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AHA's 7th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, May 7-9, 2006

American Heart Association's 7th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke

The American Heart Association's 7th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke took place May 7-9 in Washington, D.C., and covered a wide variety of quality-of-care and clinical-practice issues.

"There was much discussion of the so-called 'iron triangle' in health care, the relationship between access, cost and quality, and the difficulties in providing universal access to high-quality care at low cost," said David Goff, M.D., of Wake Forest University in Winston-Salem, N.C., an AHA spokesman and a member of the forum's program committee. "The cost part of the triangle is driven largely by technological advances and over-delivery of supply-sensitive services. So we're now able to provide highly sophisticated care to the sickest people but are failing to deliver simple care to the larger population. We need to figure out how to drive down supply-sensitive care so we free up resources for effective care. That may mean creating a system distinct from academic health centers that have to some extent become irrelevant to these needs."

Rita Redberg, M.D., of the University of California San Francisco, advocated adding affordability to the "reasonable and necessary" criteria for Medicare coverage. Randall Williams, M.D., of Northwestern University in Chicago, addressed the concept of "disruptive innovation," which is leading some industries to offer products aimed at meeting the simpler, less-expensive needs of their customers, and how it might apply to health care. "The direction we're going in seems unsustainable," Goff said. "We need to apply lean engineering techniques such as have been applied in other segments of our economy, at Toyota, for example, to drive some of the waste out of health care delivery."

Gregg Fonarow, M.D., of the University of California Los Angeles, presented research from a large registry showing that hospitalized heart-failure patients who were started on a beta-blocker had better outcomes, lower mortality rates and fewer re-hospitalizations than those who were not started on a beta-blocker. "This was probably the biggest piece of news," Goff said. "There has been controversy over whether patients hospitalized with acute exacerbation of heart failure should be placed on a beta-blocker while they're in the hospital. The data he showed supports the idea that beta-blockers should be started. Although a large clinical trial with hospitalized patients is needed to confirm these findings, it's clear that if a patient is stable enough prior to discharge to be given a beta-blocker, there seems no reason not to do so."

John Foreyt, Ph.D., of the Baylor College of Medicine in Houston, discussed behavioral intervention in the treatment of obesity. "The good news is that it really works," Goff said. "He showed that people can stop gaining weight simply by reducing their dietary intake by 100 calories a day, which is three bites of a fast-food hamburger or eight ounces of soda, and by adding 20 minutes a day of reasonably brisk walking. These aren't big changes. The bad news is we need to figure out a better way of delivering it. Physicians are probably not the best people to be delivering it because they aren't well trained in behavioral theory and counseling. And they're expensive, so we need to find a more efficient way to deliver this intervention."

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