Cardiology Subspecialty Research Articles

Recommendations for the training and practice of fetal cardiology from the Association of European Paediatric Cardiology.

Prenatal detection of cardiac abnormalities has increased significantly over the past few decades, such that fetal cardiology has developed into a sub-specialty of paediatric and congenital cardiology. As this speciality develops further and extends across Europe and more globally, it is important to standardize the requirements for training and subsequent practice, to optimize prenatal diagnosis and perinatal care. In addition to the knowledge and technical skills required to make a correct diagnosis, the counseling of families after diagnosis and the planning of appropriate perinatal management is equally important. The aim of these recommendations is to provide a framework for both basic and advanced training for paediatric cardiologists wishing to practice as fetal cardiologists, as well as highlighting requisites for a fetal cardiology service. All aspects regarding training in fetal cardiology and service provision are addressed including diagnosis, counseling and management.

Transthyretin amyloid cardiomyopathy: Literature review and red-flag symptom clusters for each cardiology specialty.

Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is a progressive and infiltrative cardiac disorder that may cause fatal consequences if left untreated. The estimated survival time from diagnosis is approximately 3-6years. Because of the non-specificity of initial symptom manifestation and insufficient awareness among treating physicians, approximately one-third of patients with ATTRwt-CM are initially misdiagnosed with other cardiac diseases. Although heart failure (HF) is the most common initial manifestation of ATTRwt-CM, observed in nearly 70% of affected patients, patients may also present with other cardiologic symptoms, such as atrial fibrillation (AF) and aortic stenosis (AS). This non-specific and diverse nature of the initial ATTRwt-CM presentation indicates that various cardiology subspecialties are involved in patient diagnosis and management. Standard guideline-directed pharmacological treatment for HF is not recommended for patients with ATTRwt-CM because of its limited effectiveness. However, no established algorithms are available regarding HF management in this patient population. This literature review provides an overview of the red flags for ATTRwt-CM and research findings regarding HF management in this patient population. In addition to commonly recognized red flags for ATTRwt-CM (e.g., HF, AF and severe AS), published literature identified potential red flags such as coronary microvascular dysfunction. For HF management in patients with ATTRwt-CM, the use of mineralocorticoid receptor antagonists (MRAs) was reported as a well-tolerated option associated with a low discontinuation rate and reduced mortality. Although there is no concrete evidence for recommendations against sodium-glucose cotransporter 2 inhibitor (SGLT2i) administration, research supporting its use is limited to small-scale studies. Robust evidence is lacking for AF ablation, implantable cardioverter-defibrillators and cardiac resynchronization therapy. Based on the published findings and our clinical experience as Japanese ATTRwt-CM experts, red-flag symptom clusters for each cardiology specialty (HF, arrhythmia and ischaemia/structural heart disease) and a treatment scheme for HF management are presented. As this research area remains at an exploratory stage, our observations would require further discussion among experts worldwide.

Multidisciplinary Approach to Patent Foramen Ovale Closure for Cryptogenic Stroke: Brain-Heart Board Experience.

Patent foramen ovale (PFO) is present in approximately 25% of adult population. The prevalence of PFO is high in patients with cryptogenic stroke suggesting paradoxical embolism. PFO closure in carefully selected patients is an effective secondary preventive strategy in these patients. We report predictors of management recommendations by the multidisciplinary Board and their impact on outcomes. Brain-Heart Board comprises vascular and interventional neurology and cardiology subspecialties (structural, electrophysiology, and cardiac imaging). Adult patients referred to the Board for consideration of PFO closure between October 2017 to March 2021 were included in this retrospective cohort analysis. Demographics, comorbid conditions, risk of paradoxical embolism (RoPE) score, event frequencies (transient ischemic attack [TIA] or stroke, intracranial hemorrhage [ICH], post-PFO closure cardiac arrhythmias), and modified Rankin Scale (mRS) at 1 year were compared between the groups (PFO closure vs medical management). Multivariable logistic regression was used to identify factors associated with management recommendation and chi-square tests to test differences in outcomes for patients according to management. Two hundred seventy patients (229 stroke; 41 TIA) were discussed by the Board for PFO closure. 119 (44.0%) patients were recommended for PFO closure of which 117 (98.3%) had evidence of ischemic infarct on imaging. In univariate analysis, age was similar (50 ± 11.9 vs 52 ± 12.8, p = 0.17), but RoPE score was higher in closure as compared with the medical management group (6 [IQR 5-7] vs 5 [IQR 4-7], p < 0.05). In multivariable analysis, TIA as the index event was an independent predictor of Board recommendation against PFO closure (OR 0.05, 95% CI 0.01-0.19, p < 0.05). Event frequency was low in both cohorts (5.9% vs 4.8%, p > 0.05) and comprised cardiac arrhythmias (6 cases of atrial fibrillation and 1 ICH in closure group; 1 TIA and 1 recurrent stroke in medical management group). Excellent functional outcome (mRS 0-1) was similar in both cohorts (66.3% vs 70.7%, p > 0.05) at 1 year. Multidisciplinary Brain-Heart Board provides a clinical practice model of collaborative care to ensure proper patient selection for PFO closure. TIA as the index event is associated with recommendation of medical management by the multidisciplinary Brain-Heart Board.

