1. 026 门诊 CLINIC
东闻视野·国际瞭望 outlook
我们需要彼此的经验，我们提供更好的医疗
We learn from each other, We improve patient Care
在刚刚结束不久的OCC&CSC 2015大会上，一支美国心脏病学会（ACC）的心衰团队十分引
入注目。他们是参加此次中国学术峰会的所有A CC成员。这支心衰团队不仅举办自己的ACC分
会场，还参与ACC-CSC联合会场。《门诊》杂志希望传达ACC选择“心衰”作为讨论话题的原因
及意义，将其制作成本期ACC中国行特别报道，以飨读者。
ACC Heart Failure team arrived at OCC&CSC 2015 in Shanghai, China with its specific
topic – Heart Failure – every presenter in this team contributed his or her speech to
address the high concern of this chronic area both in the ACC Session and ACC-CSC
Union Session. Clinic Journal had an eye to this team and found the value of their address
in Conference. We collected some of their essential contents to form an [ACC Forum], in
which we hope to participate in the addressing of the importance of patient care of heart
failure area brought from US, impacting every place.
2. 027门诊 CLINIC
Learn from Each Other ACC中国行之中美互补·东闻视野
CSC & ACC: What We Can Learn
from Each Other
in Order to Improve Patient Care
Dr. Richard A. Chazal
I am here today to speak about some of the interactions between
our countries – the United States and China – and how we can
work together to improve our nations’ care. The importance of
your country cannot be overstated both in terms of the number of
people and also in terms of the amount of critical information you
have that can help inform the rest of the world. The population
of China is roughly 4x that of the United States. Importantly, a
large proportion of the population resides outside urban areas.
This presents particular challenges and opportunities for learning,
particularly in cardiovascular patients. Furthermore, your urban
centers are quite large and present other particular issues. The
rest of the world can look to your nation and learn from your
experiences and challenges, especially considering that China has
20% of the world’s population.
Ⅰ. China and US: Common Issues of Physicians and
Healthcare Cost
China has a quite youthful population; however, in recent years
your age over 65 has grown rapidly in proportion to the younger
population, which creates challenges with regard to care. Back in
2007, working aged Chinese nationals outnumbered the elderly
over 60 by almost 8 to 1. That is 8 workers for every elderly
person. For 2050, that ratio is predicted to be 1 to 1.5. This
presents a real challenge that is being faced by the rest of the
world as well. Hence, one of the gaps that you experience here
in China is a “recruitment” gap, which influences the retention of
physicians in the profession. We are seeing a shift in numbers in
the United States that were once extraordinarily high are actually
now coming down. This could take away focus on trying to recruit
and retain the highest caliber students to enter or stay in the
medical field. Such an issue will make hiring staff in your highest
level hospitals very challenging at least for now.
Now the healthcare expenditures in China are relatively speaking
low at 4%. In the United States, we are spending almost 18% of
the Gross Domestic Product on healthcare. It is an unsustainable
number for the United States. In turn, we may have to turn to
China to understand how to better utilize existing resources
and reduce overall spending on healthcare, especially for our
increasingly aging population.
While in China, there are multiple factors driving the healthcare
When we have a lot to learn from the experience of Guidelines of America, America also declared that “We Learn from
Each Other, We Improve patient Care” in the keynote presentation of Dr. Richard A. Chazal who represented ACC in
the opening ceremony of Conference. In his speech, Chazal emphasized American people now is facing the challenge of
lacking cardiologists because that population in the United States are getting older. In turn, the US needs to turn to China
to learn from the experience of how to utilize fewer physicians to treat more patients. Chazal stressed that we must utilize
resources effectively for they are finite and we need use every resource in the right area. Finally, Chazal explained the ACC
future strategy which was dived into more in the Clinic interview with him.
