As reform of the US healthcare system becomes reality and evolves over the next several years, we can expect changes in the ways in which cardiovascular diseases are managed. We enter this period with an impressive record of progress in understanding the molecular basis of atherosclerosis, heart failure, and cardiac arrhythmias and in providing treatments for these conditions. The net effect has been a substantial reduction in cardiovascular mortality over a relatively short period of time. While there is optimism that even greater improvements in outcomes are possible, there are important challenges that must be faced in order for this promise to be fulfilled.
There is a need for better and more widespread utilization of existing proven therapies in the much higher percentage of patients who could be helped by these treatments. Increasing the number of Americans with comprehensive healthcare insurance should go a long way toward accomplishing this goal. A corollary of this is that the cost-effectiveness of new and expensive diagnostic tests and treatments must be a requirement for their initiation into the treatment regimen so that funds allocated to healthcare can be used most wisely. Less cumbersome (and costly) strategies for developing and obtaining approval of novel therapies need to be developed, as the ones currently in place threaten to strangle innovation. Healthcare providers will also need to become more cognizant of and proactive in issues regarding end-of-life care. Most importantly, while there are often conflicting valid opinions about many of the particulars of all of these issues, we risk failing to make progress in critical areas if we conduct their evaluation by anything short of transparent and evidence-based debate. Substituting sloganeering and soundbites for rational discourse will serve only to obscure the real issues.
While the above thoughts pertain equally well to a variety of medical specialties in addition to cardiology, one area of particular urgency for cardiovascular medicine is the prevention of disease. Many of the root causes of the major cardiovascular diseases that affect Americans have been clearly identified, and screening procedures that allow their detection are available. Moreover, there are highly effective and relatively inexpensive treatments that can successfully treat many of these conditions (e.g. hypertension and dyslipidemia) and greatly reduce the risk for future disease. Widespread implementation of cardiovascular risk factor modification within the population must be the highest priority for all stakeholders, including government (national and local), the insurance industry, healthcare systems, individual providers, and patients. The approach should include not only detection and treatment of known risk factors but also encouragement of lifestyle modification, including changes in dietary, smoking, and exercise patterns. If healthcare reform measures proceed without a strong emphasis on preventive measures, it will be a Pyrrhic victory if what we accomplish is only better treatment of diseases that we in fact have the ability to prevent.
This edition of US Cardiology includes a wide range of articles, from cholesterol management and hypertension to cardiac rehabilitation, while highlighting such noteworthy salient topics as implantable cardioverter–defibrillators and discussing frameworks for the implementation of quality initiatives. I hope that you find the content to be both informative and interesting.