Radiation Awareness and X-Ray Use in Cardiology: An International Independent Web-Based Survey

Background. Cardiologists are today exposed to a growing dose of ionising radiation in their practice. Radiation awareness and correct management of X-ray use are the cornerstone to comply with the principles of exposure optimization and justification. Methods and Results. An investigator-initiated international voluntary-based survey including 28 questions was conducted across 19 European countries. 228 cardiologists participated in the survey. Invasive cardiology subspecialties were the most represented (83.6%). Radiation exposure is the cause of personal protective equipment-related orthopaedic injuries (personally or in coworkers) or anxiety in 68.5% and 62.9% of cases, respectively. 38.4% of participants have encountered difficulties in having their institutions recognizing periods off work for exceeding radiation exposure limit (16.3% usually and 22.1% on rare occasions). Gender was not associated with any difference in the answers. Age older than 40 years old was associated with an increased knowledge of personal dosimeter data (71.6% vs. 51.3%, p=0.008). Invasive cardiologists more frequently suffer from orthopaedic injuries (73.0% vs. 44.8%, p=0.006) and show greater participation to radioprotection courses (78.4 vs. 27.6%, p&lt;0.001). Conclusion. European cardiologists show appropriate awareness of the risks associated with X-ray use in medical practice and of the principles guiding a proper management of radiation hazard. However, there is still room for improvement, and institutions should promote risk education policies, which are the basis for the creation and diffusion of a community consciousness on radiation hazard.

Cardio-rheumatology: the cardiovascular, pharmacological, and surgical risks associated with rheumatological diseases in women.

Cardiovascular disease (CVD) remains the number one cause of death worldwide. Women are at increased risk of death from CVD, but the mechanisms for how and why this occurs remain elusive. One subset of women who are exceptionally vulnerable to CVD are those with rheumatic diseases (RDs). Indeed, women account for 80% of all RDs, disorders that encompass a broad range of autoimmune and autoinflammatory diseases that lead to chronic inflammation and pathology. The clear association of increased CVD risk in women with RD is thought to be mediated by a number of factors, including RD pathology itself, pharmacological induction of CVD, and/or as yet unidentified mechanisms. As such, elucidation of the causes and treatments of these pathologies has given rise to a new subspecialty of cardiology: cardio-rheumatology. Here, we review and discuss the CVD risks in patients with RDs, the associated sex disparities in RD and CVD care, as well as the current therapeutic and interventional options available to specifically help women with RDs. We hope this discussion will provide guidance and support to patients, as well as to cardio-rheumatologists, as these groups are the most uniquely positioned to radically improve CVD care in these individuals. Moreover, we are hopeful this discussion may lead to better, more efficacious approaches to treating these disorders in women in the near future.

Historical development of diagnosis of bradyarrhythmias : The early years of clinical electrophysiology in Germany

The introduction of His bundle electrography by Benjamin Scherlag (New York) in 1969, together with programmed stimulation of the heart by Philip Coumel (Paris) in 1967, and Hein Wellens (Amsterdam) in 1972, were decisive turning points on the way to invasive electrophysiology and the development of an independent, now distinctly interventional subspecialty of cardiology. The main topic of the 1970s was bradycardic arrhythmias, promoted by pacemaker therapy, which had been introduced just over 10years earlier. The recording of the potentials of the bundle of His and other recording locations in the atria and ventricles allowed adifferentiated assessment of the excitation process and the refractory periods. High-rate atrial stimulation to determine sinus node recovery time and premature stimulation to determine sinoatrial conduction time were developed to analyze sinoatrial node function. This article describes the introduction of His bundle electrography in agradually increasing number of centers in Germany and their scientific contribution.

