AHA / ACC guide on ethics, professionalism in cardiovascular care


The American Heart Association (AHA) and the American College of Cardiology (ACC) have published a new report on medical ethics and professionalism in cardiovascular medicine.

The report addresses a variety of issues, including diversity, equity, inclusion and belonging; racial, ethnic and gender inequalities; conflicts of interest; clinical well-being; data privacy; Social justice; and modern health care systems.

The 54-page report is based on the proceedings of the Joint Consensus Conference on Professionalism and Ethics 2020, held on 19 and 20 October 2020. It was published online on 11 May at Circulation and the Journal of the American College of Cardiology .

The 2020 consensus conference on professionalism and ethics came at an even busier time than the times of the previous three meetings on the same topics, held in 1989, 1997 and 2004, the drafting group notes.

“We have seen how the COVID-19 pandemic challenged the physical and economic health of the entire country, along with a series of national tragedies that have aroused the call for social justice,” said conference president C. Michael Valentine , MD, in a news release.

“There is no better time than now to review, evaluate, and adopt a new perspective on medical ethics and professionalism,” said Valentine, a professor of medicine at the Heart and Vascular Center, University of Virginia, Charlottesville.

“We hope that this report will provide cardiovascular professionals and health systems with the recommendations and tools they need to address conflicts of interest, racial, ethnic and gender inequalities and improve diversity, inclusion and well-being among our workforce, ”Valentine added. “Most of our members are working now and need to be involved as leaders in the change in cardiovascular care.”

Roadmap to improve diversity and achieve alliance

The drafting committee consisted of a diverse group of cardiologists, internists, and associated health professionals and lay people, and was organized into five working groups, each of which addressed a specific topic: conflicts of interest; diversity, equity, inclusion and belonging; clinical well-being; patient autonomy, privacy and social justice in health; and a modern medical service.

The report serves as a roadmap for achieving equity, inclusion and membership among cardiovascular professionals and calls for a continuous assessment of professional culture and climate, focused on improving diversity and achieving allies. effective, according to the drafting group.

The report proposes ongoing training to address individual, structural and systemic racism, sexism, homophobia, classism and capacism.

It offers recommendations for advocating for equity in patient care that include an annual review of practice records to look for differences in patient treatment by race, ethnicity, zip code, and primary language.

The report calls for a basis for alliance and anti-racism training as part of the requirements and experiences of medical school courses: a compulsory course on social justice, race and racism as part of the first-year curriculum; school programs and professional organizations that support students, training participants, and members in alliance and anti-racism actions; and facilitate immersion and association with surrounding communities.

“Up to 80% of a person’s health is determined by the economic and social conditions of their environment,” Ivor Benjamin, MD, said in a statement.

“To achieve social justice and mitigate health disparities, we must go to the margins and change our discussions to include populations such as rural and marginalized groups from the perspective of health equity for all.” said Benjamin, professor of medicine, Wisconsin College, Milwaukee.

The report also highlights the need for psychosocial support from the cardiovascular community and recommends that health organizations prioritize regular assessment of well-being and the involvement of clinicians.

It also recommends addressing the well-being of participants in postgraduate training programs and calls for an ombudsman program that allows for confidential reporting of abuse and access to support.

The report also highlights additional opportunities for:

  • improve the efficiency of health information technology, such as electronic health records, and reduce the administrative burden

  • identify and assist physicians suffering from mental health conditions, alcoholism, or substance abuse

  • emphasize patient autonomy through shared decision-making and patient-centered care that supports individual patient values

  • increase the protection of privacy of patient data used in research

  • maintain integrity as new ways of caring emerge, such as telemedicine, team-based care approaches, and physician-owned specialty centers

  • perform routine audits of electronic health records to promote optimal patient care as well as ethical medical practice

  • expand and make mandatory the notification of intellectual or associative interests, in addition to relations with industry.

Details and recommendations of the report will be presented and debated on Saturday, May 15 at 8:00 p.m. AM ET, during ACC.21. The session is titled Diversity and equity: the means to expand inclusion and belonging.

The AAH will present a live webinar and a six-chapter podcast series (available a la carte) to highlight the details, dialogue and practical steps of the report for cardiovascular and health professionals, researchers and educators.

This research had no commercial funding. The list of 40 volunteer committee members and co-authors, including its dissemination, is listed in the original report.

Circulation. Published online May 11, 2021. Report

J Am Coll Cardiol. Published online May 11, 2021. Report

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