3. 028 门诊 CLINIC
东闻视野·国际瞭望 outlook
Richard A. Chazal
MD, FACC
President Elect, American
College of Cardiology
M edic al D ire cto r, H e a r t
and Vascular Institute, Lee
Memorial Health System
Photographer: BingZhang
4. 029门诊 CLINIC
Learn from Each Other ACC中国行之中美互补·东闻视野
cost including a rise in incomes and urbanization, particularly with
the adoption of an unhealthy Western diet, increased problems
with smoking and air pollution, and an aging population with
longer life expectancies. Furthermore, the Chinese government
policies are pushing for universal access to medical healthcare
and demand for higher quality healthcare, particularly with
the increasing education of your population and awareness
of opportunities and technologies. The resulting figures are
staggering at 13.7% annual growth rate in healthcare spending
projected from 2013 to 2017. Even in context of the remarkable
economic growth in China, these numbers are extremely large.
Ⅱ. We Expect Challenging, Future Expects Our Success
A. China Bears an Increasing Cardiovascular Disease
The World Health Organization has published and interpreted
China’s demographic data, which shows that the changes in
diet and habits in China have contributed to the growth of
cardiovascular disease. The World Health Organization estimates
that about 45% of deaths are a result of cardiovascular disease and
in both males and females. Furthermore, the likelihood of dying
between ages 30 and 70 from the four main non-communicable
diseases is now 19% in China. The largest contributor of this high
percentage is cardiovascular disease followed by cancer. Much of
this again is due to changing eating habits and frequent tobacco
smoking. From a conversation with my Chinese colleagues, I
understand that the tobacco industry is currently targeting the
female population in order to raise the percentage of tobacco
consumers for financial gain. That occurrence was seen in the
United States just a generation ago and, as a result, what we have
seen is a rise in morbidity and mortality from cardiovascular
disease. Your blood pressure issues are significant and likely much
higher than the figure shown here from 2008 based on the obesity
problems.
B. Multiple Issues Are not Insurmountable
The current immediate problem in China is overcrowding
particularly in your tier–three hospitals. This also places
a financial burden on all of the government. These problems are
not dissimilar to those in the United States. Overcrowding is an
issue that we face as well in the United States in certain areas of
the nation. Similarly, like China, eliminating corruption in the
healthcare sector is a major issue in the United States as well. I
think the biggest shared issue in China and the United States is an
epidemic of diabetes and obesity that mandates increased training
5. 030 门诊 CLINIC
东闻视野·国际瞭望 outlook
of physicians. Again, something that you share with the United
States has been a focus on volumes and increasingly trying to
focus on outcomes.
C. The Address of China Is Continually Expected
However, the successes of your healthcare system are shown by
data shows that you have about 95% of your population currently
receiving medical coverage. Of course, this number is not all-
inclusive and comprehensive, but it is a huge accomplishment
considering that in the early 21st
century, only half your population
received medical coverage. China has also seen a massive
expansion of hospitals and clinics as well as a massive expansion
of extremely high volume facilities with cutting edge technology.
Your nation has also educated a large number of physicians
and initiated advanced medical care that is similar to Western
medicine. On the other hand, Western physicians are beginning
to research traditional Chinese medicine that we all believe may
offer promise in improving cardiovascular care, but we do not yet
have adequate data. The rest of the world is looking to you to help
lead and teach us.
Ⅲ. US and China: A Mutual Learning in Experience and
Methodology
A. Better Utilization for More Healthcare
The United States is not so different from China in many ways. In
your country, you have a problem of not having enough physicians
trained. In our country, we have an aging physician population. In
the United States, the average cardiologist is now over 50 years of
age. We are not replacing ourselves rapidly enough. This is what
that the ACC estimates is a real workforce crisis. We also have the
same type of obesity and diabetes epidemic in the United States.
Furthermore, our costs of healthcare – the highest in the world –
are unsustainable.
When we put these issues in the United States and China together,
we can find some solutions. While China has a need for additional
physicians, you also have advanced experience on how to do more
for patients with fewer physicians. In the United States, we have
a need for additional physicians and we are less experienced in
using fewer physicians to treat more patients. In turn, there is a
tremendous opportunity for us to learn from you.
B. ACC Expand Training Opportunity for China and World
As an organization, ACC has reached out to about 4000 Chinese
physicians in order to help train additional physicians. Founded in
2010, the Chinese chapter is the one our largest and most active.
We have been working with them to try to extend the use of
CardioSmart, our online tool for patient education, and to be made
available in their native language. There is a lot of educational
opportunity in terms of journals, mobile apps, clinical target
sessions, webinars, courses, and online education products. One of
the things we must continually work on is keeping them up to date
with literature.
