When Cathie Biga was appointed president of the American College of Cardiology last April, she made history as the organization's first non-physician president.

In advance of the ACC’s annual meeting in Chicago from March 29-31, she spoke with HCB News about the transition of the ACC from a physician-only organization to one that’s inclusive of the entire cardiovascular care team, the adoption of “collaborative AI” and the importance of inclusivity.

HCB News: What inspired you to get into healthcare, and more specifically, into cardiology?
Cathie Biga: When I was in college, women were really just evolving in the workforce. Not to stereotype, but girls were heavily recruited in high school to be nurses and teachers, as I was when I was entering college. Back in the day, I joined a future nurses club and did what was called candy striping back then.

It's funny, because neither one of my parents were really in healthcare when I was that age. My brother ended up becoming a physician and my mom, after I finished school, went to nursing school. We actually worked together for a while, which was really cool. My favorite aunt was an RN – and she was very influential in my decision. It was also that time when nurses had 2 or 3 years of training, but I knew I wanted a degree so I enrolled in one of the few BSN programs.

Cardiology began to interest me when I trained at (the) Mayo (Clinic) – St. Mary’s Hospital - in Rochester. It was the days of open-heart surgery and it just fascinated me. We used to go to the amphitheater and watch surgery on our afternoons off. There was just something about the heart. I went right from school into the critical care areas and loved every minute of it.

HCB News: How long have you been a member of the ACC?
CB: (At first) they didn't allow, for lack of a better word, non-physicians, so my official membership, when I could actually pay dues, was probably in the mid 2000s. They opened it up to nurses first and now of course ACC is the professional home for the whole CV team. One of the most gratifying things to have watched over the last 25 years is that evolution, and I think they have led the way for professional societies.

Cardiology really takes a team approach (with) the chronicity of our disease process. Unlike orthopedics, for example, (where) you break a leg, you fix a leg, you rehab and you move along, once you're diagnosed with coronary disease, it's usually a lifelong disease process to manage it, treat it and help our patients stay out of the hospital.

One of the evolutions in our delivery of CV care has been imaging. I'll date myself, but when I first started in the coronary care unit, patients would be on bedrest for five days after their heart attack. We didn't give them ice water because it would stimulate the vagus nerve. Now we float valves in from the groin. The technology and pharmaceutical changes have been fascinating to watch. Cardiovascular treatment and care delivery is a phenomenal field.

HCB News: In what ways has the ACC supported your career development?
CB: It really started (with the) MGMA (Medical Group Management Association), which was our professional society for the business side of medicine. They had a subsection for cardiovascular disease. I was a president of that back in the '90s. As imaging was really starting to take hold, and as sub-specialization was evolving, there was another entity called the Cardiovascular Leadership Alliance, the CLA. Right along with that was MedAxiom. These last 2 organizations is where I learned everything from operational efficiencies, measuring quality outcomes, and dyad leadership, a management style of understanding and maximizing the different skill sets of a physician lead and administrative lead who come together to learn from each other. Powerful! That was before ACC had really opened its doors for non-physicians. This powerful background was important when ACC opened its doors to the CV team, it was able to capitalize on non-clinical competencies. When ACC aligned with the MedAxiom family, it was really just that perfect synergy of clinical and non-clinical competencies to lead our CV teams They're responsible for my career development: the networking, the mentorship, the sponsorship of my colleagues throughout the early 2000s.

When ACC started the CV summit back in 2008-2009, it was really the first focus on non-clinical competencies for our physicians. It was my favorite meeting of all time because physicians just saw things very differently. It wasn't like their clinical meetings, and we learned so much from each other. At that point, I'd already been a hospital CEO, so now it was time for my career development on the physician side of things, designing and transforming care delivery for CV patients in a team approach with dyad leadership. Physician led, professionally managed.

HCB News: What trends do you expect to shape cardiology over the next few years?
CB: I think leadership. Physicians have got to be at the executive table and be allowed to lead. In addition, as cardiovascular care becomes more and more subspecialized, I think our sub-specialty clinics, which should be physician-led using guideline directed medical therapy and APP-run – to ensure compliance, (is) another type of a dyad leadership shaping the cardiology workforce. COVID taught us a lot, and at the same time it didn't really teach us anything. We changed very quickly, but we went right back to our comfort zone. And so truly transforming what we need to do – changing HOW we deliver care, truly being able to transform, is so very, very critical.

I think digital transformation (and) appropriate utilization of collaborative AI are all critical elements. The formation of our CV teams will continue. We know we have a physician shortage. We actually have a workforce shortage, so really being able to allow our teams to develop and to flourish, and to allow different leaders in different stages of a patient's care plan is also going to be critical.