Fetal Cardiology Bioethics: An Innovative New Curriculum for Cardiology Trainees.

Decision-making in fetal cardiology is fraught with ethical issues yet education in bioethics for trainees is limited or nonexistent. In this innovation report, we describe the development of a fetal cardiologybioethics curriculum designed to address this gap. The curriculum was developed to supplement the core curriculum for cardiology fellows and fetal cardiology subspecialty trainees. The series combines didactic and interactive teaching modalities and contains 5 key components: (1) introduction to bioethics and its role in fetal cardiology, (2) counseling and pathways for compassionate terminal care, (3) case vignette-based ethical analysis and discussion cases, (4) fetal counseling considerations for shared decision-making and recommendations, (5) facilitated communications role play. The curriculum was refined using session evaluations from end users. This report describes the innovative curriculum as a starting point for further incorporation and study of bioethical education in pediatric cardiology and fetal training programs.

Abstract 18955: Post Webinar Survey Responses Regarding Maternity and Legal Rights for Cardiologists

Introduction/Background: Women are under-represented in cardiology and cardiology subspecialties. Work life challenges are often a stated reason why women do not choose cardiology. Pregnancy and motherhood represent a time of significant challenges to women in cardiology due to lack of support and discrimination. The American Heart Association (AHA)Women in Cardiology (WIC) Committee recently held a case-based webinar to increase awareness about the issues, discuss available resources for support, and understand laws protecting women against discrimination. Goals/Aims: The goal of the survey was to understand the current landscape of perceived institutional support during the maternity period and gauge awareness of the laws protecting women against discrimination. Methods/Approach: After the webinar, an email survey was sent to all those who registered on behalf of the AHAWIC Committee within 7days of the event. Results/Data: There were 189registrants for the webinar, of which 29(15%)responded to the survey. Of those who responded, 72%were female, 48%were &lt;40years of age, 33%of the attendees were mothers, and 20%reported fertility issues. Almost all respondents reported working in a hospital-based practice (90%),59%were attending physicians and 38%were trainees. Only 28%reported that their work environment was very supportive of mothers and only 31%were aware of maternal legal rights in the workplace. After the webinar, 76%planned to learn or implement new maternal rights related policies in their workplace (Figure 1). Conclusions: Pregnancy and motherhood represent a challenging time in the career of a female cardiologist or trainee. Perceived support in the workplace is low. Very few women know their legal rights, but a majority had a plan to learn more after the webinar. This survey highlights opportunities for the cardiology community and national societies to help support women cardiologists.

Training Pathways in Critical Care Cardiology: Competencies and Considerations for Cardiologists.

Critical care cardiology (CCC) is a rapidly developing field undergoing a renaissance of interest and growth to meet the well-documented population shift in the cardiac intensive care unit (CICU). With this has come the emergence of novel training paradigms that seek to combine specialties with meaningful overlap. The benefit of having critical care expertise in the CICU has been clearly established; however, there is no formal or uniform CCC training pathway. Contemporary approaches seek to provide appropriate clinical and procedural experience while minimizing opportunity cost. The combination of additional cardiology subspecialties, specifically advanced heart failure or interventional cardiology, has been demonstrated. Educational tracks that integrate critical care training have generated interest but have not yet manifested. CCC training strives to meet the needs of an increasingly sick and diverse patient population while preparing trainees for fulfilling and meaningful careers. The hope is for ongoing development of novel training pathways to satisfy evolving needs.

Sports cardiology centre - experience to date, data from the 2020-2022 registry and challenges of the third year of operation