ACC now has over 15,000 members outside of the United States
and 34 chapters worldwide. We have reached out so far in China
to over 10,000 physicians. We think that there are opportunities
to expand our ability and utilize tools we have to treat patients.
We are focusing this year to expand our advantageous testing
to expand patient care. Like you, we are trying to provide better
care at lower costs and to make certain that the right resources are
placed in the right areas.
At a professional level, I can tell you from the ACC that we
highly value our relationship with Chinese society and Chinese
physicians. We think it is important for patients here and
worldwide and we also think it is important for our collective
experience. Our relationship with your leadership and with you,
the Chinese people, is also very personal.
8. 033门诊 CLINIC
Guideline Methodology ACC中国行之指南制定·东闻视野
In ACC Session, Dr. Biykem Bizkurt went to the granular to walk us through all the steps of how ACC Heart Failure
Guideline was developed. Bizkurt presented a rigorous approach, which practically avoided the conflict of interests, and
reached the ultimate balance of representation in writing committee. In the new Heart Failure Guideline, some new sections
were added to cover the essential concepts with exception to the recommendation, including transitions of care, patient-
centric care and team management. In addition, the new guideline practice is not only an approach, but a platform also to
create opportunity for the rising stars to generate the future leadership. It is the methodology that ensures the impact of US
guidelines, which brings too much for edification.
Development of Heart Failure
Practice Guidelines
Dr. Biykem Bozkurt
I will try to walk you through the steps of how we developed the
guidelines in heart failure, which took almost 18 months from the
time of conception to the time of publication. It was a 1.5 year
process. The new approach is much faster and hopefully more up
to date. We in the US are visiting whether we are too formulated
in our approach, too rigorous, but at the same time we want to be
up to date and show attention to avoiding conflict of interests.
Ⅰ. STEP ONE: The Principle to Form a Writing
Committe
A. The Components of Guideline Writing Committee
The first step is finding the writing group. For a heart failure
guideline, we like to have representation from individuals who
practice in the arena of heart failure, cardiac transplantation,
Biykem Bozkurt
MD, FACC
Professor of Medcine, Section of Cardiology, Winters Center for
Heart Failure Research
9. 034 门诊 CLINIC
东闻视野·国际瞭望 outlook
pulmonary hypertension, and EP. We also wanted to make sure
that we had representation from academic and practicing faculty
with up to date information. A triple threat would be someone
who practices, knows the data, and knows the research. These
are the type of individuals we needed on the guideline writing
committee. This is a unique attribute in the academic arena that
you want individuals who practice evidence-based approach
and are not impacted solely by the market strategies. We also
wanted representation from established senior positions along
with emerging faculty. This is to create an opportunity for the
rising stars and ensure there is succession in the leadership at the
college level. We wanted to have representation from endorsing
societies, so that it would be a collaborative affair representing
the current state of the art approaches at least as a nation but also
a society.
B. Strict Constriction of Conflict of Interests
The conflict of interests was a very important issues. This was
raised by the institute of medicine a couple of years prior to this
guideline endeavor. They had looked into the process existing in
the United States and voiced a concern regarding impact from
industry. With that notice in mind, ACC prior to the start of the
heart failure guidelines had a very rigorous methodology to
prevent conflict. In the initial planning sessions, there is a delicate
balance that we try to achieve with more than 51% of the faculty
in the writing group not having any relationship with industry.
Also, the chairs, which represent the overall leadership and
expertise at the national level, should not have any relationship
with industry.
C. Selection and Endorsement
In addition to not having a relationship with the industry, there
were queries in terms of intellectual bias. We wanted to have
equally poised individuals having an objective stance towards
new treatment modalities. With this approach, once the writing
committee members are identified, then comes the selection
process. The nominations are made through a variety of societies
as well as a task force and leaders in the field. The selection is
done according to expertise and lack of a conflict of interests.
We strive for an ultimate balance of representation of academic
faculty and practicing faculty, emerging faculty and seniors, and
representations from societies. Once the selection process is
complete, invitations are sent to individuals who declare that they
have no conflict of interests again at the time of selection. This
then goes to the task force for the vetting process. Eventually,
individuals are endorsed into the writing committee. The chairs,
as I mentioned, are critical in ensuring that the process is adhered
to, or the guidance provided from the task force, and overall, the
execution of the guideline.
