CARDIOVASCULAR CARE IN THE 21ST CENTURY

Although clinical outcomes among patients with a variety of cardiac diseases have improved over recent decades, the incidence
of diseases such as heart failure and ischemic heart disease continues to increase as the population ages. Additionally, as the
globe grows increasingly smaller and previously rural populations are exposed to modern West- ern diets and habits such as
tobacco use, there has been an explosion of atherosclerotic disease around the world, including in countries with emerging
economies.117,118 The global epidemics of obesity, diabetes, and cardiovascular disease require global collaborations addressing
prevention, detection, and treatment of cardiac disease (http://www .world-heart-federation.org).

The practice of cardiovascular medicine has evolved as well from one centered on observation and treatment based on
empiricism to one reliant on science, guidelines, and the delivery of measurable qual- ity care. 119 The challenge of the next decade
will be to establish which therapies truly work best for which patients, 120 to move toward the goal of precision health/medicine, 121
and to advocate for the successful delivery of those therapies to patients with cardiovascular disease.

Imaging technologies will continue to improve in their technical sophistication, but societal cost demands will place the burden
for establishing their incremental benefit back on the cardiovascular com- munity, which must be poised to both understand and
participate in the required research that demonstrates the added/incremental value. Endovascular and surgical techniques will
evolve and encourage greater collaboration among sub-subspecialists to offer state-of-the-art vascular care to an increasingly
older population affli