Dr. Kim Eagle, editor-in-chief of ACC.org, discusses the biggest advances and shortcomings of the past year, and looks ahead to the challenges that await in 2016.
Q: Where did health care make the biggest advancements in the past year?
The Systolic Pressure Interventional Trial (SPRINT), which was just reported in November, will have a potentially tremendous impact on practice and on health care in the US. Trial results suggest tighter blood pressure control for up to 20% of U.S. citizens could potentially reduce cardiovascular events by 33% and death by 25%. Even though it was a single trial, it included almost 10,000 patients. Because hypertension is such a driver for health risks, this is a very meaningful trial.
Second, we are still gaining information on the use of percutaneous aortic valve replacement. The procedure is continuing to gain market share in the US and this past year we saw further evidence building on the PARTNER trial showing more favorable and durable long-term outcomes for adults undergoing percutaneous valve replacement than open aortic valve surgery.
Something that is still developing is where we will land in terms of the use of PCSK9 inhibitors for the treatment for hyperlipidemia. This year, a study of approximately 5,000 suggested a reduction in the risk of cardiovascular events by as much as 50% in patients with very severe hyperlipidemia. With so many statin intolerant patients out there, this class of agents could fill a real need. However, safety is something that we are watching very closely, and costs will be a big challenge. Nevertheless, these drugs have the potential to be revolutionary for statin intolerant patients.
Q: What do you think the biggest shortcoming was in 2015?
Probably the biggest challenge in American medicine lies in the fact that we don’t have an organized system of health care – each state has its own landscape in terms of insurers and how it is participating in the Affordable Care Act. The nation has continued to struggle in terms of whether it wants a health care system for all and if so, if it will be national or state by state. At the same time, we don’t want to continue spending as much on health care. There is frustration from everyone – legislators, providers and other stakeholders – around how to reduce costs. Medicare is taking the lead in reimbursing based on the value of care performed rather than on encounters. This is something that will continue to be a challenge, but a very important endeavor for us to be involved in.
Q: What health care trend are you most excited about for the coming year?
As an optimist, I am ambitious about seeing insurance reform and for the nation to achieve a health care system that is focused on prevention rather than simply treatment of disease. I think we can reform our systems, whether regionally or nationally, and can find ways of providing better care than we are.
Q: What do you see as the biggest challenge for CV professionals in 2016?
There is an increased complexity with documentation and electronic health records. We just introduced the new ICD-10 coding system for patients hospitalized and in clinics and we have growing challenges with documenting performance. On top of this, there is a large increase in the elderly patient population at a time when we are not producing more doctors. Cardiologists are finding themselves having to organize in teams with other professionals to find ways to provide good care for an ever growing number of elderly Americans. In cardiology, we are challenged with a maldistribution, if not a shortage, of physicians and nurses. This collision of complexities amid resource challenges carries a lot of stressors and obstacles to providing good patient care.