Abstract Body (Do not enter title and authors here):
Introduction: Political advocacy is crucial for combating health inequities, improving population health, increasing funding of cardiovascular research, and promoting clinician wellbeing. The political activities of major cardiovascular organizations have not previously been characterized.

Methods: Lobbying expenditures for six major cardiovascular professional societies were queried from OpenSecrets. Campaign finance data for three cardiovascular political action committees (PACs), ACC’s HeartPAC, SCAI-PAC, and STS-PAC, were obtained directly from the Federal Election Commission. Descriptive statistics of each organization’s lobbying expenditures and PAC donations from members were compared to other medical specialties. Data were aggregated per year to assess trends between 2003-2023.

Results: From 2003-2023, the ACC and AHA spent $34,130,110 and $14,285,652 on lobbying, respectively. Other societies reported less robust and consistent lobbying expenditure over the study period: American Society of Echocardiography ($2,080,000), Heart Rhythm Society ($1,450,918), American Society of Nuclear Cardiology ($759,000), and Heart Failure Society of America ($140,000). Annually, the ACC and AHA spent more on lobbying compared to all other societies combined ($2,526,767 vs. $224,000). Temporal analysis revealed a meaningful increase for ACC, from $80,068 in 2003 to $1,890,000 by 2023 and a numerical decrease for AHA, from $570,000 in 2003 to $550,000 by 2023. Notably the American Society of Nuclear Cardiology and American Society of Echocardiography showed increases in annual lobbying expenditure over the study period ($10,000 to $90,000 and $40,000 to $200,000). HeartPAC and SCAI-PAC collected 19,326 donations from 2003-2023. HeartPAC received $7,015,821 from 6266 donors (median, $250) and SCAI PAC received $358,643 from 256 donors (median, $500). STS-PAC received $3,160,192 from 2231 donors (median, $500). Most donations to HeartPAC and SCAI-PAC came from cardiologists (95.5%), followed by administrators (1.0%) and executives (1.0%), and 2870 donations (14.9%) came from university-affiliated individuals.

Conclusion: The ACC and AHA remain key stakeholders in cardiovascular lobbying efforts. Several other medical specialties raise >two-fold greater PAC contributions compared to cardiovascular medicine. With the rising importance of advocacy to affect issues facing clinicians, enhancing cardiovascular society engagement would be an important political strategy.