When we started we had 25 faculty members. We had
representation from different societies such as the American
College of Physicians, American College of Chest Physicians, the
Society for Heart Lung Transplantation, the American Academy
of Family Physicians, and Heart Rhythm Society, as well as the
Task Force for Performance Measures, which is a great integration
of translation of the guidelines to the performance metrics.
Ⅱ. STEP TWO: Finalization of the Outline
A. The New Concepts Conveyed by New Guideline
The second step was coming up with the outline. Heart failure is a
huge field and as you can imagine, even finalization of the outline
took a few sessions for the writing committee members to agree
upon. We wanted this to be a rigorous document focusing on the
treatment, but also wanted to cover other areas such as transitions
of care, patient-centric care, as well as important concepts of team
management. This guideline was not solely about prescription
of medications or devices, but also the patient’s quality of life,
preferences in decision making as well as the merging concepts of
transition of care from hospitals to outpatient settings, and what
we needed to do to prevent unnecessary treatment that may result
in a poorer quality of life for the patient.
10. 035门诊 CLINIC
Guideline Methodology ACC中国行之指南制定·东闻视野
B. The New Sections added in New Guideline
With that in mind, we added numerous new sections to the
guideline such as the coordination of care for patients with
chronic heart failure along with the development of new guidance
for the performance metrics, we had sections of quality and
recommendations for performance. We also added a section on
the gap where we thought would be an appropriate area to call for
future research and an area of development. We struggled with a
lot of these areas in clinical practice, but didn’t have data to come
up with recommendations.
Ⅲ. STEP THREE: Recommendations and Text
Achieved
A. Nope for Conflict of Interests from Start to End
In regard to the execution of the guideline writing, we met several
times in-person and via teleconference. At each session, each
member must declare again that they have no conflict of interests.
Assurance is provided that no member has developed new
conflicts. The writing group members then volunteered for the
sections that I have outlined. The primary author is the individual
who eventually writes the recommendation and the text related
to the recommendation. The way we write the guidelines are
different than what it used to be a decade ago.
B. Look into the New Method: Evidence→Recommendati
on→Text→Approval→Publish
The way we write the guidelines is at the ACC Task Forces. First,
we come up with the evidence tables. When I first began to write
this guideline, we were not allowed to write recommendations
until we formed the evidence tables. From the evidence table,
we then write the recommendations as sentences. The important
concept is to adhere to the evidence in the verbiage and sentence
of recommendation.
We then write the text supporting the recommendations. The
primary author wrote the recommendations and that individual
could not be with any conflict related to that recommendation that
he or she was writing. The literature search in the heart failure
guidelines was conducted by the writing group members.
The writing committee votes on each recommendation in an
anonymous fashion. After that, the recommendations go to the
task force, and after approval for publication in the journal of
the American College of Cardiology. We have a task force that
oversees this process – the task force on practice guidelines. This
task force meets regularly to determine what topics the members
will write as guidelines. They decide the priorities.
目前，ACC成立了一个循证检索委员会，这是ACC新建设的一个平台。循证检索委员会的职责是文献检索，并且有
时候对循证进行荟萃分析和系统性回顾分析，然后将搜集与分析的证据编写为独立的文件以支持指南撰写的需要。
Now ACC has a new platform, a new committee called the Evidence Review Committee. This committee reviews the literature
and sometimes performs meta-analyses and systematic reviews and then compiles the evidence as a stand-alone document to
supplement and help members write recommendations.
13. 038 门诊 CLINIC
东闻视野·国际瞭望 outlook
Clinic: We noticed that this time it is the team of heart
failure of ACC to come to China. Why did you choose this
topic – heart failure – to discuss in China this time?
Dr. Chazal: Particularly, in the United States, because so many
of our patients are living longer, the burden of heart failure is
increasing. For us, the number of patients with heart failure is
extraordinarily high and the cost, both in terms of USD and in
terms of affect on families and people, is tremendous in the United
States. We find that when we look at the treatment of heart failure,
both in the United States and worldwide, there are treatments that
are proven to improve care that are not always utilized. Many of
these treatments are actually inexpensive.
