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PubMed1996

[Research methods in clinical cardiology (I). Types of basic designs. Observational studies in clinical cardiology (I)].

Clinical investigation studies can be classified according to their purpose (causality, diagnosis, therapy, etc), by its research strategy (observation or intervention), by the characteristics of its design (descriptive or analytic) or according to the basic axes of the investigation process (directionality and time orientation); and the personal attributes (exposure and disease) of the study population. Among observational designs, the cross-sectional and ecological studies are the main representatives of descriptive research. Their main objectives are the estimation of disease prevalence and risk factor distribution in the population, as well as the comparison of prevalence and risk factor distribution among several populations. On the other hand, the aim of analytical studies is the identification of individual risk factors associated with the disease. The key difference between descriptive and analytical studies is the existence of a comparison group in the latter, which allow hypotheses testing. Examples or analytical studies are the case-control and cohort studies. This paper deal with the principles of basic design and methods of descriptive (cross-sectional and ecological), and case-control studies. Finally we outline the basic concepts and principles of the screening, a frequent objective in many cardiovascular surveys, specifically in primary prevention.

Case-Control Studies↗
PubMed1999

Assessing the cost of a cardiology residency program with a cost construction model.

BACKGROUND: Although the total costs of graduate medical education are difficult to quantify, this information is of great importance in planning over the next decade. METHODS AND RESULTS: A cost construction model was used to quantify the costs of teaching faculty, cardiology fellows' salaries and benefits, overhead (physical plant, equipment, and support staff), and other costs associated with the cardiology residency program at the University of Texas-Houston during the 1996 to 1997 academic year. Surveys of cardiology faculty and fellows, checked by the program director, were conducted to determine the time spent in teaching activities; access to institutional and departmental financial records was obtained to quantify associated costs. The model was then developed and examined for a range of assumptions concerning cardiology fellows' productivity, replacement costs, and the cost allocation of activities jointly producing clinical care and education. The instructional cost of training (cost of didactic, direct clinical supervision, preparation for teaching, and teaching-related administration, plus the support of the teaching program) was estimated at $73,939 per cardiology fellow per year. This cost was less than the estimated replacement value of the teaching and clinical services provided by cardiology fellows, $100,937 per cardiology fellow per year. Sensitivity analysis, with different assumptions on cardiology fellows' productivity and replacement costs, varied the cost estimates but generally represented the cardiology residency program as an asset. CONCLUSIONS: Cost construction models can be used as a tool to estimate variations in resource requirements resulting from changes in curriculum or educators' costs. In this residency, the value of the teaching and clinical services provided by cardiology fellows exceeded the cost of the resources used in the educational program.

Cardiology↗
PubMed2004

Cardiology management improves secondary prevention measures among patients with coronary artery disease.

OBJECTIVES: The goal of this study was to determine if cardiology subspecialty involvement improves the attainment of recommended low-density lipoprotein (LDL) cholesterol and blood pressure (BP) targets in coronary artery disease (CAD) patients. BACKGROUND: The impact of physician specialty on secondary prevention measures for CAD in ambulatory care is unknown. METHODS: This was a retrospective cohort study of 13,995 patients with CAD seen at eight ambulatory care Veteran Affairs facilities from 1998 to 2000. Patients with cardiology involvement were defined as those seen in cardiology clinic in addition to primary care. The main outcomes of interest were LDL cholesterol < or =100 mg/dl and BP < or =130/85 mm Hg. Multivariable hierarchical regression analyses were used to determine the independent association of cardiology involvement with improved LDL cholesterol and BP control. RESULTS: Overall, 3,771 (27.0%) patients had cardiology involvement. A higher proportion of patients with cardiology involvement achieved LDL cholesterol (55.6% vs. 45.6%; p < 0.01) and BP (45.3% vs. 35.9%; p < 0.01) goals. In multivariable hierarchical regression analysis, cardiology involvement was independently associated with better LDL cholesterol (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.40 to 1.82) and BP (OR, 1.52; 95% CI, 1.32 to 1.77) control. The benefit of cardiology involvement was consistent across a range of LDL and BP targets, in analysis of LDL and BP as continuous outcomes, and among subgroups of high-risk patients, including diabetic patients, the elderly, and those with prior revascularization. CONCLUSIONS: Cardiology involvement is associated with better LDL cholesterol and BP control among CAD patients. However, significant room for improvement in secondary prevention measures remains, irrespective of physician specialty.

Adrenergic beta-Antagonists↗
PubMed1998

A survey on the intended purposes and perceived utility of preoperative cardiology consultations.

