ACC President Discusses Women in Leadership, Future of Cardiovascular Care

Pharmacy Times spoke with Dipti Itchhaporia, MD, the 70th president of the American College of Cardiology (ACC).

Q: As you reflect over the past year, what has it meant to you to be the 70th president of ACC?

Dipti Itchhaporia, MD: You know, I think that to be ACC president is a real honor. And I think the being the the fifth woman president of the college was very impactful, particularly because I became president after Athena Poppas. And so the idea of becoming president and getting power from another woman, I think shows how long how far we have come in terms of diversity and inclusion. So, I think I was happy about that.

But of course, it was a challenging time because of the COVID-19 pandemic and the fact that we weren't able to travel, there was a lot of uncertainty. I think that was a challenging time. But I was able to focus on my priorities for the college. You know, I've been thinking long and hard for a long time about digital transformation, and the pandemic forced us to pivot [and] to really embrace digital transformation and telehealth in a way that we had never done before. So that was a real opportunity.

I think that the other big piece that was important to me was this idea of health equity and the pandemic really brought to light a lot of the existing health disparities that really have existed for a long time in our society. But this was the first time that we started to really focus in on that. I had the opportunity to be the chair of the Health Equity Task Force in my vice presidential year, and so I was able to really focus in on that. And during one of my leadership pages, I'm particularly proud of the fact that I coined the term quintuple aim. In 2007, the Institute of Health Care coined the term “triple aim,” and then in 2014, we did achieve the triple aim and it evolved to the quadruple aim because of the fact that we didn't think about clinicians. And so then clinician wellbeing became a piece of it. But now, in 2021, I really felt that we had evolved to really putting health equity in there, as part of that missing piece of the puzzle. I think the pandemic really showed us how important health is, and how important not only health is, but how that is so linked to the economy. And so, the fact that we will try to embrace the quintuple aim really, you know, it brings all of that together. And I think that a lot of how we're going to scale health equity is digital transformation. And so, it really fit nicely with sort of some of the things that I've been thinking about for digital transformation.

I also think that digital transformation is probably the way that we're going to counter clinician wellbeing. You know, the true definition of digital transformation is something that actually makes your life and makes the patients’ lives better. It makes the clinician’s life better. So, telehealth actually did that, right? With telehealth, people could be at their homes and they had easy access. They no longer had to [deal with] parking, pay for parking, traffic, take time off, and they could still have their visits. Now, are we exactly where we want to be with telehealth? Maybe for some subspecialties, but certainly in cardiology, we need some of that remote patient monitoring data. We need digital stethoscopes and other data. But I think it's so great that we leapt into where we are with this because I think we're starting to see how we can utilize this.

And then also identify some of the gaps. For example, with health equity, we certainly can't have a conversation about innovation and health equity without thinking about the digital divide, and how we're going to counter the digital divide. And so, I think that for the first time, I had the opportunity to say to the membership, that, hey, let's embrace digital transformation, you've done this. We did this. Let's go further. And let's talk about the problems that we had, and how do we overcome them? What are some of the issues that we encounter? And I see the members of really embracing that.

So, I think that it's a long winded answer to say, you know, what has it meant? It has meant so much because professionally, it's made me really articulate a lot of what I had been thinking about for a long time.

Q: As we begin to enter a new, endemic phase of the COVID-19 pandemic, what do you see changing in the cardiovascular space?

Dipti Itchhaporia, MD: I think we learned a lot of lessons during the pandemic. I think number 1, as I mentioned, I think we really learned that health is extremely important. I don't think we ever thought about our health in the way that we do now, and I think that's a good thing. And maybe we can channel all that energy, in terms of health, to maybe preventative care that we want that get people to do that. We recognize that patients that had underlying cardiovascular disease were at the highest risk of potentially getting COVID, so I think it really nicely ties into the health message.

I think that we have asked clinicians for a long time to pay attention to the economics of health care and the fact that health and the economy are so inextricably tied together. Now we can show that and demonstrate that. I think that we have, as I said, shifted to telehealth, so that's another important thing. When you look at particularly cardiovascular disease, we've really shifted so much of our care from inpatient to outpatient, and that is not a trend that's going to change. So, if you look at post [percutaneous coronary intervention] discharge, there's a huge uptick in post PCI. I don't think that's going to go back.

Same thing we were talking about, I was at a session earlier today about in the [electrophysiology] world how people are going home faster after [implantable cardioverter-defibrillators] and pacemakers and atrial fibrillation. Those things, those trends are going to continue. I think that's positive.

I also think we're really shifting to value-based care. More than ever, we recognize that we really need to make that shift.

I think that the last thing is the concept of teamwork. You know, we've had teams for a long time, we've talked about team-based care. But COVID-19 really showed us how important team-based care was. If we needed proof of concept, we got proof of concept. So, I think not only do we understand that it works, but we recognize now that it's very necessary.

Q: Can you discuss pharmacists’ role in cardiovascular care?

Dipti Itchhaporia, MD: It's interesting that you're asking me that because yesterday, our [Invasive Cardiovascular Technology] team had their meeting, and the chair is a pharmacist. And, you know, I think that if in the past we did not think of a pharmacist as part of the team, we now know that a pharmacist is part of the team. So, I think we recognize that cardiovascular diseases are complex, there are many complex diseases, and we need different people at the table to really provide the care that we need. And you know, there are many, many people. Pharmacists are extremely important, particularly as people have complicated medical issues with lots of pharmacotherapy. It is difficult to know, without the help of your pharmacist, are we going to be encountering some drug-drug interaction that we're not aware of? Do we need dose adjustments when we're adding on something? So, I think they're an extremely important part of that.