JULY 2019 VIEW ONLINE
Advocacy   Health Equity   ACA   Health Care   Drugs   FDA   Medicare   Practice   Research   Health Tech   Funding  
ADVOCACY NEWS
ABC, CRF Launches Leadership Initiative For Women and Minorities
In May, the Association of Black Cardiologists, Inc. (ABC) and the Cardiovascular Research Foundation (CRF) launched an on-going joint initiative called A New Beat, which is dedicated to creating a supportive community and sharing resources for women and minorities rising as leaders in the field of cardiology, so they can provide better access and improve care for all patients.

This new initiative will focus on the most recent medical and device-specific therapies for conditions that widely affect women and minorities, and for which they are currently being undertreated on a national level. This knowledge will be shared by leaders in medicine – both men and women – to promote early diagnosis, improved access, and quality of care with the goal of prioritizing the care of female and minority patients to eliminate gender and racial disparities in healthcare. In addition to the seminars, content will be available on ANewBeat.org and LinkedIn.

To learn more about the initiative’s first symposium and a recent FaceBook Live event, click below.
READ MORE
CMS Finalizes New Coverage Policy for TAVR
Last month, the Centers for Medicare and Medicaid Services (CMS) finalized updates to its coverage policy for Transcatheter Aortic Valve Replacement (TAVR). The decision is nearly identical to changes that were proposed by CMS in March 2018.

For over nine months, ABC advocated for modification of volume requirements, citing the low proportion of African Americans with aortic stenosis who actually receive TAVR. While the changes did not go as far as ABC had advocated, CMS did acknowledge comments submitted by ABC and others that existing volume requirements may limit some hospitals from establishing a TAVR program, particularly those in rural areas and those serving large minority populations. Although CMS said it anticipates the new volume requirements will allow more TAVR centers to develop, it is uncertain what future impact the changes will have on minority patient access to TAVR and their outcomes.

ABC is committed to removing barriers in access to care for African Americans and will continue to monitor minority patient access to TAVR. ABC thanks Dr. Aaron Horne, Co-Chair of the Structural Heart Disease Program, for his tireless efforts to improve access to TAVR among African Americans as well as all the members who responded to ABC’s call to action. To learn more click below.
READ MORE
ABC Seeks Improved Access to PCSK9 Inhibitors
On April 2, ABC sent a letter to the Centers for Medicare and Medicaid (CMS) asking that the Agency take steps to increase access to PCSK9 (Proprotein convertase subtilisin/kexin type 9) inhibitors for high-risk patients. The letter follows actions by Amgen, Sanofi and Regeneron to lower the list price of their PCSK9 inhibitors by 60 percent, which has not been met with a commensurate increase in patient access to these drugs.


Legislative approaches to healing the access crisis are looming. In particular, a recently passed Kentucky bill (Senate Bill 54) regarding prior authorization (PA) addressees many of the sources of delays and hindrances that prevent access. Additionally, national legislation (Improving Seniors' Timely Access to Care Act of 2019) introduced last month also focuses on, among other things, the multiple forms and redundant requirements for clinicians prescribing medications they deem medically necessary. However, many patients cannot currently afford newer and novel medications. Therefore, the lack of universal health care coverage and rising prescription drug prices will require additional measures, beyond PA legislation, in order to further decrease and ultimately eliminate disparate cardiovascular outcomes.
— Keith C. Ferdinand, MD, Chair, ABC Access to Care Initiative

ABC Unites with Other CV Societies in Support of Tobacco Legislation
ABC and ten other cardiovascular societies wrote letters to Congress to support two bills: - the Tobacco Free Youth Act and the Tobacco to 21 Act - aimed at reducing tobacco use in the U.S.

In the first letter, addressed to Senator Brian Schatz (D-Hawaii) and Representative Diana DeGette (D-Colorado), and the second letter, addressed to Senators Mitch McConnell (R-Kentucky) and Tim Kaine (D-Virginia), the eleven cardiology professional societies thanked them for their leadership in introducing the legislation and highlighted the important role each Act could play in helping to prevent chronic disease and protect public health by restricting youth access to tobacco products.