At the ACC, we have mounted increased efforts to try to deal
with heart failure and utilize the best science available. One of
our efforts is to utilize a team of heart failure people that includes
physicians, nurses, pharmacists, and others that can come together
and make certain that we deliver the highest quality of care to
these patients.
Clinic: I listened to the presentation on Heart Failure
Guidelines by ACC yesterday. Can you tell me about the
Heart Failure Address by ACC:
An Equivalent Moving On
Dr. Richard A. Chazal
new features and new advances of the US Guidelines of
heart failure?
Dr. Chazal: We know that the most dramatic changes in the
last year have been with the combination ACE Inhibitor and the
Neprilysn inhibitor, which is a new class of agent that has shown
substantial improvement in outcomes in patients with heart
failure. This class of drugs has just recently become available
in the United States. We think it is going to impact what is
happening. However, beyond the development of new strategies,
some of the older strategies have further been confirmed to be
highly advantageous and cost effective. We are still trying to make
certain that we not only develop new strategies but that we also
properly utilize those that are already available and make them
very cost effective.
We are going to be looking at updates on the heart failure
Guidelines that will include some of the newer agents that are
available to try to help deliver improved care. Some of the
agents are completely new and at least one of the agents has
been available outside the US but has just been approved by the
Food and Drug Administration (USFDA). One of the nuances
of the ACC / AHA Guidelines is that they have to be somewhat
Clinic interviewed ACC President Elect, Dr. Richard A. Chazal. Chazal noted the reason that ACC pays high attention to
heart failure area, and the new advances and features of the latest Heart Failure Guideline by ACC. When asked about the
pyramid concerning the future strategy of ACC, Chazal stated, “The strategies include effective education in the worldwide
range.” And ACC aims at translating all of this important science into what is usable to improve the care of patients. At last,
Dr. Chazal implied the opportunities for collaboration between ACC and Chinese Societies are tremendous. The solution
that the US needs to solve the current challenge of lacking physicians may be found in Chinese practice experience.
14. 039门诊 CLINIC
heart failure address ACC中国行之关注心衰·东闻视野
in compliance with regulations in the United States, which are
sometimes very tight in regards to some of these medications.
Clinic: You mentioned the ARNI / LCZ696, a new drug,
has just been put into the market in the US. All of the world
has their eyes on it and predict the greater future of it. Even
some cardiologists commend it saying it will dramatically
change heart failure. What’s your perspective on this drug?
Dr. Chazal: We believe that based on the available data that
it will substantially reduce risk if used in addition to other
modalities. We are very excited. The degree of improvement that
is seen is similar to the degree of improvement that we saw with
some other modalities. It is just that it has been so many years in
heart failure since we have had a breakthrough like this. So the
ACE Inhibitors and the beta-blockers and the mineralocorticoid
blockers are relatively old. We haven’t had a break through drug
until recently. We are very optimistic that this therapeutic modality
on top of others will really improve care further.
Clinic: One thing is a concern, especially in China that,
with the development of the general cardiovascular field,
some sub-fields develop very quickly and some sub-field
may be behind. In this kind of background, how do we
balance the developments between the high and the low?
Dr. Chazal: This has been also happening in the United States.
Some of the technology with heavy specialties like interventional
cardiology are very exciting and can have an immediate impact
that can be visible to patients and physicians, and it is very
gratifying. It has received a great deal of attention appropriately
so. Sometimes treatment of heart failure, though, takes longer to
realize the benefits. In turn, it perhaps does not grow as rapidly
initially because physicians are drawn to something where they
can act promptly and see an immediate impact like putting a stent
in or opening an artery.
With heart failure, it is a bit different. Heart failure often involves
chronic treatment and can have the same long-term impact as
dilating an artery, but sometimes you have to wait to see the
outcomes. As a result, in some areas those fields do not grow as
dramatically or rapidly. But they are critically important. This
is one of the reasons we have emphasized heart failure at this
meeting – the burden that it places on patients, on families, and
on our society in regard to the cost – is tremendous. We have to
emphasize this as an important area.
