AHA president asks peers to consider how the new landscape in cardiology care impacts patients – and how to avoid looming threats

CHICAGO — In the late 1980s, when Dr. Keith Churchwell was training to be a cardiologist, the cardiac unit at the Atlanta hospital where he worked was an open area with beds separated by curtains. Most patients came from nearby because protocols weren't in place to transfer heart patients anywhere else. After training, he followed the typical path by going into private practice.

Now, cardiac units have largely been replaced by heart and vascular centers filled with private rooms and high-tech equipment. These hubs draw patients from far and wide and offer teams of specialists, mostly employed by hospitals and other corporate entities.

Clearly, the then-and-now difference is stark. But is it better?

Churchwell posed this question to his peers Sunday during his Presidential Address at the American Heart Association's Scientific Sessions conference.

As simple as the question seems, the answer is heavily nuanced.

Start with this: Statistics show far fewer patients who get to a hospital are dying of heart attacks.

"From this alone, it seems clear the hospital system model is a significant upgrade," Churchwell said.

However, statistics also show that ischemic heart disease – the kind marked by heart attacks – "remains the single largest cause of death in countries of all income groups." Among the reasons for this, Churchwell cited an evaluation of the global burden of cardiovascular disease, which showed that 17% of the world's population use tobacco and 20% are considered physically inactive. Each increases a person's risk for cardiovascular events.

"Efforts to reduce long-term risk need to be focused outside the hospital – in our neighborhoods and communities," Churchwell said.

Churchwell also discussed the importance of seeking equitable health for all people.

Sometimes, it requires a new way of doing things. Such as how his team at Yale New Haven Health in Connecticut approached COVID-19.

"First, we acknowledged that we didn't know how to treat this disease because … well, nobody did," he said.

Rather than applying a set of standards to all patients, they essentially learned what worked and what didn't for each patient. The result? Mortality rates for Black, Hispanic and Pacific Islander people were better than the national averages for all groups.

"We must fight and conquer implicit biases that can influence how we treat patients, and we must optimize therapies and hold ourselves accountable to ensure everyone has access to the best care available," he said. "We must also continually look for ways to enhance our impact, such as leveraging technology and health information to improve results."

Churchwell pointed to a recent AHA presidential advisory warning that if statistics continue on the present path, many key clinical disease metrics will surge in the wrong direction by 2050.

"An associated economic analysis showed that the annual financial costs – if unchecked by 2050 – will top $1.8 trillion in the U.S. alone," he said. "These statistics on global risk factors and recent advisories should be a wake-up call for all of us."

His suggestions for avoiding this include:

• "First, we must find more ways to aggressively treat hypertension, control diabetes, battle obesity and treat hyperlipidemia with therapies that we know work … and continue pursuing new and innovative treatments.
• "Next, with our partners in government, industry and communities, we must find ways to improve the social drivers of health. Access to care is a universal problem. And while many countries have worked effectively to pay for health coverage for everyone, there is a worldwide struggle to provide adequate care for patients in rural settings and those with persistent social and economic challenges.
• "Lastly, we must enhance the working environment for clinicians, scientists and nurses so they can be more efficient and continue to feel that their work is fulfilling. And we must assure that the use of AI improves our ability to deliver quality care and improves the lives of our patients and clinical staff."

Churchwell emphasized that having quality leaders is a key step toward finding and implementing solutions. He then introduced a video on leadership that included "two of the best" leaders he's worked with: his brothers, Kevin and André. Kevin, Keith's identical twin, is president and chief executive officer of Boston Children's Hospital, and André is senior advisor on inclusion and community outreach at Vanderbilt University.

Family played a large theme in Churchwell's speech.

He shared how his parents grew up in Nashville, Tennessee, when it was segregated. His father, Robert Churchwell Sr., became a pioneering journalist, known as "the Jackie Robinson of journalism," for integrating the newsroom of Southern major metropolitan newspapers. His mother, Mary Churchwell, earned a college degree while he and Kevin were young and then taught for 30 years.

"I share all this not only because I'm proud of my family," he said. "I share this so you can understand the environment I grew up in – a household where academic achievement was expected; where I was encouraged to forge my own path, knowing I had my family's unwavering support; where I learned to believe all things were possible, that the only limitations were those I placed on myself; and that with these privileges came a responsibility to give back to my community.

"And the important question my parents would always ask was: What can you do to help?"

In his call to action, Churchwell returned to that question. Only he spun it slightly by asking the audience, "What can we do to help?"

"What can we do to help accelerate progress while at this conference?" he said. "What can we do to help when we get back to our clinics and labs? And what can we do to help make a difference in our communities?

"None of us is expected to have all the solutions. But I've learned that each of us can do something – and together we can play parts large and small to make a difference. And not only can we. We must.

"This ethos is beautifully expressed in these words etched into the tombstone of Jackie Robinson: 'A life is not important except in the impact it has on other lives.'"

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