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1.
Circulation ; 146(16): e229-e241, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36120864

RESUMO

Academic medicine as a practice model provides unique benefits to society. Clinical care remains an important part of the academic mission; however, equally important are the educational and research missions. More specifically, the sustainability of health care in the United States relies on an educated and expertly trained physician workforce directly provided by academic medicine models. Similarly, the research charge to deliver innovation and discovery to improve health care and to cure disease is key to academic missions. Therefore, to support and promote the growth and sustainability of academic medicine, attracting and engaging top talent from fellows in training and early career faculty is of vital importance. However, as the health care needs of the nation have risen, clinicians have experienced unprecedented demand, and individual wellness and burnout have been examined more closely. Here, we provide a close look at the unique drivers of burnout in academic cardiovascular medicine and propose system-level and personal interventions to support individual wellness in this model.


Assuntos
Esgotamento Profissional , Medicina , Médicos , American Heart Association , Esgotamento Profissional/prevenção & controle , Atenção à Saúde , Humanos , Estados Unidos
2.
Stroke ; 46(6): 1525-32, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25953368

RESUMO

BACKGROUND AND PURPOSE: It is not known whether racial or ethnic disparities observed with other revascularization procedures are also seen with carotid artery stenting (CAS) and endarterectomy (CEA). METHODS: We compared the utilization and outcomes of CAS and CEA across racial/ethnic groups within the CARE Registry between May 2007 and December 2012. RESULTS: Between 2007 and 2012, of the 13 129 patients who underwent CAS, majority were non-Hispanic whites (89.3%), followed by blacks (4.4%), Hispanics (4.3%), and other groups (2.0%). A similar distribution was observed among the 10 953 patients undergoing CEA (non-Hispanic whites, 92.6%; blacks, 3.5%; Hispanics, 2.8%; and other groups, 1.1%). During this time period, a trend toward proportionate increase in CAS utilization was observed in non-Hispanic whites and other groups, whereas the opposite was observed among Hispanics and blacks. This trend persisted even when hospitals performing both CAS and CEA were exclusively analyzed. Adherence to antiplatelet and statin therapy was significantly lower among blacks post CEA. In-hospital major adverse cardiac and cerebrovascular events remained comparable across groups post CAS and CEA. At 30 days, the incidence of stroke (7.2%) and major adverse cardiac and cerebrovascular events (8.8%) was higher among blacks post CEA (P<0.05), after risk adjustment. CONCLUSION: During the study period, utilization of CAS and CEA was highest among non-Hispanic whites. There was a trend toward increased CAS utilization over time among non-Hispanic whites and other groups, and a trend toward increased CEA utilization among Hispanics and blacks. In-hospital major adverse cardiac and cerebrovascular events remained comparable between groups, whereas 30-day major adverse cardiac and cerebrovascular events were significantly higher in blacks.


Assuntos
Negro ou Afro-Americano , Revascularização Cerebral/efeitos adversos , Endarterectomia das Carótidas/efeitos adversos , Cardiopatias , Hispânico ou Latino , Sistema de Registros , Acidente Vascular Cerebral , População Branca , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Cardiopatias/epidemiologia , Cardiopatias/etnologia , Cardiopatias/etiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Incidência , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/administração & dosagem , Stents , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/etiologia , Estados Unidos
3.
Echocardiography ; 31(5): E145-6, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24495221

RESUMO

This case highlights the utility of agitated saline studies during transesophageal echocardiography (TEE) for detection of pulmonary arteriovenous malformations (PAVM) as a viable alternative to contrast-enhanced imaging studies. By carefully studying each pulmonary vein individually during saline contrast studies, TEE is able to demonstrate and localize PAVM. In addition, this report represents the first documentation of PAVM arising as a complication of graft-versus-host disease after allogeneic hematopoietic stem cell transplant.


Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Doença Enxerto-Hospedeiro/diagnóstico por imagem , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hipóxia/etiologia , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Malformações Arteriovenosas/complicações , Diagnóstico Diferencial , Doença Enxerto-Hospedeiro/complicações , Humanos , Hipóxia/diagnóstico , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem
4.
Echocardiography ; 31(6): E181-4, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24661120

RESUMO

Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly that can be congenital or acquired. We report 2 cases of SVA. The first case involves a 59-year-old male presenting with frequent syncope. Echocardiogram revealed a large right SVA obstructing the right ventricular outflow tract (RVOT). The second case involves a 21-year-old female presenting with sudden onset chest pain and a continuous machinery murmur. Echocardiogram revealed a ruptured right SVA into the right atrium. Although advanced percutaneous techniques have been implemented in the correction of this anomaly, open-heart surgery with or without aortic valve replacement remains the treatment of choice.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Dor no Peito/etiologia , Seio Aórtico/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/etiologia , Aneurisma Roto/cirurgia , Aneurisma Aórtico/cirurgia , Dor no Peito/diagnóstico , Dor no Peito/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seio Aórtico/cirurgia , Resultado do Tratamento , Ultrassonografia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adulto Jovem
5.
Echocardiography ; 28(7): 775-81, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21752091

RESUMO

BACKGROUND: Pulmonary vein (PV) antrum isolation with ganglionated plexi (GP) ablation is a novel atrial fibrillation (AF) ablation technique. The aim of this study was to evaluate acute changes in left atrial and PV flow velocities following PV antrum isolation with GP ablation using transesophageal echocardiography (TEE). METHODS: TEE was performed before and after PV antrum isolation with GP ablation in 88 consecutive patients. All four PVs, when possible, were analyzed with regard to peak systolic and diastolic pulsed-wave Doppler flow velocities. Left atrial appendage emptying velocities were also obtained. PV stenosis was defined as a peak PV Doppler flow velocity of ≥110 cm/sec with spectral broadening (turbulence). RESULTS: All but four right inferior and four left inferior PVs were visualized. Compared to preablation values, both PV systolic and diastolic velocities increased after ablation (P < 0.05 for each of the four PVs). However, the systolic to diastolic ratio decreased significantly after ablation in all PVs (1.3 ± 0.6 to 0.9 ± 0.4, P < 0.0001, 1.2 ± 0.7 to 0.9 ± 0.4, P < 0.0001, 1.2 ± 0.6 to 1.0 ± 0.6, P = 0.035 and 1.1 ± 0.5 to 0.9 ± 0.5, P = 0.0001, for left superior, left inferior, right superior and right inferior PV, respectively). Left atrial appendage emptying velocities showed a trend towards higher values following ablation (62.7 ± 26.1 cm/sec vs. 67.5 ± 23.2 cm/sec, P = 0.07). Asymptomatic PV stenosis occurred in seven patients (seven PVs). CONCLUSIONS: PV antrum isolation with GP ablation acutely increased PV flow velocities and altered the pattern of PV Doppler flow signal, likely correlating with increased left atrial pressures, but did not appear to adversely impact on left atrial appendage physiology.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Ecocardiografia Transesofagiana/métodos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Adulto , Idoso , Fibrilação Atrial/fisiopatologia , Velocidade do Fluxo Sanguíneo , Comorbidade , Feminino , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/fisiopatologia , Reoperação
7.
Echocardiography ; 27(9): 1141-6, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20678129

RESUMO

AIMS: Pulmonary vein (PV) stenosis is a potentially serious complication of catheter ablation of atrial fibrillation (AF). The optimal method for diagnosis of PV stenosis has not been established. We undertook a systematic review of the literature to investigate the diagnostic performance of transesophageal echocardiography (TEE) for the detection of PV stenosis after catheter ablation of AF. METHODS: We searched MEDLINE and EMBASE databases for studies evaluating the diagnostic performance of TEE for the detection of PV stenosis after catheter ablation of AF, compared to a reference standard of PV angiography, magnetic resonance imaging (MRI), or computed tomography (CT). Study quality was assessed using the QUADAS tool. RESULTS: A total of seven studies that included 344 patients (1,344 PVs) met the selection criteria. Of these, three studies used PV angiography as the reference standard, while MRI and CT were used in two studies each. Compared to PV angiography, TEE had sensitivity between 82% and 100% and specificity between 98% and 100%. Compared to MRI, TEE sensitivity was 100% in both studies, while the specificity ranged between 98% and 99%. Compared to CT, TEE had sensitivity between 86% and 100% and specificity of 95%. Quality of the reviewed studies was somewhat limited by the retrospective design in most of the studies. CONCLUSIONS: TEE has a high sensitivity and specificity in detecting PV stenosis. Given its wide availability and favorable side effect profile, these data suggest that TEE is very useful tool for the diagnosis of PV stenosis after catheter ablation of AF.


Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/estatística & dados numéricos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Pneumopatia Veno-Oclusiva/diagnóstico por imagem , Pneumopatia Veno-Oclusiva/epidemiologia , Fibrilação Atrial/diagnóstico por imagem , Comorbidade , Feminino , Humanos , Incidência , Masculino , Medição de Risco , Resultado do Tratamento
8.
JACC Basic Transl Sci ; 5(12): 1181-1186, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33426375

RESUMO

The effects of mentorship on measurable outcomes of success and the aspects of mentorship that are most valuable in promoting the careers of cardiologists are unclear. To address this, we conducted a large-scale survey of cardiologists in a real-world setting. We identified factors that enhance the mentorship experience, and found that mentee needs change with career stage. Importantly, satisfaction with the mentoring relationship is significantly associated with perceived satisfaction in achieving professional goals. Furthermore, we found that gender and race concordance in mentoring relationships is an important variable with the potential to increase diversity in the field of cardiology.

9.
J Am Heart Assoc ; 9(17): e017196, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32838627

RESUMO

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 Questionários
12.
Catheter Cardiovasc Interv ; 82(2): E69-111, 2013 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-23653399
14.
J Clin Hypertens (Greenwich) ; 10(3): 219-25, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18326964

RESUMO

Hypertension in older adults is not well controlled in clinical practice. Isolated systolic hypertension is often more difficult to manage. A systematic PubMed search was conducted to look for evidence showing benefits of lowering blood pressure (BP) in older hypertensive adults. Lowering BP in these individuals significantly reduces the risk of coronary artery disease, stroke, and cardiovascular and all-cause mortality. Based on trial evidence, a low-dose diuretic should be considered the most appropriate first-step treatment for preventing cardiovascular morbidity and mortality. Therapy with >1 medication is often necessary to reduce BP in these patients. There is unequivocal evidence that cardiovascular events can be prevented in older adults, even those older than 80 years, by treating hypertension.


Assuntos
Anti-Hipertensivos/uso terapêutico , Doença das Coronárias/prevenção & controle , Medicina Baseada em Evidências , Hipertensão/tratamento farmacológico , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Doença das Coronárias/mortalidade , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Hipertensão/mortalidade , Masculino , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Acidente Vascular Cerebral/mortalidade
16.
J Am Coll Cardiol ; 70(18): 2290-2303, 2017 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-29073958

RESUMO

Early-career academic cardiologists, who many believe are an important component of the future of cardiovascular care, face myriad challenges. The Early Career Section Academic Working Group of the American College of Cardiology, with senior leadership support, assessed the progress of this cohort from 2013 to 2016 with a global perspective. Data consisted of accessing National Heart, Lung, and Blood Institute public information, data from the American Heart Association and international organizations, and a membership-wide survey. Although the National Heart, Lung, and Blood Institute increased funding of career development grants, only a small number of early-career American College of Cardiology members have benefited as funding of the entire cohort has decreased. Personal motivation, institutional support, and collaborators continued to be positive influential factors. Surprisingly, mentoring ceased to correlate positively with obtaining external grants. The totality of findings suggests that the status of early-career academic cardiologists remains challenging; therefore, the authors recommend a set of attainable solutions.


Assuntos
Cardiologistas/educação , Cardiologia/educação , Escolha da Profissão , Mentores/educação , Cardiologistas/economia , Cardiologistas/tendências , Cardiologia/economia , Cardiologia/tendências , Humanos , Apoio à Pesquisa como Assunto/economia , Apoio à Pesquisa como Assunto/tendências
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