ACC spearheaded these advocacy efforts along with the ABC, the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Magnetic Resonance, Society for Vascular Medicine, Society of Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography and The Society of Thoracic Surgeons.
Dr. Icilma Fergus Rallies for Ban on Flavored Tobacco and E-cigarettes
In April, ABC Past President Icilma V. Fergus, MD, FACC, represented ABC at the Flavors Hook Kids NYC Campaign event at New York City Hall. This policy effort is aimed at limiting the availability of all flavors of tobacco and e-cigarettes — products that have a greater rate of usage by African-Americans, Latinos, women and youth. Legislation is pending before the New York City Council pertaining to flavored tobacco products and cigarettes. New York City Council bill (1362) would ban the sale of flavored electronic cigarettes. And, the other bill (1345) would ban the sale of menthol, mint and wintergreen flavored cigarettes. ABC has signed on as a partner of the Campaign.

Dr Fergus was also quoted in a news release issued in conjunction with the launch of the NYC Campaign: “Heart disease is the top killer for all Americans, and the risk is even higher for African-Americans. African-Americans can improve their odds at preventing cardiovascular disease by not smoking. Physicians can’t win this fight alone, however. City Council needs to help us end the predatory practices of the tobacco industry on young people who disproportionately use menthol-flavored products — a gateway to a life-long smoking addiction and heart disease.” Here is a clip on Facebook of Dr. Fergus speaking at the event and a post-event CBS news segment, where Dr. Fergus was interviewed.
HEALTH EQUITY NEWS
Three Big Questions For the AMA's New Chief Health Equity Officer
Pediatrician, preventive medicine and public health physician Aletha Maybank MD, MPH, has taken on the task of leading the AMA’s new Center for Health Equity, which the AMA House of Delegates directed the Association to create as part of sweeping policy on health equity adopted at the 2018 AMA Annual Meeting. Dr. Maybank took some time to answer three big questions about her role.
READ MORE
Assessing Payment in Social Determinants of Health Programs
The National Quality Forum is chipping away at the idea of payment as a key part of social determinants of health (SDOH) programming. Their Social Determinants of Health Payment Summit, being held in August this year, aims to uncover the best payment solutions addressing the SDOH.
READ MORE
$21 Million Study Will Research Health Disparities in the Rural South
The Risk Underlying Rural Areas Longitudinal (RURAL) project will study around 4,000 people who live in the rural South. Researchers from 16 institutions across the country are going to build a clinic on wheels that will house a full-sized CT scanner and travel to 10 counties across Alabama, Mississippi, Kentucky and Louisiana. Participants who enroll in the study will get a comprehensive health screening and genetic testing. They will also be interviewed about their environment and lifestyle choices.
READ MORE
Access to Healthcare Challenge for a Quarter of Rural Patients
Access to healthcare is a problem for individuals living in rural areas, with a quarter forgoing treatment even when they are experiencing pressing symptoms, according to survey data from the Robert Wood Johnson Foundation (RWJF). The survey, the second in a two-part series about rural America, looked at the experiences rural dwellers have accessing their healthcare.
READ MORE
Initiative Will Leverage UCSF's Economic Power to Promote Health Equity in San Francisco
UC San Francisco announced its intention to join a growing national movement to establish “anchor institutions” – universities and hospitals that are doubling down on their commitment to strengthen and support under-resourced populations – by hiring, buying and investing locally.
READ MORE
ACA NEWS
The ACA Is Helping Americans With CVD - But Not Enough
The Affordable Care Act increased access to healthcare and health insurance for millions of Americans after it was first implemented five years ago. But for CVD patients in particular, some experts argue the law is falling short. Since the ACA took full effect in January of 2014, U.S. citizens living with heart disease and CV risk factors have seen wider access to medical care, Ameen Barghi, of Harvard Medical School, and colleagues wrote in the Journal of General Internal Medicine. But certain corners of the country remain untouched by the ACA and, even with Medicaid expansion, some 20.6 million CV patients remained uninsured in 2015-2016.
