This spring, discussions on how to build a workforce that better meets the needs of the heart failure population will begin in earnest.
The alarming number of unfilled fellowship spots for advanced heart failure and transplant cardiology (AHFTC) each year shows that the field is not enticing new trainees, despite the growing clinical need and advances in therapeutics. As recently as the 2023-2024 cycle, just 71 of the 127 AHFTC positions were filled, according to data from the National Resident Matching Program.
Meanwhile, the 1,100-plus fully fledged heart failure physicians in the U.S. are grossly outnumbered by the 6.2 million people living with heart failure. One estimate projects more than 8 million heart failure patients by the year 2030.
Initial efforts are already underway to overhaul the training pipeline for greater interest and efficiency in the heart failure field.
"Day in and day out, I'm so grateful to be a part of this field, which is increasing what it addresses and encompasses. I think innovation is moving at lightning speed. All fields of cardiovascular medicine are converging into heart failure, and it behooves those of us who are in this field to recognize the incredible excitement and fulfillment there is to be gained from entering the field," said Anuradha Lala, MD, program director for the advanced heart failure & transplant fellowship at the Icahn School of Medicine at Mount Sinai in New York City.
Of note, the Heart Failure Society of America (HFSA) has assembled a task force to address the workforce issue.
John Barnes, CEO of the HFSA, told MedPage Today that the task force "will be organizing a consensus conference to develop strategies to increase the number of trainees interested in pursuing subspecialized training in heart failure through [AHFTC] programs. This will include assessing the current design of AHFTC fellowship programs, developing novel approaches that are more responsive to contemporary needs and of interest to potential trainees, and assessing the feasibility and value of AHFTC fellowship programs offering distinctions in addition to core training in [AHFTC]."
The group is expected to make its recommendations to the HFSA Board of Directors this spring, Barnes said.
For starters, there is a need for survey data from fellows and faculty to get an idea of what they think is motivating or deterring applicants, Lala told MedPage Today in an interview. "We are assuming a lot. We need to get that primary data," she said.
Theories of why it is so difficult to recruit include inadequate exposure to AHFTC during the 3 years of cardiovascular disease fellowship, as many programs lack a heart transplant or left ventricular assist device (LVAD) component. Additionally, the designation of "AHFTC" itself fails to capture the widening scope of heart failure cardiology that now overlaps with critical care, some cardiomyopathies, cardio-oncology, cardio-obstetrics, and other disciplines.
Then there's the reality of the limited job market at transplant and LVAD centers -- and the relatively low compensation among those who do find jobs.
Some suggest that compensation models should be overhauled so that heart failure cardiologists are not penalized for spending more time in evaluation and management services and care coordination compared with other cardiovascular subspecialties. "The idea of one billing code [doesn't capture] all the work put into our interactions and care," Lala said.
Lala and colleagues recently published a proposed roadmap of next steps in the Journal of Cardiac Failure that discusses improvements in heart failure compensation models, among other suggestions for the field.
"The time to bridge the divide between the dearth of AHFTC fellowship applicants, exciting therapeutic advances, and an increasing need for a larger heart failure-specialized workforce is now," the authors wrote.
"What to me is clear is we'll require concerted efforts across organizations like CMS, professional societies, as well as education bodies to really recognize that this is a problem that needs attention. What we are proposing are not solutions but certainly suggestions to explore as a start," Lala said.
AHFTC was introduced as a cardiovascular subspecialty in 2008 by the American Board of Internal Medicine. Its subspecialty requirements and scope of training were codified by the Accreditation Council for Graduate Medical Education in 2013.
As for advanced practice providers, the recently launched HFSA heart failure professional certification may be earned by registered nurses, pharmacists, physicians, and physician assistants who demonstrate the ability to provide heart failure services at an advanced level.
Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow
Disclosures
Lala and colleagues had no disclosures.
Primary Source
Journal of Cardiac Failure
Source Reference: Blumer V, et al "A roadmap to reinvigorating training pathways focused on the care of patients with heart failure: shifting from failure to function" J Card Fail 2023; DOI: 10.1016/j.cardfail.2022.12.009.