Clinic: As the president of ACC for the next year, you
gave the keynote speech in the opening ceremony. I paid
attention to the pyramid you presented of future strategies
of ACC. Can you give us a brief introduction to the pyramid
of future strategies?
Dr. Chazal: The American College of Cardiology developed a
new strategic plan (Figure1) trying to look forward with the full
intent to trying to help our members in the United States, China,
and throughout the world to try and begin to translate all of this
important science into what is usable to improve the care of
patients and improve outcomes overall. We also do so in a cost
effective manner because the resources are not infinite. We need
to be able to effectively utilize those.
The strategies to accomplish that goal include very effective
Figure 1: Strategic Plan of American College of Cardiology
15. 040 门诊 CLINIC
东闻视野·国际瞭望 outlook
education that is based on needs, the use of large data, advocacy
with governments and other agencies, to make certain that
the expenditures are appropriately utilized, the transformation
improves systems of care and provides value to the members
of the College of Cardiology, whether they are in Fort Meyers,
Florida or in Shanghai so that they can actually utilize information
to care for their patients.
Clinic: In your strategic plan, is there any space for further
collaboration between ACC and China?
Dr. Chazal: I think that the opportunities for collaboration
between ACC and the Chinese Society or Chinese physicians are
tremendous because there is a lot to learn from one another. When
we begin to look at our issues and our problems, we find that so
many of them are very similar. While our experience in terms of
solving these is quite different. In turn, we have a tremendous
opportunity to learn from one another.
I really feel as though we have an obligation to our patients to
listen to one another so that we learn because people are the same
all over the world. And we have to treat them all.
Clinic: Are there any details of the strategy or collaboration
or not yet?
Dr. Chazal: I think that we have to try to further develop
relations between societies to do things like collaborate
scientifically on guidelines. I believe for example that, some of the
scientific information that you have in China increasingly needs
to be incorporated into guidelines that we utilize, so that they are
applicable to a wide range of patients.
It is really important because people’s genetics are different and
they may respond to one therapy differently. I think there is a
tremendous opportunity there. I believe that collaboration with our
younger members is a tremendous opportunity as well, so that the
cardiovascular leaders of the future grow up looking at each other
as brothers and sisters and they can genuinely treat patients better.
Clinic: We really need your experiences of the Guidelines.
Dr. Chazal: We need yours as well because there is a wealth of
experience here in different areas. It is not all about technology;
it is also about effective utilization of resources. We need to
think about how to empower some of the primary physicians
to take on the roles that would traditionally have been taken on
by cardiologists. For instance, the population of cardiologists is
decreasing in the United States because they are getting older.
In turn, we need to learn from the experiences in China by
understanding how your nation utilizes fewer cardiologists to
provide care to many patients. We have a lot to learn from you as
well.
Clinic: What do you think can we do to rise up more young
good physicians? What do you do in the US?
Dr. Chazal: In the United States we have been very fortunate over
the years. Within our Society, physicians have held a reasonable
level of esteem and accomplishment. They are reimbursed at a
high level. Generally, we have been successful at recruiting people
that are very smart and might otherwise have gone into another
field. Nowadays, it is a little bit more challenging in the United
States, but the opportunity in science and translation of this
science to care for patients is such a big draw that we are still very
fortunate.
I think that one of the things that needs to occur in China is
an evolution of that process so that you have the same draw in
China to attract the best and brightest people – young men and
young women – to go into this field to try and provide care. It
is an honorable profession and has been for thousands of years.
You need good physicians here. I think there is a tremendous
opportunity.
Personally, I believe that the collaboration among different
countries helps to accomplish that, because physicians learn from
one another and then they influence their peers, and they influence
their governments eventually to realize the value that they see.
18. 043门诊 CLINIC
heart failure address ACC中国行之关注心衰·东闻视野
编者手记
正如Chazal教授在回答《门诊》杂志采访时的回答，经验不是仅局限于技术，有一些重要的经验是在于资源的利用。
如何利用较少的医师治疗更多的患者，是我们两个国家共有的挑战。因为我们都面临医师不足的问题。因此，我们有许多
需要彼此学习的地方。未来，全世界期待中国成功的经验成为各国的启发与借鉴。
Editor: Yubing Jin 责任编辑: 金瑜冰
Afterword
As was told in the interview, Dr. Chazal noted to Clinic, the experience is not all about technology; it is also about effective
utilization of resources. To understand how to utilize fewer physicians to provide more patient care is an urgent issue for both of our
countries, for we meet the ‘Recruitment Gap’ as the common challenging derived from different reasons though. In turn, we have
much space to learn from each other. And the world is looking to China for a further success to help lead and teach this experience.
