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Chronic Disease

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Few cardiology fellowship programs offer advanced congenital heart disease training

An estimated 650,000 to 1.3 million adults in the United States suffer from congenital heart disease (CHD), a number that is expected to grow at 5 percent per year. At least half of these patients will likely require care by a physician specializing in CHD, who can perform specific complex cardiac procedures; however, few cardiology fellowship programs offer advanced adult CHD training. This makes it likely that there will not be enough CHD specialists to meet future clinical needs, concludes a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00046 and HS13217).

Researchers analyzed survey responses of directors of 94 adult cardiology and 34 pediatric cardiology (PC) fellowship programs in the United States. Nine adult and 2 pediatric programs offered adult CHD fellowships, and only 31 adult and 11 pediatric fellows had pursued advanced CHD training in the last 10 years. Most PC programs were in children's hospitals (38 percent) or children's hospitals within adult hospitals (50 percent). Of adult programs, 70 percent were in university hospitals and 40 percent were associated with PC groups.

PC-affiliated adult programs allowed fellows to see more CHD patients, since they had more adult CHD clinics and more adult CHD visits than those without PC affiliation. Over 60 percent of the adult cardiology fellowship programs evaluated 10 or fewer CHD outpatients per month, and 69 percent evaluated less than 5 inpatients per month. Most of the fellowship programs were medium-sized with 6 to 20 adult fellows (76 percent) or 4 to 9 pediatric fellows (59 percent).

See "Variations in adult congenital heart disease training in adult and pediatric cardiology fellowship programs," by Michelle Z. Gurvitz, M.D., Ruey-Kang Chang, M.D., M.P.H., F.A.C.C., Fernando J. Ramos, and others, in the September 6, 2005, Journal of the American College of Cardiology 46(5), pp. 893-898.

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