 Thank you for the opportunity to be with you this this afternoon. I think this has been a great forum Already tweeted about it. Believe it or not, and that's one way I guess to to communicate and You know people back at the ACC can tweet to 10,000 people. So I mean this is We need to communicate the challenges and the opportunities that we have and I know These would So I think this is a great forum so What you will see is Won't be much different of some of the thoughts that you had here Bob Roberts a Previous chief at Baylor College of Medicine. I think it's a great for us to be able to do this in a duo I want to thank Bill Arjun here and Mary Ellen Belly-Voe who really helped also put this presentation together Well, what we'll address in the next 30 minutes before we get a bad sign from Terry is The diseases, I mean, what is the landscape that we're dealing with in cardiovascular disease? I know I know Donna had a nice preamble to that Will give you a feel for a survey that we did and our practitioners What are the current offerings and what are the future directions that the college is doing? So I'll do about 10 minutes then Bob will do 10 minutes and then we'll finish with another 10 minutes So this is the landscape from a cardiovascular disease point of view and we have to put it in the context of genetics genomics Mendelian diseases from HCM to long QT Marfan familial diet of cardiomyopathy in fact and you can add some more to it Unfortunately the most common diseases that we deal with and cardiovascular medicine Do not belong in that area Otherwise we would have been having a very different conversation this afternoon so the most common diseases More than 90 percent probably 95 percent of the diseases that we deal with are more of the complex genetic type So I think that pauses a challenge and that's part of the challenge that our practitioners and I just want to remind you I think this is an opportunity. I think was just you know talked about one is that The college represents 43,000 individuals professionals And in those professionals are the majority are physicians, but also nurse practitioners nurses and also has a Reach for international we have about 6,000 international members So whatever we decide whichever way from an education point of view and impact will have some Global impact in addition to the whole cardiovascular care team that we're dealing with And Donna also mentioned some pharmacogenetics opportunities and still challenges although they seem Very easy to apply if you look around in practice How many people are applying for pharmacogenetics to to this area of warfarin And clopidogrel is is still a minority Now, let me share with you a survey 150 cardiovascular professionals and these are across the board if you will representative of these 40,000 members meaning I would guess although I don't know exactly the numbers that maybe 20 25 percent are in academic practice And the other are various kind of practices although you need to know That probably cardiology and other specialties is the practitioners are going into a different model which will impact how we talk about genetics and order genetics, which is more of a employed model 70 percent of cardiologists nowadays are employed one way or another either in academic institutions or hospital systems And only 30 percent are in private practice the traditional model and things are still evolving So the impact of what we do certainly would affect what we're dealing with so To the question of what is personalized medicine to the physicians that are answering Genetic testing is the most common, but it's interesting what personalized medicine and it has some meanings To that particular person is their age group Their gender yes molecular diagnostics race Comorbidities and social economic status. So when we talk about personalized medicine Indeed, it probably has all these connotations and we're we're focusing mostly on genetics genomics today But when we personalize it obviously it has to take many of these other things Now to the question of percent of patient asking the cardiologist about personalized medicine The bottom line is about six percent of these patients now There is a heterogeneity depending on where you are if you're a referral center Obviously patients are coming in because of that But this is from the survey is about probably six percent of these patients are asking questions regarding Their own condition and probably about genetics about it Now percent of patients that cardiologists are using personalized medicine Not much different about seven percent It depends of where you are at times 20 percent of the patients that a cardiologist can see maybe in a In a really big referral center for hcm or other diseases I think that could be but this is in general about the same So we're talking about a conversation Somewhere somehow or at least on the radar screen which could be improved depending on the situation about six to seven percent The future of personalized medicine as to these individuals The vast majority are just not sure because they are a bit confused as to where is the field going going forward Now do they have hope for the future? Most of them put these categories to the future role of personalized medicine going forward Somewhat larger or much larger However, if you ask them and this is really if you want to ask me what is the bottom line This is the bottom line that we as a community have to address is What are the challenges to clinical implementation of personalized medicine one patient outcomes data Tell me that indeed it will change the outcome if I do this test or I do something different payment reform Looking at value who pays for what I think that the value question just came before CME Needing more knowledge regarding what are we talking about here Guidance from professional societies about 50 plus Patient education At the ACC we have a cardio smart.org. This is where our patient education portal And we'll like to infuse more and more data and information and patients asking questions regarding that But we still need to do quite a bit of that guidance from regulatory bodies Update to medical school curriculum Which is I think is important so and other so I think all of them in a way are relevant And and I think we have to whichever way we take this conversation We have to address Several of these challenges that we're dealing with and I really think that was to me among the most revealing Because these are individuals in different kind of practices from academic to private practice Rural or urban and I think they're asking and They're wondering About the situation they have hope for the future But they have quite a few challenges for us to take forward Now I'm going to ask bob to come and and tell us about some of the new discoveries and realities regarding Some of the diseases and cardiovascular medicine particularly where genetics has some