UNLABELLED: Cardiology consultations are often requested by surgeons and anesthesiologists for patients with cardiovascular disease. There can be confusion, however, regarding both the reasons for a consultation and their effect on patient management. This study was designed to determine the attitudes of physicians toward preoperative cardiology consultations and to assess the effect of such consultations on perioperative management. A multiple-choice survey regarding the purposes and utility of cardiology consultations was sent to randomly selected New York metropolitan area anesthesiologists, surgeons, and cardiologists. In addition, the charts of 55 consecutive patients aged >50 yr who received preoperative cardiology consultations were examined to determine the stated purpose of the consult, recommendations made, and concordance by surgeons and anesthesiologists with cardiologists' recommendations. Of the 400 surveys sent to each specialty, 192 were returned from anesthesiologists, 113 were returned from surgeons, and 129 were returned from cardiologists. There was substantial disagreement on the importance and purposes of a cardiology consult: intraoperative monitoring, "clearing the patient for surgery," and advising as to the safest type of anesthesia were regarded as important by most cardiologists and surgeons but as unimportant by anesthesiologists (all P < 0.05). Most surgeons (80.2%) felt obligated to follow a cardiologist's recommendations, whereas few anesthesiologists (16.6%) felt so obligated (P < 0.05). The most commonly stated purpose of the 55 cardiology consultations examined was "preoperative evaluation." Only 5 of these (9%) were obtained for patients in whom there was a new finding. Of the cardiology consultations, 40% contained no recommendations other than "proceed with case," "cleared for surgery," or "continue current medications." Recommendations regarding intraoperative monitoring or cardiac medications were largely ignored. IMPLICATIONS: We conclude that there seems to be considerable disagreement among anesthesiologists, cardiologists, and surgeons as to the purposes and utility of cardiology consultations. A review of 55 consecutive cardiology consultations suggests that most of them give little advice that truly affects management.

Anesthesiology↗
PubMed1998

Nuclear cardiology in the UK 1994: activity relative to Europe, USA, and British Cardiac Society targets.

OBJECTIVE: To survey practice in nuclear cardiology in the UK in 1994. DESIGN: A questionnaire was sent to 219 centres performing nuclear imaging asking for details of current practice in nuclear cardiology. Replies were received from 192 centres (88%). MAIN OUTCOME MEASURES: Activity in performance of myocardial perfusion imaging (MPI) and radionuclide ventriculography (RNV), anticipated changes in activity, differences between regional and district hospitals, technical imaging parameters, and referral sources. RESULTS: Of the responding centres, 125 (65%) performed nuclear cardiology procedures. More regional than district hospitals performed nuclear cardiology procedures (85% v 55%, p < 0.0003) and regional centres performed a higher proportion (62% v 24%, p < 0.001) of nuclear cardiology activity. Nuclear cardiology activity was 0.82 scans per 1000 population per year (MPI 0.56, RNV 0.26). There has been a significant increase (24%) in nuclear cardiology since 1988. There has been a pronounced rise in MPI (350%) while RNV has fallen by 47%. Myocardial perfusion activity in the UK remains very low (25% and 5% in regional and district hospitals, respectively) compared with the 1994 figures of 2.2/1000/year for Europe or 10.8/1000/year for the USA. CONCLUSIONS: MPI has increased on average by 23%/annum (compound rate) since 1988, but in 1994 was still only 32% of the British Cardiac Society target of 2.6/1000/year. Proper resources for capital expenditure on new equipment and new staff will be important to maintain momentum in closing the gap. Also important is improved clinical understanding, as already implemented by including nuclear cardiology in guidelines for specialist cardiology training.

Cardiology Service, Hospital↗
PubMed2004

A history of pediatric specialties: the development of pediatric cardiology.

Pediatric cardiology, as a discipline, arose from early descriptive studies of congenital cardiac defects. The development of the stethoscope allowed some clinical diagnoses to be made during life. Cardiology as a medical specialty was limited, mainly, to internists. When Robert Gross ligated a patent ductus in 1938, pediatric cardiology, as a discipline, was born. Physiologic studies, angiography, and the development of extracorporeal circulation allowed congenital cardiac lesions previously considered a curiosity to be diagnosed and treated successfully. The few pediatricians who were interested in cardiology taught themselves, and soon pediatric cardiology training programs developed. By 1961, pediatric cardiology became the first subspecialty board in pediatrics. The past 60 y has brought enormous progress. Cardiac ultrasound, color-flow Doppler, and magnetic resonance imaging have made diagnostic cardiac catheterization almost unnecessary. Instead, interventional cardiac catheterization rapidly developed and is already able to replace surgery in the treatment of a number of cardiac defects. The first 50 y of cardiology has been focused on patient care, education, and clinical research, but the last 10 y has added exciting, basic research discoveries, which are elucidating the cause of cardiac defects with hope for prevention in the future. As a discipline, pediatric cardiology has always required a team-pathologists, physiologists, cardiologists, surgeons, intensivists, interventionists, and anesthesiologists-all playing an important role in the treatment of children with cardiac problems. Today the geneticists, molecular biologists, and other basic scientists are joining the team to ensure an exciting future for pediatric cardiology and the children yet to be born.

