AHA/ACC Guidance on Ethics, Professionalism in Cardiovascular Care

Megan Brooks

May 12, 2021

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

The report addresses a variety of topics, including diversity, equity, inclusion, and belonging; racial, ethnic and gender inequities; conflicts of interest; clinician well-being; data privacy; social justice; and modern healthcare delivery systems.

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

The 2020 consensus conference on professionalism and ethics came at a time even more fraught than the eras of the three previous meetings on the same topics, held in 1989, 1997, and 2004, the writing group notes.

"We have seen the COVID-19 pandemic challenge the physical and economic health of the entire country, coupled with a series of national tragedies that have awakened the call for social justice," conference cochair C. Michael Valentine, MD, said in a news release.

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

"We hope 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 inequities and improve diversity, inclusion and wellness among our workforce," Valentine added. "The majority of our members are now employed and must be engaged as the leaders for change in cardiovascular care."

Road Map to Improve Diversity, Achieve Allyship

The writing committee was made up of a diverse group of cardiologists, internists, and associated healthcare professionals and laypeople, and was organized into five task forces, each addressing a specific topic: conflicts of interest; diversity, equity, inclusion, and belonging; clinician well-being; patient autonomy, privacy, and social justice in healthcare; and modern healthcare delivery.

The report serves as a road map to achieve equity, inclusion, and belonging among cardiovascular professionals and calls for ongoing assessment of the professional culture and climate, focused on improving diversity and achieving effective allyship, the writing group says.

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

It offers recommendations for championing 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 foundation of training in allyship and antiracism as part of medical school course requirements and experiences: a required course on social justice, race, and racism as part of the first-year curriculum; school programs and professional organizations supporting students, trainees, and members in allyship and antiracism action; and facilitating immersion and partnership with surrounding communities.

"As much as 80% of a person's health is determined by the social and economic conditions of their environment," consensus cochair Ivor Benjamin, MD, said in the release.

"To achieve social justice and mitigate health disparities, we must go to the margins and shift our discussions to be inclusive of populations such as rural and marginalized groups from the perspective of health equity lens for all," said Benjamin, professor of medicine, Medical College of Wisconsin, Milwaukee.

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

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

The report also highlights additional opportunities to:

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

  • identify and assist clinicians who experience mental health conditions, alcoholism, or substance abuse

  • emphasize patient autonomy using shared decision-making and patient-centered care that is supportive of the individual patient's values

  • increase privacy protections for patient data used in research

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

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

  • expand and make mandatory the reporting of intellectual or associational interests in addition to relationships with industry.

The report's details and recommendations will be presented and discussed Saturday, May 15, at 8:00 AM ET, during ACC.21. The session is titled Diversity and Equity: The Means to Expand Inclusion and Belonging.

The AHA will present a live webinar and six-episode podcast series (available on demand) to highlight the report's details, dialogue, and actionable steps for cardiovascular and healthcare professionals, researchers, and educators.

This research had no commercial funding. The list of 40 volunteer committee members and coauthors, including their disclosures, are 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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