READ MORE
Health Insurers Are Still Profiting From Obamacare in 2019
Coming off of a profitable 2018, health insurers were still making money selling plans on the individual insurance market, including the Affordable Care Act exchanges, during the first three months of this year, an analysis by the Kaiser Family Foundation shows. Insurers remained profitable even though the individual mandate requiring most people to buy health coverage was zeroed out and cheaper, skimpier short-term plans became widely available, researchers found.
READ MORE
Invalidating the ACA Would Eliminate Health Insurance For 20 Million People
More than 20 million nonelderly people will find themselves uninsured if an appellate court invalidates the Affordable Care Act, according to a new study from Urban Institute. Most of those losing coverage would be young adults, or from lower-income, working families earning below 200% of the federal poverty level, or $12,490, for one person.
READ MORE
Early ACA Exchange Rate Filings Signal an End to Massive Premium Hikes
Early exchange plan rates requested by insurers in several states suggest massive premium hikes may be a thing of the past. In Washington, for example, 13 payers that intend to participate in the state’s Affordable Care Act (ACA) markets have filed a “record low” average of under 1%, Washington’s Office of the Insurance Commissioner announced.
READ MORE
Supreme Court Takes Case on ACA Risk-Sharing Payments
The Supreme Court recently agreed to consider whether the federal government is obligated to pay billions of dollars to health insurers that participated in Affordable Care Act exchanges that offered policies to consumers.
READ MORE
Single-Payer Reform: "Medicare for All"
Single-payer reform could mitigate the stresses on patients and clinicians. A well-designed reform could potentially generate large savings on billing-related costs and lower drug prices, which would make expanded coverage more affordable.
READ MORE
HEALTH CARE NEWS
HHS to Delay Implementing 'Conscience Protection' Rule
The Department of Health and Human Services (HHS) is delaying until at least late November implementation of its "conscience protection" rule allowing healthcare providers to decline treatment and services to certain groups of people based on religious and moral beliefs, pending the outcome of several lawsuits over the regulation. HHS said in a court filing that it agreed to the delay "because it is the most efficient way to adjudicate the Final Rule on the merits" -- the rule was originally planned to be implemented on July 22.
READ MORE
Health Groups Call for Action on Climate to Protect Public Health
A declaration signed by scores of leading US medical and health groups, including the American Medical Association, the American Heart Association, the American Lung Association, and the American Association of Public Health—a total of 74 groups in all—sets forth that high public health costs are to be expected from continued global heating and issues a call for action.
READ MORE
Academy Pinpoints Strengths, Weaknesses in Draft Senate Bill
Robust investment in primary care, beefier safeguards for patients and a five-year reauthorization of the Teaching Health Center Graduate Medical Education program are among the virtues the Academy sees in a bill recently introduced in the Senate.The Lower Health Care Costs Act -- informed by a series of Health, Education, Labor and Pensions Committee hearings for which the AAFP has provided significant input -- includes policies that could benefit family physicians and yield better health outcomes, the Academy said in a June 5 letter to the committee in advance of its June 18 hearing on the draft legislation.
READ MORE
States Sue HHS Moral Objections Rule, Claim Care Access Violations
A coalition of 23 state and local governments have filed a joint lawsuit against the Department of Health & Human Services (HHS), claiming that a recent rule regarding providers’ moral objections to certain medical care in fact infringes upon citizens’ rights to access healthcare.
READ MORE
Female Lawmakers Launch First Black Maternal Health Caucus
A record number of women were elected to Congress last year, and two congresswomen are showing their power by shining a spotlight on critical women’s issues. Freshman Rep. Lauren Underwood, D-Ill., and Rep. Alma Adams, D-N.C., have launched the Black Maternal Health Caucus to address the U.S. epidemic of black women dying in pregnancy-related deaths.