I think the change will continue to be relatively rapid, both with the introduction of AI and the ongoing technology and pharmacological changes that we see in the prevention and treatment of heart disease. But the one trend that we've got to do better at, is to start to bend that curve for the global burden of heart disease. Since COVID, that is just going the wrong way, and I think everybody recognizes it, and so we need to use all these tools: dyad leadership, subspecialty clinics, team-based care and collaborative AI to get that global burden of heart disease under control.

HCB News: How is AI currently being integrated into cardiology workflows, and what challenges still need to be addressed for wider adoption?
CB: Many people find it easier to identify AI when it's embedded in our imaging or technology, but I think we're missing an opportunity when it relates to the cardiology workflow. The biggest issue for burnout for our physicians is our EMR. We have got to be able to have our physicians go home at the end of the day and “go home,” not put their bunny slippers on and have to sort through an inbox and finish charts.

Our patients are complex, and our throughput in the office is complex. When you see a well-oiled -clinic – functioning efficiently, where everybody's working to the top of their license and your MA is rooming your patient, your physician is assessing and diagnosing, your nurse is in there teaching and educating, and your APP is doing follow-up — that's when patients feel well cared for. They don't care that their office appointment is only 15 or 20 minutes. It's what happens in that 15 to 20 minutes. Using AI in that workflow is critical. (Also) critical is using AI for patient remote monitoring, making sure we're doing that appropriately, making sure our patients understand what digital monitoring is, and making sure that we're utilizing AI to predict heart disease so that we are using preventative skills as opposed to waiting until people are sick before utilizing our healthcare dollars.

Digital transformation is critical, and we're seeing it. We see it with our remote patient monitoring, we see it with our inter-loop recorders, we see it with our devices that we put in. There's lots of data available to us, but how we are utilizing that data? and how are we embedding that data into a workflow that is meaningful for our patients and their outcome – that is what is very, very important. To have it adopted, to have our teams accept it, we have to remember that our patients have to stay at the center of this. It's utilizing it cautiously, making sure that it is doing what we think it is doing. It will never replace the need for our physician's and support team, but collaborative AI must be well understood.

HCB News: What are the most exciting advancements in cardiovascular care that will be highlighted at this year’s ACC meeting?
CB: Obviously, the late-breaking clinical trials are always something that we are all anxious and looking forward to. The science will never cease to amaze me. Looking at the continual advances in the treatment of heart failure, and what we can really do for our patients, is really remarkable.

Looking at the new use of GLP1’s, and their role in caring for our CV patients. Understanding cardio-metabolic syndrome, and looking at weight loss is important. We know we have an epidemic of obesity and these drugs are having an amazing impact for many patients, but now we've got to get them economically accessible.

One of the big late-breaking clinical trials is looking at the primary and secondary outcomes for women. (We need to make) sure that our trials are set up in such a way that is very inclusive — not only gender inclusive, but culturally inclusive. We know our Southeast Asian population identifies very differently with disease processes all these areas need research in order for us to truly care for our patients.

I believe one of the other early late-breakers will be looking at semaglutides and diabetes, so I think our GLP-1 (drugs) and how we really use those for our patients is going to be a hallmark for future years. Evidence-based research is amazing. It sometimes gives us answers that we didn't even know we were looking for. Look at the amazing impact it has had with our diabetic patients and in our heart-failure patients. Utilizing the science to drive our technology is so critically important, and that's what ACC is all about.

HCB News: How is the ACC working to improve health equity in cardiovascular care, particularly for underrepresented populations?
CB: Our true north will remain, as it has been, with diversity, equity and inclusion. Our Diversity and Inclusion Committee has been very active. Our Health Equity Committee will become a standing committee of the college at this meeting. We must ensure equitable access for all our patients – no matter where they live.

COVID showed us a lot — I'm not going to say it taught us a lot, because I'm not sure we learned, but it certainly showed us a lot. So (we) really (need to be) looking at our underrepresented populations as it relates to many, many things, including prevention - something as simple as blood pressure screenings and lipid screenings. At our community event that we will be doing at the (Salvation Army) Kroc Center over on the south side of Chicago on Tuesday, (we'll be) making sure that we really are bringing care to our patients in their neighborhoods, where they live, where their communities are, making sure that our social determinants of health are really embedded in every single treatment plan.

Having guideline-directed medical therapy is not going to get us to the end point. We need to use that guideline-directed medical therapy with our social determinants of health so that our patients are compliant, they understand the treatment plan (and) they can afford it. We have to explain it to them in language and in verbiage that is at their educational level — not ours, but theirs — so they truly become partners in their healthcare. Health equity will remain front and center, as well as making sure our care teams are diverse and inclusive, and that they understand the cultures of our patients that we're treating globally as well as nationally.