Fellows’ corner on theheart.org

Dr Tariq Ahmad leads this frank discussion with Dr Chris O'Connor about finding the right path from fellowship through to a successful career in academic medicine. Find out about the essential role of mentorship, why it's important to be engaged in research, and why you should never be afraid to fail, as well as the hottest areas in heart-failure research.

Cardiac CT imaging has emerged as an important tool in the armamentarium of the clinical cardiologist. What are the best ways to get trained? Cardiology fellow Dr Michael Blaha talks to Dr Matthew Budoff, president of the Society of Cardiovascular Computed Tomography (SCCT), about training, how CT imaging is the "mammogram of the heart," the failure of biomarkers to stratify risk, and the issue of radiation risk.

Drs Budoff and Blaha have no relevant financial relationships to disclose.

Heart failure is the most common discharge diagnosis for patients over 65 years of age, with yearly costs to the US healthcare system estimated at $38 billion. Data show that 25% of patients are readmitted within 30 days of discharge and that 90% of readmissions are preventable. What is being done to promote better outcomes? Dr Robb Kociol puts this question to Dr Adrian Hernandez, who has been active with both the Get With The Guidelines for HF and the Hospital to Home initiatives and has published numerous articles pertaining to quality of care, heart-failure outcomes, and clinical effectiveness.

See:

Hernandez AF, Greiner MA, Fonarow GC, et al. Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA 2010; 303:1716-1722. Abstract.

Don't come back soon: Early follow-up after HF discharge shows early benefit

The revolving hospital door for HF and sensory-implant guides to cut hospitalization risk

Strategies to lower hospital readmission rates

Hospital-to-Home National Quality Improvement Initiative

Get-With-the-Guidelines shows quality gaps countrywide in treating heart failure

Aging populations, modified lifestyles, and changing environments in developing countries have contributed to making cardiovascular disease the leading cause of death worldwide. As 80% of cardiovascular disease occurs outside developed nations, more research in global cardiovascular disease is essential to understand and address the burden of this disease. In this episode, Fogarty International Clinical Research Fellow Dr Jerry Bloomfield asks respected mentor Dr Tom Gaziano about career opportunities in global research, the importance of mentorship, current areas of opportunity, and the importance of serendipity in career development.

See:

Bloomfield GS, Huffman MD. Global chronic disease research training for fellows: perspectives, challenges, and opportunities. Circulation 2010 Mar 23;121(11):1365-70. Abstract.

NHLBI Global Health Initiative: Collaborating Centers of Excellence Set to Combat Chronic Diseases in Developing Countries

In this insightful interview, Dr Marty Leon shares his experience in transcatheter aortic-valve implantation (TAVI) with interventional fellow Dr Philippe Genereux. The discussion addresses the pioneering work of Drs Alain Cribier and John Webb, Dr Leon's involvement in the field, important clinical trials such as PARTNER, and lessons learned from the 10 000 procedures performed so far. They also review devices and techniques and ponder the future of TAVI, including insight into collaboration across multiple disciplines to create the ideal heart-valve therapy center.

Interventional fellow Dr W Schuyler Jones leads this discussion, with Drs Kenny Rosenfield and Jim Zidar addressing what led them to interest in peripheral arterial—as well as vascular—disease and pointers for fellows interested in pursuing this career path.

Dr Mauro Montevecchi joins Dr Philip Greenland for a discussion of novel biomarkers (including CRP) and noninvasive radiological studies (including coronary calcium scoring) and their influence on predictive tests such as the Framingham Risk Score and the C statistic. On a broader level, they also examine the opportunities for fellows in the burgeoning fields of prevention and epidemiology.

Dr Ravi Shah joins Dr Marc Semigran for an insightful discussion of Dr Semigran's seminal work on pulmonary vasoconstriction in advanced heart failure syndromes and a review of the new CHF/transplantation certification process and how it impacts fellows' training and career prospects.

Dr Mike Blaha leads this discussion on the importance of following your heart and heeding a new calling in this frank discussion with Dr Roger Blumenthal who traded his interventional cardiology training for a prolific and fulfilling career in prevention. Find out what provoked Dr Blumenthal's change of direction and other tips to moving ahead in your own career including developing writing skills, productive collaboration with colleagues, and asking the advice of trusted mentors.

Drs David Kandzari and Sunil Rao join Dr Philippe Généreux to discuss the reasons for using transradial access and the situations best suited for it. From the fellow just starting out through to the most seasoned interventionalist who is more accustomed to transfemoral access, what are the ways to address the learning curve associated with this procedure, and what does it take to be successful and comfortable with it?