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): grant IGA_LF_2022_027. Introduction Sports cardiology is a dynamically developing subspecialty of cardiology. There are four Sports Cardiology Centres in the Czech Republic, which were established under the leadership of the Sports Cardiology Working Group thanks to the Czech Society of Cardiology (CSC) and the Czech Society of Sports Medicine. Objective To describe the experience, data from the registry of the Sports Cardiology Centre of our hospital for the period 1.1.2020-15.8.2022. Functioning and file: A) The patient logs into our way by way of the web interface, where the basic information and previous examinations are given. B) These input data will be incorporated by the center coordinator , ensure communication with the client, other necessary information or examination and after consultation with sports cardiologists, determine a plan of care. C) The organisational aspects of the established procedure are ensured by the nurses. D) After the follow-up examination, the client has a final consultation at the centre, where sport recommendations are always given. Between 1/2020 and 8/15/2022, 133 athletes were consulted at our Sports Cardiology Centre. Of these, 18 athletes are not completed and 115 clients with completed examinations were included in the next cohort, where 100 were male(87%) and 25 were female(13%). All were Caucasian, with a mean age of 26 ± 11 years. The youngest athlete was 15 years old and the oldest was 71 years old. The sports the clients participated in were 66.1% mixed, 27.8% endurance, 4.3% strength and 1.7% skill sports according to the European Society of Cardiology(ESC)2020 sport distribution. The average training load was 10 h/week. The minimum training load was 3h/week and the maximum 25h/week. The average duration of sport activity was 12 years per individual. The most frequent request for consultation was without a medical referral and this was in 41.7%, a physical therapist indicated an examination in 36.5%, a cardiologist in 14.8% and a PL in 6.1%. Reasons for referral were most commonly abnormalities in preparticipation screening /PPS/ 40.9%, symptoms 22.6% and Covid infection 13.9%. A final diagnosis was completed in 89 athletes(77.4%), a suspected diagnosis was made in 8 clients(7%). Eligibility for sport and eligibility with condition was received in 90 individuals(78.3%). Ineligibility was issued in 4 athletes(3.5%). The number of athletes who did not complete the investigation/ did not come in for a result was 21(18.3%). Conclusion The established organisational procedure of consultations allows for the least possible staff load on the hospital and speeds up the process of athlete follow-up. In the pursuit of the development of the field and the achievement of a stable quality of care, our centre is potentially able to meet the requirements of the ESC/ European Association of Preventive Cardiology for a sports cardiology unit in terms of methodological/procedural and personnel parameters.

Advance directive screening among veterans with incident heart failure: Comparisons among people aging with and without HIV

BackgroundHeart failure (HF) is common among people aging with HIV (PWH) and without HIV (PWoH). Despite the poor prognosis for HF, advance directives (AD) completion is low but has not been compared among PWH and PWoH. ObjectivesDetermine the prevalence and predictors of AD screening among PWH and PWoH with incident HF. MethodsWe included Veterans with an incident HF diagnosis code from 2013–2018 in the Veterans Aging Cohort Study (VACS) without prior AD screening. Health records were reviewed for AD screening note titles within -30 days to 1-year post-HF diagnosis. Analyses were stratified by HIV status. Trends in annual AD screening were evaluated with the Cochran-Mantel-Haenszel test. The associations of AD screening with demographics, disease severity (Charlson Comorbidity Index, VACS 2.0 Index), and healthcare encounters (cardiology, palliative care, hospitalization) were evaluated with Cox proportional hazards regression. ResultsHF was diagnosed in 4516 Veterans (28.2% PWH, 71.8% PWoH). Annual AD screening rates increased in both groups (Ptrend<0.0001) and aggregate rates were higher among PWH than PWoH (53.5% vs. 48.2%, p=.001). In both groups, the likelihood of AD screening increased with greater disease severity, palliative care contact, and hospitalization (HR range=1.04–3.32, all p≤.02) but not with cardiology contact (p≥.53). ConclusionsAD screening rates after incident HF remain suboptimal but increased over time and were higher in PWH. Future quality improvement and implementation efforts should aim for universal AD screening with incident HF diagnosis, initiated by providers skilled in discussing AD, including in the cardiology subspecialty setting.

Contributions of Women to Cardiovascular Science Over Two Decades: Authorship, Leadership, and Mentorship.