You can watch the press conference here.
READ MORE
PHARMACEUTICAL NEWS
Inclisiran Safe and Effective in Patients With Impaired Renal Function: ORION
Inclisiran, a small, interfering RNA (siRNA) that targets the synthesis of PCSK9 in the liver, can be safely given to patients with and without impaired renal function, as well as to patients with rare homozygous familial hypercholesterolemia (FH), according to new data. In an analysis of the ORION-7 and ORION-1 studies, inclisiran (The Medicines Company) significantly lowered LDL cholesterol levels in patients with normal renal function and in those with varying degrees of kidney impairment.
READ MORE
Surprise! Drug Prices Continue to Soar
The cost of brand-name medications continues to rise, regardless of generic or biosimilar competition, a study showed. Of the 49 common top-selling brand name drugs examined, 44% at least doubled in price from January 2012 through December 2017. Among the drugs available since the beginning of that period, 78% have seen a rise in out-of-pocket and insurer costs of over 50%.
READ MORE
Sanofi Cuts 466 Jobs, All Ties to New CV Research
French drugmaker Sanofi is cutting 466 jobs as part of an R&D “reshuffle” that will also put an end to the company’s new research efforts in cardiology, Reuters reports. A spokesperson said on June 19 the reorganization of Sanofi’s R&D department will allow the company to concentrate its research efforts on cancer, immunology, rare diseases and vaccines.
READ MORE
FDA NEWS
FDA Clears Biotronik's Next-Gen Injectable Cardiac Monitor
Biotronik on July 8 announced its BIOMONITOR III injectable cardiac monitor (ICM), a diagnostic tool designed to document suspected arrhythmias, has been cleared by the FDA. The BIOMONITOR III device is 60% smaller than its predecessor and comes pre-loaded in an injection tool, facilitating the ICM insertion process. The single-piece injector can be easily used in clinical settings, according to a release, and Biotronik says it supports reduced case times and lower procedural costs in patients with suspected arrhythmias or unexplained syncope.
READ MORE
Empagliflozin Earns FDA Fast Track Designation for Chronic Heart Failure
Fast Track designation for empagliflozin (Jardiance, Boehringer Ingelheim and Eli Lilly) has been granted by the FDA for a new indication. According to Boehringer Ingelheim, the drug has earned the designation for reducing the risk of cardiovascular death and hospitalization for heart failure in people with chronic heart failure.
READ MORE
FDA Program Streamlines Expanded Patient Access to Treatments
The Food and Drug Administration has officially launched Project Facilitate, a new program to help providers with submission to the Expanded Access program, which FDA has set up to create patient access to treatments when they are seriously ill.
READ MORE
FDA Clears First Anticoagulant for Pediatric Patients With VTE or PE
The U.S. Food and Drug Administration (FDA) approved Fragmin (dalteparin sodium) injection, for subcutaneous use, to reduce the recurrence of symptomatic venous thromboembolism (VTE) in pediatric patients one month of age and older. VTE can include deep vein thrombosis (DVT) and pulmonary embolism (PE), which can lead to death.
READ MORE
Social Monitoring: How the FDA Mined Social Media to Gain Insights About Patients With Diabetes
The US Department of Health and Human Services’ Office of Minority Health funded a pilot study to analyze social media posts for useful data about minority patients with diabetes and their treatment. During the last 2 years, the agency used data-mining software to collect, monitor, and analyze more than 100,000 conversations on Twitter. The effort targeted a variety of keywords, including diabetes, glucose, diabetic, and blood sugar.
READ MORE
Federal Judge: Illegal Actions by FDA Fueled E-Cig Epidemic
U.S. District Judge Paul W. Grimm, of the U.S. District Court for the District of Maryland, ruled in favor of six American medical societies and five individual pediatricians Wednesday a year after the groups filed a lawsuit challenging the FDA’s decision to allow electronic cigarettes and cigars to remain on the commercial market until 2022 without obtaining FDA approval.
READ MORE
MEDICARE NEWS
CMS Proposes to Relax Medicaid Patient Care Access Measures
A new proposed rule from CMS could relax some regulations related to care access for Medicaid beneficiaries, leaving states much to their own devices when monitoring and mandating patient care access for different Medicaid plans. Previously, state Medicaid programs were beholden to federal mandates for network adequacy in Medicaid programs.
READ MORE
CMS Proposes Rule to Set Part D Electronic Prior Authorization Standards
Streamlining the prior authorization process through electronic means has been a goal for HHS, and the head of the Office of the National Coordinator for Health IT, Don Rucker, spoke earlier this month about encouraging more providers to adopt the process. Rucker told the audience at Academy Health's annual research conference current prior authorizations practices are a "non-computerized kabuki of payment" and should be overhauled. He said it "may be the battlefield" for better integrating financial, clinical and quality data.
