Journal of the American College of Cardiology
Ó 2013 by the American College of Cardiology Foundation
Published by Elsevier Inc.
Vol. 61, No. 23, 2013
ISSN 0735-1097/$36.00
http://dx.doi.org/10.1016/j.jacc.2013.05.005
FROM THE ACC
President’s Page: Honoring Those Who Have
Served With High Quality Cardiovascular Care
I
n March 1865, the Civil War was coming to an end and President Abraham Lincoln
was entering his second term as president. As part of his second inaugural address,
Lincoln focused on transitioning from the divisiveness of war to the healing of the
nation. He closed his address with a now famous quote affirming the government’s
obligation to care for war veterans and their families.
“With malice toward none, with charity for all, with firmness in the right as God gives us
to see the right, let us strive on to finish the work we are in, to bind up the nation’s wounds,
to care for him who shall have borne the battle and for his widow, and his orphan, to do all
which may achieve and cherish a just and lasting peace among ourselves and with all
nations,” he said (1).
Today, a portion of this quote greets those entering the U.S. Department of Veteran
Affairs (VA) headquarters in Washington, DC d and there are many who walk through the
doors. The VA is the largest integrated health care system in the U.S., with over 1,400 sites
including hospitals, nursing homes, and clinics. More than 8 million veterans are cared for
in this system (2), many of whom suffer from, or are at risk of, cardiovascular disease.
As such, hundreds of cardiovascular professionals are part of the VA system. Not to
mention, >90% of clinicians trained in this country spend at least some of their training
at a VA facility.
The VA hasn’t always been known for high quality care. Indeed, it has undergone
a remarkable transformation in the last 25 years, evolving from the woeful depictions of care
such as in the movie “Born on the Fourth of July,” to being identified by many as the highest
quality health system in the U.S. In the cardiovascular arena, VA cardiology has developed
widely acclaimed, innovative national programs, such as an active cardiac device surveillance
system in collaboration with the Food and Drug Administration (3). In his book, Best Care
Anywhere, author Phil Longman also cites the VA’s national electronic health record system
and commitment to evidence-based medicine as key drivers of its’ successful transformation
(4). In this era of health care reform, the VA is basically a model accountable care
organization.
The American College of Cardiology (ACC) has long recognized the important role the
VA plays in cardiovascular care and in recent years has moved to further strengthen the role
of its VA, military, and public health sector members in college-wide activities. Today, VA
clinicians serve on the ACC’s Board of Governors and Board of Trustees and other national
ACC committees, and, conversely, multiple FACC’s have national leadership roles in the
VA system. This past ACC.13 in San Francisco included special sessions designed
specifically to bring together ACC members working within the VA, Army, Air Force,
Marines, and public health sector to address challenges and opportunities unique to these
groups.
However, the care of veterans does not end with the VA health care system. In thinking
about U.S. veterans today the answers to the following ‘True or False’ questions may be
surprising:
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John Gordon
Harold, MD,
MACC
ACC President
John S. Rumsfeld,
MD, PHD, FACC
National Director of
Cardiology, U.S.
Veterans Health
Administration;
ACC Board of Trustees
We need to renew
our dedication to
providing the
highest quality
cardiovascular care
for U.S. veterans,
including a focus on
cardiovascular
prevention for
younger and
women veterans.
Let’s rise to the
occasion and make
each clinical
interaction an
acknowledgement
and thank you for
those who have
served the Nation.
2390
JACC Vol. 61, No. 23, 2013
June 11, 2013:2389–90
Harold and Rumsfeld
President’s Page
1. The majority of U.S. veterans are cared for primarily
within the VA health care system. Answer: False
2. In the current U.S. veteran population, there are more
“Gulf War era” veterans than the Korean War and
World War II era veterans combined. Answer: True
3. There are currently over 2 million women U.S.
veterans. Answer: True
Today, there are over 22 million U.S. veterans comprising
roughly 7% of the total U.S. population (2). This means that
two-thirds of U.S. veterans receive their care outside of the
VA system. It is, in fact, almost certain that all ACC members
involved in adult (and in some cases pediatric) clinical care
take care of veterans and/or their family members. Therefore,
the U.S. health care system as a whole dincluding all
cardiovascular clinicians and the ACC as an organization d
shares the responsibility, and honor, of providing high quality
care for our veterans.
While most cardiovascular professionals are familiar with
World War II, Korean War, and Vietnam War era veterans,
many may not yet be familiar with the following acronyms:
OEF, OIF, and OND. These stand for Operation Enduring
Freedom, Operation Iraqi Freedom, and Operation New
Dawn, together representing the “Gulf War era” veterans.
There are over 1.6 million OEF/OIF/OND veterans (2).
And while OEF/OIF/OND veterans are less likely to have
extant cardiovascular disease than older veterans, they
have elevated cardiovascular risk factors that deserve our
attention. As one example, the rate of active smoking in the
general U.S. population and the overall VA population is
w19%, while over 35% of OEF/OIF/OND veterans are
active smokers. These veterans also have a high prevalence
(over 30% by some estimates) of post-traumatic stress
disorder (PTSD), which is predictive of the development of
cardiovascular disease. The ACC and its’ members have
a major opportunity to serve OEF/OIF/OND veterans
through prevention of cardiovascular disease by effective
risk factor recognition and treatment.
Similarly, it may be surprising to learn that about 10%
of U.S. veterans, or more than 2 million, are women (2).
With women currently representing over 15% of active duty
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military, this number will continue to grow. As the numbers
of women veterans increase, it is becoming clear that many
have cardiovascular risk factors, including active smoking,
diabetes, obesity, hypertension, and dyslipidemia. At least
one major cardiovascular risk factor is present in approximately 30% of women veterans under age 45, 65% of women
veterans between ages 45 to 65, and 80% of women veterans
over 65 years of age (5). Moreover, about 1 in 3 women
veterans under 65 years of age have depression, which is
independently predictive of developing heart disease.
Semper Fidelis, the motto of the U.S. Marine Corps,
means ‘always faithful’ in Latin. Only a few days ago, the
U.S. celebrated Memorial Day d a dedicated day to
remember and honor those who were “always faithful” and
gave their lives in military service. Our challenge d our own
opportunity to be Semper Fidelis d lies in the months
and years ahead as we care for those veterans and their
family members who find their way into our offices and
our lives.
Address correspondence to:
John Gordon Harold, MD, MACC
American College of Cardiology
2400 N Street NW
Washington, DC 20037
E-mail: [email protected]
REFERENCES
1. Lincoln, A. Second Inaugural Address. March 4, 1865. Available at:
http://www.abrahamlincolnonline.org/lincoln/speeches/inaug2.htm.
Accessed May 4, 2013.
2. Department of Veterans Affairs Statistics At A Glance, and Veteran
Population Projections FY2010 to FY 2040. Available at: http://www.
va.gov/vetdata/. Accessed April 30, 2013.
3. Tsai TT, Box TL, Gethoffer H, et al. Feasibility of Proactive Medical
Device Surveillance: The VA Clinical Assessment Reporting and
Tracking (CART) Program. Med Care 2013;51 Suppl:S57–61.
4. Longman P. Best Care Anywhere: Why VA Health Care Would Work
Better for Everyone. 3rd Edition. San Francisco, CA: Berrett-Koehler
Publishers, 2012.
5. Whitehead AM, Davis MB, Duvernoy C, et al. The State of Cardiovascular Health in Women Veterans, Volume 1. Women’s Health
Services, Veterans Health Administration, Department of Veterans
Affairs, January 2013.