Assuntos
Cardiologia , Estados Unidos , Humanos , American Heart Association , Relatório de Pesquisa , Política de SaúdeRESUMO
Cardiovascular risk stratification is often performed in patients considered for renal transplantation. In a single center, we sought to examine the association between abnormal stress testing with imaging and post-renal transplant major adverse cardiovascular events (MACE) using multivariable logistic regression. From January 2006 to May 2016 232 patients underwent renal transplantation and 59 (25%) had an abnormal stress test result. Compared to patients with a normal stress test, patients with an abnormal stress test had a higher prevalence of dyslipidemia, diabetes mellitus, obesity, coronary artery disease (CAD), and heart failure. Among those with an abnormal result, 45 (76%) had mild, 10 (17%) moderate, and 4 (7%) severe ischemia. In our cohort, 9 patients (3.9%) had MACE at 30-days post-transplant, 5 of whom had an abnormal stress test. The long-term MACE rate, at a median of 5 years, was 32%. After adjustment, diabetes (OR 2.37, 95% CI 1.12-5.00, p = 0.02), CAD (OR: 3.05, 95% CI 1.30-7.14, p = 0.01) and atrial fibrillation (OR: 5.86, 95% CI 1.86-18.44, p = 0.002) were independently associated with long-term MACE, but an abnormal stress test was not (OR: 0.83, 95% CI 0.37-1.92, p = 0.68). In conclusion, cardiac stress testing was not an independent predictor of long-term MACE among patients undergoing renal transplant.
Assuntos
Doenças Cardiovasculares/complicações , Teste de Esforço , Transplante de Rim , Insuficiência Renal Crônica/complicações , Adulto , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Doenças Cardiovasculares/epidemiologia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Insuficiência Renal Crônica/patologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Fatores de RiscoAssuntos
COVID-19 , Cardiologia/educação , Educação Baseada em Competências/organização & administração , Educação de Pós-Graduação em Medicina/organização & administração , Educação , Bolsas de Estudo , COVID-19/epidemiologia , COVID-19/prevenção & controle , Competência Clínica , Controle de Doenças Transmissíveis , Educação/métodos , Educação/tendências , Bolsas de Estudo/métodos , Bolsas de Estudo/tendências , Humanos , Inovação Organizacional , SARS-CoV-2 , Estados Unidos/epidemiologiaRESUMO
Background The lack of diversity in the cardiovascular physician workforce is thought to be an important driver of racial and sex disparities in cardiac care. Cardiology fellowship program directors play a critical role in shaping the cardiology workforce. Methods and Results To assess program directors' perceptions about diversity and barriers to enhancing diversity, the authors conducted a survey of 513 fellowship program directors or associate directors from 193 unique adult cardiology fellowship training programs. The response rate was 21% of all individuals (110/513) representing 57% of US general adult cardiology training programs (110/193). While 69% of respondents endorsed the belief that diversity is a driver of excellence in health care, only 26% could quote 1 to 2 references to support this statement. Sixty-three percent of respondents agreed that "our program is diverse already so diversity does not need to be increased." Only 6% of respondents listed diversity as a top 3 priority when creating the cardiovascular fellowship rank list. Conclusions These findings suggest that while program directors generally believe that diversity enhances quality, they are less familiar with the literature that supports that contention and they may not share a unified definition of "diversity." This may result in diversity enhancement having a low priority. The authors propose several strategies to engage fellowship training program directors in efforts to diversify cardiology fellowship training programs.
Assuntos
Cardiologia/educação , Educação/ética , Bolsas de Estudo/métodos , Médicos/psicologia , Cardiologia/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Diversidade Cultural , Educação/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/métodos , Feminino , Mão de Obra em Saúde , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Percepção , Preconceito , Inquéritos e QuestionáriosAssuntos
Serviço Hospitalar de Cardiologia , Cardiologia/educação , Doenças Cardiovasculares , Infecções por Coronavirus , Educação/organização & administração , Pandemias , Pneumonia Viral , Aprendizagem Baseada em Problemas/métodos , Betacoronavirus , COVID-19 , Serviço Hospitalar de Cardiologia/organização & administração , Serviço Hospitalar de Cardiologia/tendências , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Educação a Distância/métodos , Humanos , Controle de Infecções/métodos , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , SARS-CoV-2 , Comunicação por Videoconferência/organização & administraçãoAssuntos
Cardiologia/educação , Ecocardiografia/normas , Educação Médica Continuada , Educação de Pós-Graduação em Medicina , Competência Clínica , Consenso , Currículo , Avaliação Educacional/normas , Bolsas de Estudo , Humanos , Sociedades Médicas , Conselhos de Especialidade Profissional , Estados UnidosRESUMO
PURPOSE OF REVIEW: To summarize current training guidelines for cardiac imaging and provide recommendations for future guidelines. RECENT FINDINGS: The current structure of training in cardiac imaging is largely dictated by modality-specific guidelines. While there has been debate on how to define the advanced cardiac imager for over a decade, a uniform consensus has not emerged. We report the perspectives of three key stakeholders in this debate: a senior faculty member-former fellowship program director, a cardiology fellow, and an academic junior faculty imaging expert. The observations of these stakeholders suggest that there is no consensus on the definition of advanced cardiac imaging, leading to ambiguity in training guidelines. This may have negative impact on recruitment of fellows into cardiac imaging careers. Based on the current status of training in cardiac imaging, the authors suggest that the relevant professional groups reconvene to form a consensus in defining advanced cardiac imaging, in order to guide future revisions of training guidelines.
Assuntos
Técnicas de Imagem Cardíaca , Cardiologia/educação , Educação de Pós-Graduação em Medicina/métodos , Bolsas de Estudo/normas , Guias de Prática Clínica como Assunto , Cardiologia/normas , Competência Clínica , Ecocardiografia , Educação de Pós-Graduação em Medicina/normas , Humanos , Imageamento por Ressonância MagnéticaRESUMO
Academic medical centers (AMCs) are presently facing enormous challenges arising from a prospective decline in government funding for research and education, shifting payment models emphasizing efficiency and value, and increasing competition. Left unabated, these challenges will drive many AMCs to de-emphasize or forsake their core missions in an effort to survive. Stemming from a symposium held at the 2015 Scientific Sessions of the American College of Cardiology titled, "The Academic Medical Center of the Future," we propose a series of changes, including internal restructuring, system-wide partnership, and novel approaches to support research and education, that are designed to better position AMCs to compete and face their growing challenges in a manner that preserves their essential missions. In aggregate, these changes will facilitate establishing the academic medical system of the future.