CLINICAL
NEWS JACC in a FLASH
Featured topics in the current and recent
issues of the JACC family of journals
CV Workforce Supply and Demand
Meeting the growing demands of
cardiovascular care presents a challenge to the current cardiovascular
workforce as cardiovascular disease
continues to be the leading cause of
death in the U.S., according to a Council Perspective from ACC’s Fellows
in Training (FITs) Council published
Oct. 3 in JACC.
An analysis of the cardiovascular workforce from 2013 to 2014
showed a 20% increase in general cardiology fellows since 2005. However,
a shortage of up to 12,000 specialists
is predicted by 2025. In the JACC
perspective, Akhil Narang, MD,
chair of the FIT Leadership Council,
et al., question “whether the modest
increase in FITs in the past decade
suffices to ensure that Americans
have adequate access to cardiovascular specialists remains unclear.”
Among the factors that influence the supply and demand of the
cardiovascular workforce, Narang, et
al., list demographics, training and
access to care. The Medicare payment
shift from volume to value under the
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will
also “likely result in a direct effect
on cardiovascular practice models
through the nation,” they note, as
reimbursement may influence the
specialties FITs choose after general
cardiology fellowship. In addition, an
increase in the number of patients
with insurance as a result of the Af-
fordable Care Act may likely result
in a greater demand for care from
cardiovascular specialists.
To balance the supply and demand
of the cardiovascular workforce, the
Council put forth three suggestions:
increase the focus on cardiovascular
disease prevention; utilize a cardiovascular care team; and adapt the training pathway of future cardiologists.
Increasing the focus on cardiovascular
disease prevention may subsequently alleviate the burden on the cardiovascular
workforce, while streamlined care that
includes members of the cardiovascular
care team has been shown to improve
quality and safety of patient care.
Narang, et al., further added that
“with the transition toward competency-based milestones … opportunities
exist to reconsider the length of training to achieve successful competency.”
They explain that with competencybased training, the time in which
fellows achieve competency will vary
considerably, with the potential to
allow those early-achieving fellows
to move into subspecialty training
sooner. Such changes to cardiovascular training could increase the supply
of the cardiovascular workforce to
meet the ever-growing demand.
The Council concluded that “careful consideration of how the changing
health care climate influences the
job market, career decisions and the
cardiovascular workforce for young
cardiologists is paramount.”
Narang A, Sinha SS, Rajagopalan B, et al.
J Am Coll Cardiol. 2016;68(15):1680-9.
“Careful consideration of how the changing health care
climate influences the job market, career decisions and the
cardiovascular workforce for young cardiologists is paramount.”
—ACC FIT Council statement
ACC.org/CSWN
Is Abdominal Fat
Associated With
CVD Risk Factors?
Increasing abdominal fat may be
associated with newly identified and
worsening cardiovascular disease risk
factors, according to a study published Sept. 26 in JACC.
Jane J. Lee, PhD, and colleagues
examined 1,106 participants from
the Framingham Heart Study. Over
6.1 years of follow-up, weight, body
mass index (BMI), and waist circumference increased by 2.4 kg, 1.1 kg/
m2, and 3.7 cm, respectively. Participants gained an average of 602
cm3 of subcutaneous adipose tissue
(SAT) volume and 703 cm3 of visceral
adipose tissue (VAT) volume. The
average fat attenuation decreased by
5.5 Hounsfield units (HU) for SAT
and increased by 0.07 HU for VAT
attenuation.
The authors found that increases
in fat volume and decreases in fat
attenuation were correlated with
adverse changes in cardiovascular
disease risk factor profiles. They also
found weak to moderate correlations
between changes in abdominal fat
volume and attenuation with changes
in cardiovascular disease risk factors.
For each additional 500 cm3 increase
in SAT and VAT volume, the odds of
incident cardiovascular disease risk
factors increased, with the exception
of SAT volume change with diabetes
mellitus, hypercholesterolemia, and
low high-density lipoprotein cholesterol; and VAT volume change with
impaired fasting glucose and diabetes
mellitus.
For each additional five HU decrease in the change in SAT and VAT
attenuation, the researchers found
increased odds of incident cardiovascular disease risk factor profiles (p
< 0.05), except for impaired fasting glucose and diabetes mellitus.
Changes in abdominal fat volume
and attenuation were associated
with increased risk factors, and these
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