Report from the Chair of the Board of Governors

October 23, 2009

DE TESTIMONIO

 “Healthcare information, or evidence, varies in its source, quality, and usefulness. Information derived from research may be experimental, from randomized controlled trials, or observational. Information may be derived from groups of people, possibly in planned research programs, or it may come from one or more individuals. Information may come from one source, perhaps a single trial, or it may come from many different sources, as is the case with expert opinion and meta-analyses. All of these differing types of information have their limitations and their strengths. Crucially, they all require careful interpretation and contextualization if they are to be used appropriately.” -- Professor Sir Michael David Ralwins, UK, on the evidence for decisions about the use of therapeutic interventions.

ACC’s 2009 Medical Directors’ Institute Focuses on Comparative Effectiveness

The ACC held a successful Medical Directors' Institute this week that brought together ACC  leaders and health plan representatives for thoughtful discussions around comparative effectiveness. Attendees heard from a number of key thought leaders on the real world implications of comparative effectiveness research based on models from the United Kingdom and Canada as well as its effect on cardiovascular care. Among the speakers and panelists: Michael McGinnis of the Institute of Medicine, Myrl Weinberg of the National Health Council, Peter Littlejohns from the National Institute for Health and Clinical Excellence (NICE - UK),  and Carolyn Clancy of the Agency for Healthcare Research and Quality. Participants also heard from ACC leaders on College-wide quality improvement initiatives like the IC3 Program and FOCUS, the College's newest effort to encourage the use of appropriate use criteria at the point of care. Participants came away with an understanding of ways the cardiovascular community can play a role in the comparative effectiveness arena, particularly around ways we can work together to influence the U.S. process and implement the outcomes.

Dr. Paul Casale and Dr. William Lewis co-chaired the 2009 MDI. Kudo’s to Paul, Bill, Henry McCants and the entire MDI team for creating a comprehensive world-class meeting on systematic effectiveness in the delivery of quality health care.

International Insights on CER

NICE is an independent organization responsible for providing national guidance in the UK on the promotion of good health and the prevention and treatment of ill health. NICE guidance is developed using the expertise of the National Health Service and the wider health care community including NHS staff, healthcare professionals, patients, industry and the academic world. NICE facilitates the creation of independent expert groups to review the evidence and make recommendations on the basis of best evidence. NICE produces guidance in three areas of health for UK citizens:

•  Public health - guidance on the promotion of good health and the prevention of ill health for those working in the National Health Service (NHS), local UK authorities and the wider public and voluntary sector.

• Health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS.
• Clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

 The Canadian Agency for Drugs and Technologies in Health (CADTH) is an independent, not-for-profit agency funded by Canadian federal, provincial, and territorial governments to provide credible, impartial advice and evidence-based information about the effectiveness of drugs and other health technologies to Canadian health care decision makers. CADTH programs include:

• Assessing drugs and health technologies: Health Technology Assessments (HTA).
• Conducting drug reviews and providing formulary listings recommendations: Common Drug Review (CDR).
•  Identifying and promoting optimal drug therapy: Canadian Optimal Medication Prescribing and Utilization Service (COMPUS).

Both agencies use effectiveness and cost-effectiveness to make drug coverage decisions and to look at new and evolving cardiovascular technologies. They review the quality and strength of the experimental evidence in support of a clinically meaningful effect. Comparative effectiveness and cost-effectiveness is increasingly being used across the world along with other relevant factors by national agencies to support drug decision making for national formulary coverage.

CA Chapter Meeting Highlights International Systems

 The recently concluded annual meeting of the ACC California Chapter also included a session comparing health systems in the United States and Great Britain. Professor Roger Boyle, National Director for Heart Disease for England’s Department of Health, discussed the processes involved in delivery of a quality health service under the country’s single-payer system. Dr. Steve Nissen, chair of Cardiovascular medicine at the Cleveland Clinic, discussed his experiences treating patients in the U.S. private insurance system. These discussions were followed by a roundtable that was presided over by CNN television host Larry King. The subsequent discussions highlighted the role of comparative effectiveness including outlining the advantages and limitations of a centralized national capacity. The panel addressed what can be adopted from other countries and what will not work here? The question of how do other countries handle the issues of innovation and research and development when government-dictated price controls are in place was also highlighted.

In Summary …

Thomas Friedman writes in “The World Is Flat A Brief History of the Twenty-first Century” that the “flattening” of the world happened at the dawn of the twenty-first century; what it means to countries, companies, communities, and individuals; and how governments and societies can, and must, adapt. The theme of MDI 2009 “Optimal Systems, Optimal Care Partnerships for Transformation: Systematic Effectiveness” highlighted how comparative effectiveness research has the potential to provide us unique insights into this new paradigm and how increased collaboration may allow us to learn from each other and collectively benefit patients around the globe. This years MDI provided a unique international prism as we pursue efforts in health care reform.

 JOHN GORDON HAROLD, MD, FACC

 All we know is still infinitely less than all that remains unknown.

William Harvey (1578-1657)