面的需要是不分国籍和地域的。更何况，我们需要救治的，
是来自世界各地的患者。
《门诊》：关于ACC与中国未来的合作，目前是否
已经有一些具体的计划？
Chazal教授：我认为，我们需要更加强与中国学会之
间的合作，共同制定联合指南。举例来说，中国获得的一些
科学信息／数据越来越有需要在指南中得以体现，使这些信
息能在临床中实际得到应用。
有一点很重要的是，不同人群的基因不同，因此他们对
一种治疗方法可能是不同的反应。在这些方面我们有很多合
作的必要性。除此之外，我认为，我们ACC年轻会员之间也
有加强交流与合作的必要性。如此一来，心血管领域未来一
代的接班人就能够紧密团结，共同促进医疗事业的发展。
《门诊》：我们的确非常需要你们在指南方面的
经验。
Chazal教授：我们也同样十分需要你们的经验。我们
在不同的方面拥有各自丰富的经验。并不是只有技术方面才
被称作经验，有一些重要的经验是在如何有效利用资源的方
面。美国需要思考，如何培训一些全科医师，使他们能够承
担部分传统意义上由心血管医师承担的责任。在美国，心血
管医师的数量正在递减，因为这个医师群体越来越老龄化。
因此，我们亟需在这一方面学习中国的经验。我们需要理
解，中国如何利用较少的心血管医师资源为如此多的患者提
供医疗服务。你们有很多值得我们借鉴的地方。
《门诊》：您认为中国如何才能培养更多优秀的青
年医师？在美国，你们是如何做的？
Chazal教授：在过去的这些年间，美国是一个幸运
儿。在我们的社会中，医师这个职业被给予很高的社会地位
及认可度。成为一名医师十分令人骄傲，并且在收入方面得
到很高的回报。因此，过去这些年以来，我们的医疗领域很
容易获得最为优秀的人才。但是如今，这一方面变得具有挑
战。尽管如此，在美国，医疗服务行业仍然具有很大的吸引
力，因此美国直到现在仍是幸运的。
我认为，中国需要经过这样一个进化的过程，使医疗服
务在中国成为一个具有吸引力的行业，从而中国最优秀、最
出色的人才，无论性别都愿意选择医疗领域，为患者提供医
疗服务。医师数千年来是一个值得尊敬的职业。你们需要优
秀的医师。因此，在中国，有着巨大的机会。
我个人相信，不同国家之间的合作将促成这种局面的发
生。当不同国家的医师之间有更多的交流，他们会影响彼
此，他们也会影响他们的政府，使政府最终意识到发展医疗
事业的价值。
![026 门诊 CLINIC
东闻视野·国际瞭望 outlook
我们需要彼此的经验，我们提供更好的医疗
We learn from each other, We improve patient Care
在刚刚结束不久的OCC&CSC 2015大会上，一支美国心脏病学会（ACC）的心衰团队十分引
入注目。他们是参加此次中国学术峰会的所有A CC成员。这支心衰团队不仅举办自己的ACC分
会场，还参与ACC-CSC联合会场。《门诊》杂志希望传达ACC选择“心衰”作为讨论话题的原因
及意义，将其制作成本期ACC中国行特别报道，以飨读者。
ACC Heart Failure team arrived at OCC&CSC 2015 in Shanghai, China with its specific
topic – Heart Failure – every presenter in this team contributed his or her speech to
address the high concern of this chronic area both in the ACC Session and ACC-CSC
Union Session. Clinic Journal had an eye to this team and found the value of their address
in Conference. We collected some of their essential contents to form an [ACC Forum], in
which we hope to participate in the addressing of the importance of patient care of heart
failure area brought from US, impacting every place.](https://image.slidesharecdn.com/a82a3ed4-fbb9-4d96-8a9b-37195e31db79-170201021050/85/2015-10-ACC-1-320.jpg)