Background Women remain underrepresented in cardiology. We aimed to assess gender trends in research authorship, authorship in leading roles, mentorship, and research team diversity. Methods and Results We identified "cardiac and cardiovascular systems" journals from 2002 to 2020 using Journal Citation Reports 2019 (Web of Science, Clarivate Analytics). Gender authorship, mentorship, research team diversity, and trends were assessed. Associations between author gender and impact factor, journal region, and cardiology subspecialties were analyzed. Analysis of 396 549 research papers from 122 journals showed the percentage of women authors increased from 16.6% to 24.6% (β=0.38 [95% CI, 0.29-0.46]; P<0.001), whereas the proportion of women first (β=-0.03 [95% CI, -0.06 to 0.004]; P=0.09) or last authors (β=-0.017 [95% CI, -0.04 to 0.006]; P=0.15) was unchanged. Compared with men last authors, women last authors were more likely to mentor women first authors and lead more diverse research teams (both P<0.001). Journal impact factor was related to percentage of women authors overall (Spearman's correlation coefficient RS=0.208 [95% CI, 0.02-0.38]; P=0.03) but not first or last women authors (both P>0.5). Women comprised 18.4%-25.7% of authors in cardiology subspecialties. Journal region and author gender were unrelated (all P>0.4). Conclusions Women's inclusion as authors of cardiology papers increased slightly over the past 2 decades, yet the proportions of women in first and last authorship roles were unchanged. Women are increasingly likely to mentor women first authors and lead diverse research teams. Women last authors are essential to increasing diversity of future independent investigators and inclusive research teams, both of which are associated with innovation and excellence in science.

Critical Analysis and Applicability of Imaging Methods in Monitoring and Diagnosing Ventricular Dysfunction in Patients with Cancer

Cardio-oncology is a subspecialty of cardiology that has become necessary as a consequence of the favorable impact of cancer treatment, which increases patients’ survival rates, but makes them more prone to the cardiovascular side effects of cancer therapies in the short and long term. The presence of predisposing factors such as pre-existing cardiovascular disease, cardiovascular risk factors, genetic predisposition, previous antineoplastic therapies, and increased patient age is associated with a higher risk of cardiotoxicity in cancer treatment and may [...]

Applying Practice Analysis to Develop a New Test Content Outline for the Pediatric Cardiology Certification Examination.

The evolving breadth and complexity of the contemporary pediatric cardiology specialty requires regular, systematic analysis of the practice to ensure that training and certification requirements address the demands of real-world clinical experience. We report the process of the American Board of Pediatrics (ABP) for conducting such a practice analysis and revising the test content outline (TCO) for the pediatric cardiology subspecialty certification exam. A panel of 15 pediatric cardiologists conducted seven 2-h virtual meetings, during which they identified 37 unique tasks that represent the work a pediatric cardiologist may reasonably expect to perform within the first 5years after training. These tasks were grouped into nine performance domains, similar to the entrustable professional activities (EPA), previously endorsed by the ABP in collaboration with the pediatric cardiology education community, and which represent the critical activities of the profession. The panel then enumerated the knowledge, skills, and abilities necessary to perform each task. These deliberations resulted in two work products: a practice analysis document (PAD) and subspecialty board TCO based on testable knowledge, skills, and abilities. Survey assessments of the panel's work were then distributed to pediatric cardiology fellowship program directors and to practicing pediatric cardiologists for their input, which largely aligned with the panel's recommendations. Survey responses were considered in the final revisions of the PAD and TCO. This approach to practice analysis proved to be an efficient process for describing the work performed by today's pediatric cardiologists and the knowledge, skills, and abilities needed to competently perform that work.

Social Media and Cardiovascular Health: Implications for Women.

Cardiovascular disease (CVD) is the leading cause of mortality in adult women in the USA, yet CVD is underrecognized in women. Disparities in care are further pronounced in women of racial/ethnic minority backgrounds. In this review, we discuss the role of social media (SoMe) as a tool to (i) promote women's cardiovascular (CV) health and (ii) address and potentially reduce gaps in care, particularly in general cardiology (targeting atherosclerotic cardiovascular disease), cardio-oncology, and cardio-obstetrics. We also briefly discuss women's CV health as a common, although not unique, focus of women in cardiology on SoMe. Studies have suggested the utility of social media to help advance subspecialties of cardiology. Leaders within general cardiology, cardio-oncology, and cardio-obstetrics have curated social media strategies to advance their respective fields and call attention to cardiovascular health disparities in female populations and racial/ethnic minorities. In addition to these types of uses, women in cardiology also frequently use SoMe to encourage a career in cardiology and to share experiences, challenges, and resources for support and career advancement as healthcare professionals; men in cardiology and especially those who are allies for sex and racial/ethnic minorities also use SoMe for these means. Herein, we highlight the role and myriad applications of social media in the promotion of women's cardiovascular health. We discuss five primary roles of social media: increasing public awareness, disseminating medical literature in a rapid and accessible fashion, facilitating professional networking, serving as a platform for medical conferences, and empowering patients. These core strategies are discussed through the lens of general cardiology, cardio-oncology, and cardio-obstetrics. We also demonstrate how these applications can be leveraged to increase representation of women in cardiology, also supporting an increased focus on women's cardiovascular health.

