent addition of intravascular lithotripsy as well as the existing code for percutaneous transcatheter closure of the LAA.

You can learn more about the RUC process here and contact Matthew Minnella with any questions.

Salaries of cardiovascular advanced practice providers (APPs) increased 13% between 2018 and 2022, based on the 2023 Cardiovascular APP Compensation and Utilization Report released by MedAxiom. The report also finds that the APP per physician ratio is steadily climbing year-over-year, with big increases in cardiac surgery. Access more findings from the report, along with reminders for 2024 code changes and the paused CMS’ Appropriate Use Criteria program in the latest issue of Cardiology magazine. Read the full issue.

The ACC has officially launched the new CV ASC Registry Suite – the first unified registry for cardiac procedures performed in ambulatory surgery centers (ASCs) and office-based labs. With the expansion of ASCs performing select cardiac procedures on eligible patients throughout the U.S., the newest NCDR registry is the first of its kind to easily fit into the patient care workflow and provide these centers with data-driven insights for measuring care delivery and outcomes. The CV ASC Registry Suite leverages the existing NCDR CathPCI Registry and EP Device Implant Registry platforms and metrics to offer big-picture reviews, at-a-glance assessments and patient-level drilldowns on procedures such as diagnostic cardiac catheterization, PCI, and defibrillator and pacemaker implants. Learn more.

 Enhanced dashboards for NCDR’s hospital registries will continue to roll out beta version updates throughout this Spring as part of the College’s Digital Transformation and NCDR Optimization Plan investments. The new dashboards will provide more robust visualizations and a faster, more dynamic data customer experience to support hospitals, health systems and their clinical care teams in their commitment to optimize cardiovascular patient care and outcomes. Prepare for the new dashboards and learn more about the increased opportunities to provide actionable insights here. An “Introduction to NCDR’s New Dashboards” course is also available in the QII Learning Center, which is open to current NCDR and ACC Accreditation Services participants.

With more than 6 million Americans with heart failure, patient education is key in managing and living with this condition. To help patients better understand and manage heart failure, ACC’s CardioSmart team has developed a package of tools and resources including a new Action Plan for Heart Failure With Preserved Ejection Fraction (HFpEF). The package also includes infographics, decision aids, and updated tools teaching patients how to make the most of their follow-up visits, use checklists, daily trackers, and more. Download the tools for free.

CardioSmart is the ACC’s dedicated home for patient tools and resources, including infographics, shared decision-making aids, and more. Find information on specific clinical conditions, health lifestyle choices and more at CardioSmart.org.