Read the rest here:
Fixing Heart Failure Workforce Issues: Baby Steps Start This Year - Medpage Today
- Cardiomyopathy what it is and types British Heart Foundation - April 12th, 2018 [April 12th, 2018]
- Cardiomyopathy what it is and types British Heart ... - May 28th, 2018 [May 28th, 2018]
- Cardiomyopathy - what it is and types - British Heart ... - June 6th, 2018 [June 6th, 2018]
- Cardiomyopathy Symptoms, Types, Treatment & Prognosis - November 5th, 2018 [November 5th, 2018]
- Mark Drazner, M.D.: Internal Medicine | Cardiomyopathies ... - December 20th, 2018 [December 20th, 2018]
- Overview of Cardiomyopathies - Cardiovascular Disorders ... - December 27th, 2018 [December 27th, 2018]
- Cardiomyopathy | Cleveland Clinic - April 24th, 2019 [April 24th, 2019]
- Cardiomyopathy | pathology | Britannica.com - April 29th, 2019 [April 29th, 2019]
- Cardiomyopathy | Children's Hospital of Philadelphia - April 29th, 2019 [April 29th, 2019]
- Cardiac Surgery Instruments Market Prospects and Growth Assessment - TodayTimes - September 22nd, 2019 [September 22nd, 2019]
- Cardiovascular Genomic Diagnostics Market to Record an Exponential CAGR by 2025 - Rapid News Network - September 22nd, 2019 [September 22nd, 2019]
- Cardiovascular Genomic Diagnostics Market Estimated to Expand at a Robust CAGR over 2018 2028 - Space Market Research - October 9th, 2019 [October 9th, 2019]
- Cytokinetics Announces Presentation of Additional Analyses From FORTITUDE-ALS at the 18th Annual NEALS Meeting - Yahoo Finance - October 9th, 2019 [October 9th, 2019]
- Cardiac Surgery Instruments Market to be Fueled by Increasing Threat of Cardiovascular Diseases - Online News Guru - October 21st, 2019 [October 21st, 2019]
- Cell Culture Protein Surface Coating Market Current Outlook Of Industry & Forecast 2017 2025 - Health News Office - October 24th, 2019 [October 24th, 2019]
- Cytokinetics to Announce Third Quarter Results on October 31, 2019 - Yahoo Finance - October 24th, 2019 [October 24th, 2019]
- Lonza and DiNAQOR AG Announce Strategic Collaboration to Advance Gene Therapy Programs for Patients with Monogenic Cardiomyopathies - PRNewswire - November 29th, 2019 [November 29th, 2019]
- Lonza and DiNAQOR announce strategic collaboration to advance gene therapy programs for patients with monogenic cardiomyopathies - Pharmaceutical... - November 29th, 2019 [November 29th, 2019]
- Cytokinetics Announces New Results Presented at the International Symposium on ALS/MNDSubgroup Analyses of FORTITUDE-ALS on Effects of Reldesemtiv... - December 8th, 2019 [December 8th, 2019]
- Cell Culture Protein Surface Coating Market Competitive Environment and Higher Growth Rate with Forecast to 2025 - Filmi Baba - January 4th, 2020 [January 4th, 2020]
- New PET tracer provides insight on cardiac failure risk after heart attack - DOTmed HealthCare Business News - January 12th, 2020 [January 12th, 2020]
- PET tracer can help fight heart attacks earlier in the process - Health Imaging - January 12th, 2020 [January 12th, 2020]
- Atrial fibrillation in athletes - CMAJ - January 13th, 2020 [January 13th, 2020]
- Cytokinetics Announces Publication Relating to Design of GALACTIC-HF, a Phase 3 Clinical Trial of Omecamtiv Mecarbil in Patients With Heart Failure -... - February 9th, 2020 [February 9th, 2020]
- Cytokinetics to Announce Fourth Quarter Results on March 3, 2020 - Yahoo Finance - February 25th, 2020 [February 25th, 2020]
- Stealth BioTherapeutics to Present at 40th Annual Cowen Health Care Conference - PRNewswire - February 27th, 2020 [February 27th, 2020]