Cardiology↗
PubMed2006

When cardiology became a separate matter.

The cardiac catheter technique established by Werner Forssmann in 1929 not only introduced the era of modern cardiology, but also led to the identification of this specialist field and its practising doctors, the cardiologists. The intentionally scientifically oriented Deutsche Gesellschaft für Kreislaufforschung, founded in 1927, acquired a clinical focus with the Commission for Clinical Cardiology thanks to the cardiac catheter cardiologists trained mainly in other countries. Today this society is the German Society for Cardiology, subtitled Cardiac and Cardiovascular Research, with a membership of 5,339 (July 31st 2004). Simultaneously, the impulse for the specialist fields to become independent within the framework of the new advanced educational regulations came into force in 1972 leading to the first branches of internal medicine, cardiology, gastroenterology and pneumology, followed by the establishment of independent departments, clinics and university chairs in cardiology. (At the end of 2003 a total of 3,059 internal specialists in cardiology were working in Germany and there were 393 independent facilities, including 33 university chairs in cardiology.) In addition, 10-14 cardiac centres combining both adult and pediatric cardiology together with cardiac surgery. When setting up intensive care wards, the main impulse also came from cardiology, achieving a totally new dimension when coronary angiography and bypass surgery made it possible to make an exact diagnosis as well as to provide an efficient therapy, right up to interventional methods with acute PTCA in recent cardiac infarction. The necessary step towards informing the population led to the establishment of the German Heart Foundation in 1979 with a membership of 46,795 (December 31st 2003) and a scientific board of 436 highly qualified cardiologists. The development presented here would not have been possible without the cardiac catheter.

Cardiac Catheterization↗
PubMed2004

[Perspectives in cardiological research].

German cardiological research is confronted with increasing difficulties. Clinical research is restricted by regulations, such as the working hours protecting law, the revised version of the legal articles against corruption and acceptance of advantage as well as by many parts of law for the general frame of the university structures. In addition more and more administrative duties are tranferred to doctors engaged in research. Furthermore cardiology is at a disadvantage as only part of the net profits for cardiological services are tranferred to the responsible clinic. Likewise the facilities for cooperation are increasingly restricted, as basic science institutions originally allocated to cardiological research, are now devoted to other subjects and as many pharmaceutical firms have left the country. Cardiology in our country is practically not supported by private research organizations. Research projects are, therefore, predominantly financed by grants from the Bundeministerium für Bildung und Forschung and by the Deutsche Forschungsgemeinschaft. The financial resources for research in our country are declining and much smaller compared, e. g., to the USA. As a consequence of the shortage of resources not only are the weak projects turned down; it is feared that also the very innovative projects are likewise excluded for entering unknown territory. In periods of financial restrictions the central office and the experts evaluating the projects have a special responsibility, which cannot be met by technical objections, such as e. g., an "unsufficient impact factor". In order to improve the conditions for cardiological research the net profits for cardiological services should be transferred unrestricted to the responsible clinic. The acceptance rate of cardiologcal projects may be increased by more intensive cooperation. At the end, the principle of help by self-help also applies to cardiological research; the British Heart Foundation has developed into an impressive research-supporting organization in similarly difficult times.

Cardiology↗
PubMedDate not supplied

Who is interpreting nuclear cardiology studies in the United States, and what are the requirements for privileges? A national survey of institutional policies from 80 major medical centers.

BACKGROUND: This survey was conducted to determine the guidelines used by major medical centers in the United States for obtaining hospital privileges to interpret nuclear cardiology studies. The American College of Cardiology (ACC) and the American Society of Nuclear Cardiology (ASNC) have established guidelines to help maintain an adequate level of proficiency in the practice of nuclear cardiology. These guidelines were published only recently, and many hospitals have adopted different processes to obtain these privileges. It is likely that a marked difference among institutions exists. METHODS AND RESULTS: The survey was conducted predominantly by mailings with additional telephone communications if more information was needed. Chiefs of cardiovascular medicine sections were contacted to provide information concerning the policy of granting nuclear cardiology privileges at his or her institution. The responses were tabulated in four categories and the responders were asked to comment on whether they agreed or disagreed with their own university's policy. Of 80 responses (68%) from 121 institutions, cardiologists were involved in reading these studies in 62 (78%) and radiologists were the sole interpreters in 18 (22%). ACC or ASNC guidelines were strictly followed at 48 sites (60%). Eight (10%) and 6 (8%) of these institutions mandated a minimum requirement of, respectively, 12 and 6 months of additional training in nuclear cardiology. Ten (13%) of the cardiologists surveyed disagreed with their own institution's policies, primarily noting that the ACC and ASNC guidelines were more appropriate. CONCLUSION: The recently established ACC/ASNC guidelines clearly have had an impact on the practice of attaining privileges in nuclear cardiology and are the most commonly quoted criteria used by institutions in the United States to assess competence in nuclear cardiology.

Cardiology↗