The Impact of Bedside Cardiac Point-of-Care Ultrasound on the Utilization of Cardiology Subspecialty Resources in a Pediatric Emergency Department.

This study sought to determine the impact of cardiac point-of-care ultrasound (cPOCUS) in a pediatric emergency department (ED) on cardiology subspecialty utilization for subjects with chest pain or syncope. Diagnostic yield of cPOCUS and transthoracic echocardiograms (TTEs) for these subjects was also examined. A retrospective chart review of subjects presenting to a tertiary pediatric ED with chest pain or syncope 1 year before (2015, pre-cPOCUS group) and 1 year after (2017, cPOCUS group) introduction of cPOCUS was conducted. Subjects aged 2 to 18 years evaluated for these symptoms were included. Those with known heart defects, prior abnormal TTE, or asthma exacerbation at presentation were excluded. In both groups, cardiology subspecialty utilization was assessed by determining whether cardiology referrals, cardiology consultations, or follow-up TTEs were completed. Results of TTEs were reviewed and classified as incidental (no follow-up needed), minor (follow-up needed, but intervention unlikely), moderate (nonurgent intervention needed), and severe (hospitalization/urgent intervention needed). Cardiac point-of-care ultrasound results were compared with any follow-up TTEs. Data were analyzed using χ 2 or Student t test as appropriate. A total of 1230 subjects were analyzed: 595 pre-cPOCUS and 635 cPOCUS group. There was no significant difference in TTEs (42 vs 46), cardiology consultations (36 vs 37), or cardiology referrals (47 vs 37) between groups. Of 67 cPOCUS scans performed, 63 were normal, 3 showed small pericardial effusion, and 2 demonstrated left ventricular dysfunction. Of 88 TTEs in both groups (0.7% subjects), 76 were normal, 5 had incidental, 6 had minor, and 1 had a severe finding present on cPOCUS (0.08% subjects; 95% confidence interval, 0%-0.45%). The introduction of cPOCUS did not increase cardiology subspecialty utilization in subjects presenting to the pediatric ED with chest pain or syncope. Cardiac point-of-care ultrasound may be useful in evaluating global biventricular systolic function and effusion in this population.

Drivers of variation in telemedicine use during the COVID-19 pandemic: The experience of a large academic cardiovascular practice

Background COVID-19 spurred rapid adoption and expansion of telemedicine. We investigated the factors driving visit modality (telemedicine vs. in-person) for outpatient visits at a large cardiovascular center. Methods We used electronic health record data from March 2020 to February 2021 from four cardiology subspecialties (general cardiology, electrophysiology, heart failure, and interventional cardiology) at a large academic health system in Northern California. There were 21,912 new and return visits with 69% delivered by telemedicine. We used hierarchical logistic regression and cross-validation methods to estimate the variation in visit modality explained by patient, clinician, and visit factors as measured by the mean area under the curve. Results Across all subspecialties, the clinician seen was the strongest predictor of telemedicine usage, while primary visit diagnosis was the next most predictive. In general cardiology, the model based on clinician seen had a mean area under the curve of 0.83, the model based on the primary diagnosis had a mean area under the curve of 0.69, and the model based on all patient characteristics combined had a mean area under the curve of 0.56. There was significant variation in telemedicine use across clinicians within each subspecialty, even for visits with the same primary visit diagnosis. Conclusion Individual clinician practice patterns had the largest influence on visit modality across subspecialties in a large cardiovascular medicine practice, while primary diagnosis was less predictive, and patient characteristics even less so. Cardiovascular clinics should reduce variability in visit modality selection through standardized processes that integrate clinical factors and patient preference.