- Cell Culture Protein Surface Coating Market Analysis On Trends & Need 2025 - 3rd Watch News - March 18th, 2020 [March 18th, 2020]
- Heart patients dont need to panic: Doc - The Tribune India - March 18th, 2020 [March 18th, 2020]
- Stealth BioTherapeutics to Report Full Year 2019 Financial Results on Wednesday, April 1, 2020 - Yahoo Finance - April 1st, 2020 [April 1st, 2020]
- Stealth BioTherapeutics Reports Fiscal Year 2019 Financial Results And Recent Business Highlights - BioSpace - April 1st, 2020 [April 1st, 2020]
- Stealth BioTherapeutics to Report First Quarter 2020 Financial Results on Thursday, May 7, 2020 - Tewksbury town crier - May 5th, 2020 [May 5th, 2020]
- BioMarin broadens its gene therapy horizons with a new R&D alliance in rare cardio cases - Endpoints News - May 5th, 2020 [May 5th, 2020]
- Tenaya Therapeutics to Present Preclinical Data at 2020 Annual Meeting of the American Society of Gene & Cell Therapy - thepress.net - May 12th, 2020 [May 12th, 2020]
- Stealth BioTherapeutics to Present at Upcoming Investor Conferences in September - Yahoo Finance - September 12th, 2020 [September 12th, 2020]
- What we know about what it's like to recover from Covid-19 and its long-term effects - Local News 8 - LocalNews8.com - October 7th, 2020 [October 7th, 2020]
- Should You Buy Myokardia Inc (MYOK) Stock After it Is Up 64.52% in a Week? - InvestorsObserver - October 7th, 2020 [October 7th, 2020]
- Heart Failure from ATTRwt Amyloid Cardiomyopathy is Associated with Poor Prognosis - DocWire News - October 7th, 2020 [October 7th, 2020]
- Relaxera and CBL Patras Announce Exclusive Agreement on Manufacturing and Sales of Synthetic Human R - PharmiWeb.com - December 16th, 2020 [December 16th, 2020]
- Counties combine push for more vaccines - The Record Newspapers - TheRecordLive.com - January 26th, 2021 [January 26th, 2021]
- Vet Speak: Cats are very good at hiding the signs of heart disease - RossShire Journal - January 26th, 2021 [January 26th, 2021]
- Stealth BioTherapeutics Reports First Quarter 2021 Financial Results And Recent Business Highlights - Yahoo Finance - May 25th, 2021 [May 25th, 2021]
- Suspicion of Frasier's syndrome in the nephrology unit | IMCRJ - Dove Medical Press - August 14th, 2021 [August 14th, 2021]
- Delta has set back herd immunity estimates. Heres how that affects the course of the pandemic - The Dallas Morning News - August 14th, 2021 [August 14th, 2021]
- Hypertrophic Cardiomyopathy Market to be Driven by the Emergence of Novel Pharmacotherapies & Gene-directed Approaches at a 22.24% CAGR During the... - August 14th, 2021 [August 14th, 2021]
- Stealth BioTherapeutics Reports Third Quarter 2021 Financial Results and Recent Business Highlights - PRNewswire - November 18th, 2021 [November 18th, 2021]
- Cytokinetics to Participate in the Piper Sandler 33rd Annual Virtual Healthcare Conference - GuruFocus.com - November 18th, 2021 [November 18th, 2021]
- What is cardiac transplantation? An overview - Emergency Live International - October 6th, 2022 [October 6th, 2022]
- Inherited Cardiac Disease Genetic Diagnoses Linked to Ancestry ... - GenomeWeb - January 10th, 2023 [January 10th, 2023]
- VIDEO: Using genetics in cardiology to enable earlier interventions - Cardiovascular Business - January 10th, 2023 [January 10th, 2023]
- Ahmad Masri, MD, MS: 2024 Update on Development and Future of Cardiac Myosin Inhibitor Class - MD Magazine - February 20th, 2024 [February 20th, 2024]