John Fontaine, MD, MBA, FACC, FHRS

It is a privilege and honor to serve as the 17th President of the Association of Black Cardiologists (ABC). The ABC is a non-profit organization comprised of nearly 2000 national and international members. The organization was founded in 1974 by Dr. Richard Allen Williams, an author and Harvard University trained cardiologist. Dr. Williams is a soft-spoken, compassionate individual with a penchant for problem-solving, recognized that blacks and other minorities were suffering from the ravages of cardiovascular disease and experienced a mortality rate that was disproportional to that of the majority population in the United States. More importantly, he and a small group of intrepid cardiologists and scientists, the co-founding members of the ABC, embarked upon a mission to study the plight of minority patients and to promote diversity in the workforce. From the inception of the ABC, the American Heart Association (AHA) was its most ardent supporter, that provided financial and administrative assistance that helped the ABC flourish. The mission of the ABC is to promote the prevention and treatment of cardiovascular disease, including stroke, in Blacks and all minority populations, and the elimination of disparities through education, research and advocacy.

Over the past few decades many healthcare organizations have shared the mission and vision of the ABC, both independently and in collaboration with the ABC, implemented new initiatives and programs to achieve optimum cardiovascular health for all people including minorities. In 2015 the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality, reported significant health and healthcare disparities as a leading cause of death among all people and noted that African-Americans were more likely to die from heart disease.(1)  Racial and ethnic minorities with low incomes were more likely to receive lower quality care.

The ABC has undertaken a multidimensional approach to achieving its mission and to this end developed educational and community programs that have been critical in diversifying the workforce and improving the cardiovascular health of all people. Advocacy has been the quintessence of the ABC’s socioeconomic strategies. The ABC enjoys a collaborative effort with the U.S. Department of Health and Human Services, and its subsidiary offices – National Academy of Medicine (formerly Institute of Medicine), and the Office of Minority Health, National Heart, Lung, and Blood Institute; as well as the Food and Drug Administration, through its administrative arm and liaisons. These organizations including the National Medical Association, National Hispanic Medical Association, National Council of Asian Pacific Islander Physicians and the Association of American Indian Physicians, to a large extent, have parallel objectives to those of the ABC. They possess important resources and programs that are vital, complementary and aligned with the goals of the ABC.

The ABC, in conjunction with its institutional and industry partners, has contributed to workforce diversity via its scholarship programs which provide financial assistance to qualified students at the high school, collegiate and medical school levels and directly impact the cardiology workforce in its subspecialty training program awards. Since 1995, the ABC has made it feasible to fund twenty-one fellowship positions in clinical cardiac electrophysiology and twenty-five in interventional cardiology. These subspecialty training awards totaled more than 1.5 million dollars. Additional programs include its annual educational programs which offer CME credits to participants (includes the Walter M. Booker Annual Symposium and the Richard Allen Williams – Founder’s Lectureship), programs for cardiology fellows, allied professional and other healthcare providers. The ABC is aligned with programs such as Healthy Churches 2020, the Council of Churches, and sponsors mentoring programs for medical 2 students, and cardiology fellows. Academic awards to promising students are provided through the Dr. Richard Allen Williams and Genita Evangelista Johnson Scholarship Fund. The ABC also sponsors and supports many community health programs, including its own barbershop health screening program developed a few decades ago by the late Dr. Elijah Saunders. The ABC is also involved in promoting minority participation in clinical research and will participate in programs such as the AHA’s My Research Legacy, Precision Medicine and build its ABC Cardiovascular Implementation Study.

The ABC is a wholly inclusive organization with multi-level membership categories open to all physicians, scientists, healthcare providers including nurses, students and healthcare advocates. Corporate and institutional membership categories are encouraged. There is not a pre-requisite for membership except that members are devoted to the mission of the ABC and willing to join us along with the AHA, American College of Cardiology (ACC), the Heart Rhythm Society, American Medical Association (AMA) and other partners in pursuing the elimination of healthcare disparities in all people, particularly the minority population, and diversification of the healthcare workforce.

My vision for the ABC is that the organization will continue to inexorably promote its educational and community programs and establish new initiatives and strategies to enhance its existing programs to ensure that its mission is accomplished. The mission of the ABC is sacrosanct, virtuous and noble. However, the ABC cannot do it alone. This mission only can be achieved through the determination and resolve of its leadership, board of directors, committees, members, as well as support from corporate partners and industry. Endowment of the organization in perpetuity is a worthy investment for any philanthropic entity and will be welcomed. Novel initiatives include the Access to Care Program which is multifaceted, and in-part focused on the preauthorization process that would facilitate access to pharmacologic agents needed for at-risk patients. The ABC will pursue increasing minority patient participation in clinical research and inclusion in Precision Medicine projects. Underrepresentation of minorities in Precision Medicine projects may subvert the attempts to eliminate disparities, as the potential to exacerbate existing disparities may result as an unintended consequence. Alternatively, minority participation in Precision Medicine projects in the early stages will likely provide important individualized or sub-population data needed to favorably impact decision-making and treatment outcomes.

Recently, new guidelines for the prevention, detection, evaluation and management of high blood pressure in adults have emerged and will likely result in an increase in the prevalence of hypertension in the U.S. from 32 to 46%. The recent increase in stroke related deaths since 2015 and the result of the SPRINT are factors that likely influenced a change in the guidelines.(2,3)  African-Americans have a high prevalence of hypertension and secondary complications; hence the ABC must play a vital role in addressing awareness of hypertension, treatment and effective blood pressure control. The extraordinary results of the recently completed Black Barbershop hypertension intervention trial supersede those observed in larger studies and are encouraging.(4)  The sustainability of the results observed over a longer period than the 6-month period of the study will have to be evaluated in a longer-term investigation. This study may serve as a model that will foster engagement of health advocates and pharmacists in the recognition and treatment of hypertension and other cardiovascular diseases. There is much to be done including patient, physician and healthcare provider education to eliminate disparities in the medical management of heart failure and device-based treatment for sudden cardiac arrest and other novel therapies. The ABC’s approach to resolving disparities will be comprehensive and focused on detecting disparities, finding the root cause, and promoting programs to intervene and eliminate them. These efforts will be collaborative with the ACC and AHA as these organizations have embarked upon strategic objectives that envision the elimination of disparities. We must also continue to encourage our corporate partners and industry to support our educational and community programs, research projects and advocacy. The goals of these efforts are mutually shared, and all will benefit from their success.

In the altruistic pursuit of these objectives, I will allude to a quote from the scriptures which state “almighty God has not given us a spirit of fear, but of Power, of Love and of a Sound mind”. I say let’s use these gifts to do great things! The ABC welcomes all to join us in this endeavor. The ABC invites all, who are interested in the pursuit of its goals, to become members of this organization irrespective of race, gender, religion, occupation or healthcare specialty. For more information about the ABC and to become a member today, visit the ABC website at www.ABCardio.org.

 

References

1) Agency for Healthcare Research and Quality (AHRQ) 2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy. Rockville, MD: AHRQ;2016. Available at http://www.ahrq.gov/research/findings/nkqrdr/nhqdr15/index.html.

2) SRINT Research Group, Wright JT Jr., Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373:2103-2116. Doi: 10.1056/NEJMoa1511939.  

3) Cushman WC, Whelton PK, Lawrence J, et al. SPRINT Commentary. SPRINT Trial Results. Latest News in Hypertension Management. Hypertension 2016; 67:263-265

4) Victor RG, Lynch K, Li Ning, et al. A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops. Doi: 10.1056/NEJMoa1717250