Representation of Women in Internal Medicine Specialties in North America, the United Kingdom, and Australasia: Cardiology's Outlier Status and the Importance of Diversity

Decades of research demonstrate the value of workplace diversity. Reports from individual countries show that women are underrepresented in internal medicine workforces. However, large pooled international studies are not available. This study investigates the current representation of women in the internal medicine workforce internationally and identifies specialties in which underrepresentation is evident. Peer-reviewed studies, government reports, and medical association reports were used to determine proportions of specialists and doctors training in internal medical specialties and in comparator surgical specialties. Data were available from Australia, Canada, England, New Zealand, the United States, Wales, Scotland, and Northern Ireland. A total of 380,263 doctors were studied, including 268,822 practicing specialist physicians (also known as attendings or consultants) and 53,226 doctors in internal medicine specialty training programs (also known as residents, fellows, advanced trainees, or specialist registrar trainees). Among practicing physician specialists, the rate of representation of women was 35% (95,195/268,822, p <0.001). Among trainees, the rate of representation of women was 43% (22,728/53,226, p <0.001). Among physician specialties evaluated, cardiology (15%, 4,152 of 27,328), gastroenterology (20%, 3,765 of 18,893), and respiratory/critical care (24%, 5,255 of 21,870) had the lowest representations of women compared with men (p <0.001 for all). Cardiology and particularly the subspecialty of interventional cardiology were clear outliers as the internal medicine specialties with the lowest representation of women at practicing specialist and trainee levels. In conclusion, this study is the largest international study of women in internal medicine specialties. It found that cardiology, gastroenterology, and respiratory/critical care specialties have the most substantial underrepresentation of women. These data are a global call to action to establish more successful strategies to provide a diverse and representative cardiology workforce.

Managing atrial fibrillation: The intersection of cardiology, health psychology, and the patient experience.

Atrial fibrillation (AF) is the most common cardiac dysrhythmia and is an accelerating public health challenge. Challenges related to detection, management, and prevention of disability and dysfunction secondary to AF are increasingly apparent. The subspecialty of cardiology, cardiac electrophysiology, is primarily tasked with the treatment of AF. Patients with AF are often ambushed by the condition with approximately 28% to 38% of patients experiencing significant anxiety or depressive symptoms. Behavioral risk reduction can be targeted by achieving and maintaining a healthy BMI, abstaining from smoking, avoiding alcohol consumption, and sustaining regular physical activity. AF patients are also tasked with considering possible treatment options, adhering to medication regiments & lifestyle changes, utilizing wearable technologies, and managing emotional distress, to minimize health risks and optimize quality of life. Major medical organizations have called for integrated, multidisciplinary management as the treatment of choice for AF patients. Health psychologists bring valuable expertise but are not uniformly involved in the care of AF patients. The purposes of this article are to (a) review the existing research on the medical, psychological, and behavioral aspects of contemporary management of AF, (b) highlight the intersections between cardiac electrophysiology and clinical health psychology in managing AF, and (c) call for more health psychologists in this specialized area of cardiac electrophysiology. This opportunity for health psychologists may challenge the profession to further specialize as "cardiac psychologists" and mirror our medical colleagues. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Utility and Educational Impact of a Virtual Webinar to Deliver an International Undergraduate Cardiovascular Conference.

IntroductionConferences are an important avenue for dissemination of knowledge, research and provide networking opportunities for career development. The COVID-19 pandemic has prompted adoption of virtual platforms for delivery of these conferences. The aim of the study was to determine the utility and educational impact of a student-led virtual webinar to deliver an undergraduate cardiovascular conference compared to a traditional in-person conference.MethodsWe conducted a two-day virtual conference using the Zoom platform in June 2021. The conference consisted of cardiology subspecialty lectures, and workshops were conducted by a junior doctor, senior cardiology trainees and consultants. The conference also outlaid a virtual poster hall and oral presentation session while networking opportunities were encouraged using breakout rooms and poster hall chat function. A 38-item self-administered online questionnaire was designed and disseminated at the end of the conference to all attending delegates. All data analysis and data visualisation strategies were conducted on R statistical programming.ResultsEight-hundred and forty students from 55 countries attended the event. Four hundred and ninety participants (58.5% response rate, 55.9% female) completed the questionnaire. Factors such as weekend conference (84.9%), student-led or organised (84.1%), environmental/sustainable (82.3%), appropriate level for me (81.5%) and comfort to present (80.8%) were deemed to be at least equal to traditional in-person conference. The conference also increased participants’ interest, their core cardiology knowledge and improved their critical analysis and basic echocardiography skills [median 4 (IQR 3–5) for all parameters]. Overall, participants also found it easy to use the virtual platform [median 5 (IQR 5–5)] and easier to ask questions compared to in-person conferences [median 5 (IQR 4–5) vs median 4 (IQR 3–5), p < 0.001].ConclusionOur virtual conference provided opportunities to students that the COVID-19 pandemic would have otherwise affected; however, its utility and educational impact will need to be assessed within its individual context of delivery.