Preventive cardiology training sorely lacking, study says

Program directors cite the absence of an established curriculum, faculty expertise and interest as obstacles.

By Carolyne Krupa — Posted May 4, 2012

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Most physicians being trained to specialize in cardiology are not getting nationally recommended training in preventive cardiology, according to a survey of 43 cardiology fellowship program directors and 56 chief cardiology fellows.

Only 24% of programs met American College of Cardiology Foundation guidelines, which recommend that fellows receive one month of training dedicated to preventive cardiology. Another 24% had no formal training in preventive cardiology, and 30% had no faculty with expertise on the subject, says the American Journal of Cardiology article published online April 6 (link).

“It’s a matter of priority,” said Quinn Pack, MD, lead study author and a preventive cardiology fellow at Mayo Clinic in Rochester, Minn. “There are a lot of competing demands for the education time of cardiology fellows.”

Obstacles to offering training in preventive cardiology cited by respondents included limited time, a lack of a developed curriculum, no faculty expertise and low interest from fellows.

Teaching preventive cardiology is vital, because many of the leading causes of preventable death are linked to heart problems, said Dr. Pack, a general cardiology fellow at Henry Ford Hospital in Detroit at the time of the survey.

“Tobacco use is the No. 1 cause of preventable death, but cardiology fellows never set foot in a smoking-cessation clinic,” he said.

The specialty is more focused on managing acute rather than chronic conditions, Dr. Pack said. Some physicians assume that fellows learn about preventive medicine during their internal medicine training, but cardiology preventive medicine is more specialized. The result is poor management of hypertension and cholesterol nationwide, and too few heart attack patients being referred for cardiac rehabilitation, he said.

For example, one in three U.S. adults has high blood pressure, but the condition is controlled in only half of those patients, according to the Centers for Disease Control and Prevention.

Dr. Pack said he hopes the study will encourage more cardiology fellowships to integrate prevention into their programs.

“Diet, exercise, tobacco cessation — those are the kinds of things that really make a difference to patients. What kind of stent you put in has much less effect over time,” he said. “There is time in the curriculum. We just have to prioritize prevention.”

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