READ MORE
CMS Action Aims to Lower Prescription Drug Prices, Increase Cost Transparency
The Centers for Medicare & Medicaid Services (CMS) issued a final rule in May for improving and modernizing the Medicare Advantage and Part D programs. In a joint statement reacting to the final rule, the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) said that the changes failed to reform pharmacy DIR (“direct and indirect remuneration”) - to the detriment of seniors and community pharmacies.
READ MORE
Drug Makers Sue HHS Over Rule Mandating They Post the List Price of Drugs in TV Ads
Three pharmaceutical companies and the Association of National Advertisers have sued the Department of Health and Human Services over its rule requiring the list price of prescription drugs be posted in television ads. Merck, Eli Lilly, Amgen and the association brought the lawsuit to the U.S. District Court in Washington, D.C. They want the rule declared invalid as it includes a disclosure of the "Wholesale Acquisition Cost" of the product.
READ MORE
PRACTICE NEWS
Four Reasons Why and Four Easy Ways to Stay On Top of Your Online Reputation
Investing time in verifying and enhancing your online information may be the most cost-effective forms of marketing ever. But new patient marketing is only one of many ways your online reputation affects the health of your practice business. There are other reasons why you should keep tabs on how you’re viewed online, even if you’re not actively marketing for growth. Here are four that you may not have thought of — plus four easy ways to fit online reputation management into your workflow.
READ MORE
How to Create a Vibrant Culture in Your Private Practice
Physician practice owners wear multiple hats—as clinical and management leaders, and as chief strategists—to ensure that the needs of patients and team members are met by increasing practice efficiencies, improving patient care and enhancing professional satisfaction. Physician burnout adds urgency to making the right choices for your practice, as the causes and remedies of physician burnout are strongly linked to workplace factors. The AMA offers the resources and support physicians need to start and sustain success on the path to private practice.
READ MORE
Doctors Get New Way to Voice Medical Technology Development Needs
There are people who believe that, instead of creating new burdensome tasks that serve as obstacles to patient care, technology can be used to address concerns physician practices face every day. The new Clinical Problem Database is one example of this idea at work.
READ MORE
The Growing Cyber Threat to Physician Practices
Right now, medical practices are being attacked by cybercriminals. Emails are being sent in the hope a practice employee will click on a link that will install ransomware, hackers are exploiting security flaws in medical equipment with internet connections, and information is being gathered from social media to trick staffers into revealing patient or financial records.
READ MORE
How to Survive Staff Shortages
It’s a problem most small- to medium-sized practices face at some point: A staff member quits unexpectedly or goes on leave for a long period of time because of pregnancy, illness, accident, or emergency. How the practice compensates for that staffing shortage can affect its revenues, workloads, staff morale, and even the quality of care patients receive.
READ MORE
RESEARCH NEWS
Blood Proteins Help Predict Risk of Developing Heart Failure
Cardiovascular disease remains the leading cause of pain, suffering and death in the United States, and despite tremendous advances in knowledge on prevention, treatment of risk factors such as cholesterol, blood pressure and obesity is not optimal. One of the goals of Dr. Christie Ballantyne’s lab at Baylor College of Medicine is studying whether novel biomarkers, in combination with other factors, might be useful in identifying individuals at high risk for cardiovascular disease.
READ MORE
Enzyme May Indicate Predisposition to Cardiovascular Disease
Measuring the blood plasma levels of an enzyme called PDIA1 could one day become a method of diagnosing a person's predisposition to cardiovascular disease even if they are healthy, i.e., not obese, diabetic or a smoker, and with normal cholesterol. This is suggested by a study published in the journal Redox Biology by Brazilian researchers affiliated with the University of São Paulo (USP), the University of Campinas (UNICAMP) and Butantan Institute.
READ MORE
T-Cells in Arterial Plaque Could Signal Stroke Risk
Researchers have linked a specific type of immune cell found in arterial plaque to increased probability of a stroke or mini-stroke. Chiara Giannarelli, MD, PhD, and colleagues’ study dissected and scrutinized human plaque in an effort to identify markers that might flag a patient as high-risk for vascular dysfunction, according to a release. The researchers presented their findings at the American Heart Association’s Vascular Discovery Scientific Sessions in Boston.
READ MORE
Novel Cardiometabolic Staging Tool Predicts T2D Risk in Diverse Population
A weighted cardiometabolic disease staging risk score can be used to quantify race- and sex-specific type 2 diabetes risk in a large, diverse population, according to study results presented at the American Association of Clinical Endocrinologists 28th Annual Scientific & Clinical Congress, held in Los Angeles, California.
READ MORE
Warning Signs: Many Cardiac-Arrest Victims Visited Doctors, Emergency Rooms Prior to Events
Challenging the conventional wisdom that out-of-hospital cardiac arrest occurs without warning, new data show that more than one in four patients experiencing arrest have actually been previously assessed in an emergency room within the 90 days before their event. What’s more, many visited their primary care physician in the months leading up to the cardiac arrest, the researchers note.
READ MORE
Big Picture Genetic Scoring Approach Reliably Predicts Heart Disease
Specialized risk scores derived from testing that calculates the cumulative effect of an individual’s entire DNA sequence may reliably predict heart disease in people who have not yet had a heart attack, according to new research. The research is published in Circulation: Genomic and Precision Medicine, an American Heart Association journal.
READ MORE
HEALTH TECH & TELEMEDICINE
CVS Health Expands Direct-to-Consumer Telehealth Service to 26 States
One of the nation’s largest pharmacy chains has extended its telehealth footprint to more than half of the country. CVS Health recently announced that its MinuteClinic service is now available through the Teladoc Health telemedicine platform to residents in eight more states, bringing the total number of states capable of accessing the connected health service to 26 and the District of Columbia.
READ MORE
Top Medical Uses of the New Apple Watch
The new Apple Watch has been making headlines with its new electrocardiogram (ECG) capability. Apple may be revolutionizing disease diagnosis and management via continuous monitoring of the patient. In this article, we have curated some of the most recent announcements regarding the Apple Watch in healthcare endeavors.
READ MORE
AI Algorithm Assists in Detection of Aortic Stenosis
Berkeley, Calif.-based digital health company Eko unveiled an investigational aortic stenosis (AS) detection algorithm at the American Society of Echocardiography (ASE) 2019 Scientific Sessions in Portland, Ore., aimed to assist healthcare providers in the early detection of clinically significant AS. Developed and tested in partnership with the Northwestern Medicine Bluhm Cardiovascular Institute, the early study results showed Eko’s artificial intelligence (AI) was able to accurately detect AS in a cohort of aortic stenosis patients with a sensitivity of 97.2 percent and a specificity of 86.4 percent.
READ MORE
How California Could Pave the Way for Text Messages in Medicaid
Consumer research has shown that 97 percent of Americans text at least once a day and that the texting is the number one mode of communication among people under 50. For significant swathes of the Medicaid population especially, the mobile phone acts as a central communication device and their portal to internet connectivity. It’s no surprise then, that text messages have emerged as a preferred option for many patients in how they communicate with their healthcare providers and more consistently engage with their health.
READ MORE
How Artificial Intelligence Can Predict and Detect Stroke
With its increasing role in medical imaging, artificial intelligence (AI) gradually is becoming a go-to technology for building custom healthcare software to diagnose a wide range of diseases, from diabetic retinopathy to skin cancer. With several vendors now working on stroke detection AI algorithms and a few of these recently gaining U.S. Food and Drug Administration (FDA) approval, stroke may be the next frontier to conquer.
READ MORE

FUNDING OPPORTUNITIES



2019-2020 AHA Research Funding Application Programs
Applications are open for AHA Research Awards and Fellowship Programs! We encourage applications by women, underrepresented minorities in the sciences and those who have experienced varied/non-traditional career trajectories.
APPLY TODAY
Diagnostic Excellence Initiative: Improving the Experience and Outcomes of Patient Care
The Gordon and Betty Moore Foundation is accepting applications for novel ideas and approaches for developing new clinical measures to improve diagnosis. The applications deadline is Friday, August 2, 2019. Achieving excellence in diagnosis goes beyond avoiding errors and includes consideration of cost, timeliness and patient convenience. Designing an optimal diagnostic process will require a careful balancing among these competing demands. Our work to improve diagnostic performance will focus on three clinical categories – acute vascular events, infections and cancers.
APPLY TODAY
UPCOMING EVENTS



JULY IS...
Minority Mental Health Month

SEE THE FULL EVENTS CALENDAR
This email was sent to ##email## by Association of Black Cardiologists, powered by Powered by Multiview's Content Marketing
Engage your customer base. Launch your Content Marketing program today.
Archive | View Online | Unsubscribe | Subscribe