Clinical Cardiology Innovations Essay

Given the importance of continuing medical education in our specialty, Revista Española de Cardiología presents a new Update section. In previous years, we have dealt with such interesting subjects as “Cardiovascular diseases in women” (2006),1 “Noncoronary arterial disease” (2007),2 “Cardiovascular prevention” (2008),3 “Cardiovascular translational medicine” (2009),4 “The right heart and pulmonary circulation” (2010),5 “Systemic diseases and the cardiovascular system” (2011),6 and “Arrhythmias” (2012).Clinical Cardiology Innovations Essay

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In this new volume of the Update section for 2013, we examine the subject of “Innovation in cardiology”. Cardiology is a specialty that has always been in the vanguard of technological innovation. Especially in recent years, the introduction of new technological tools has opened the door to a revolution in both diagnostic and therapeutic developments. Cardiac imaging techniques are evolving rapidly (3-dimensional echocardiography, computed tomography with measurement of coronary fractional flow reserve, etc.) and are a central pillar in the diagnosis of many cardiovascular diseases. The development of new materials—such as catheters, bioprostheses specifically designed for percutaneous implantation, and stents—has facilitated the application of effective therapeutic solutions with an excellent risk-benefit ratio. Moreover, as in the case of bioabsorbable stents, this development has served to boost the most advanced basic and clinical research.

As in previous volumes, throughout the various articles an attempt has been made to deal with the most contemporary topics, those that will continue to change cardiology. Consequently, in line with the journal’s policy, we have solicited manuscripts from highly prestigious authors with extensive experience in the various topics addressed. The first article (by Dr. Ibáñez) analyzes the future of imaging techniques, with special attention paid to those that can be combined to allow the patient to undergo a single examination. Prof. Clemmensen will portray the present and future of telemedicine8 and the new electrocardiographic monitoring systems, applied to pacemakers, defibrillators, and patients with heart failure. Prof. Ackerman will apprise us on the state of personalized medicine9 and genetic diagnosis. Dr. Gálvez will analyze the present and future of cardiac tissue engineering and organogenesis.10 In the field of interventional cardiology, the next articles will deal with the present and future of distinct techniques employed to treat various diseases: renal denervation in the case of hypertension11 (Prof. Krum), the implantation of coronary stents in coronary artery disease12 (Prof. Serruys), and percutaneous mitral repair in cases of mitral regurgitation13 (Prof. Rodés). Prof. Mayr presents a highly attractive and interesting subject, the biological approach to diagnostics involving metabolomics and proteomics.Clinical Cardiology Innovations Essay

We hope that the contents of this series will be of interest and will appeal to readers of Revista Española de Cardiología. It is our wish that the series will, to put it quite appropriately, “update” the reader on these interesting but often unfamiliar topics, and that these articles will provide a practical view of how we will be putting these new tools to use in the near future and of how they will change our relationship with the patient and heart disease.

Interventional Cardiology is an area of medicine within the subspecialty of cardiology that uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart, as well as technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system.Clinical Cardiology Innovations Essay

Specialty Description
Interventional cardiology is the subspecialty of cardiology that deals specifically with the catheter- based treatment of heart diseases. The field includes the diagnosis and treatment of coronary artery disease, vascular disease and acquired structural heart disease. For pediatric interventional cardiologists, congenital heart defects are the major focus of diagnosis and treatment.

Interventional cardiology has grown to bridge many specialties, which were traditionally seen as somewhat isolated from one another. For example, endovascular techniques mastered within the small- caliber and bifurcating coronary artery vessels of a beating heart in a conscious patient can be applied in larger vessels within immobile organs, especially when procedures are done under sedation or anesthesia. This exemplifies the way interventional cardiologists work in a variety of vascular territories, including the carotid circulation, the upper and lower extremities, and the aorta and its branches. Interventional cardiology has grown in parallel with great achievements in techniques and technologies, to many innovations in its rather brief lifetime—the first balloon angioplasty was only performed in 1977.Clinical Cardiology Innovations Essay

Interventional cardiology, a subspecialty of adult cardiology, requires a minimum one-year interventional cardiology fellowship in addition to the specialized training required for cardiology. Although there are no subspecialty boards in pediatric cardiology, most physicians planning on performing pediatric interventional catheterizations opt to complete an additional nonaccredited year of interventional catheterization.

In an effort to ensure trainees meet the rigors of the science and mastery of interventional techniques, entry into an interventional cardiology specialty fellowship program is highly competitive. Interventional cardiology has a strong foundation of device-based research and innovation that can be appealing to those with a keen interest in biotechnology, physics and hydrodynamics. This specialty requires an investment in additional years of career preparation and a lifelong commitment to learning, including Maintenance of Certification. The skills required for success in this field include excellent communication, confidence, technical ability and a willingness to participate in the increasingly utilized team-based-care approach.Clinical Cardiology Innovations Essay

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Life as an interventional cardiologist may include active on-call work, as one must be immediately available to treat a patient having an emergent event. One should also be physically strong enough to wear 20 pounds of lead protection and perform procedures in an X-ray exposure environment. Interventional cardiologists note that seeing immediate benefits in patients, including being able to stop a heart attack, is exciting and rewarding.

Interventional cardiologists’ work settings include on-call work in emergency departments; cardiology and multispecialty private practices; private, government and military hospitals; and medical schools and universities. Interventional cardiologists primarily perform diagnostic and treatment procedures, and any associated follow-up.

The Preventive Cardiology program is an integral part of the Division of Cardiovascular Medicine. Its mission is to help prevent cardiovascular disease in our city, state, region and throughout the United States. It offers a wide range of clinical, research and educational programs, each of which is focused on reducing death and disability from heart and vascular disease.Clinical Cardiology Innovations Essay

The Preventive Cardiology program encompasses the following services: preventive cardiology clinics, which include lipid, hypertension, nutrition and risk reduction clinics; inpatient and outpatient cardiac rehabilitation; pulmonary rehabilitation, risk factor and vascular screening programs, exercise stress testing, exercise prescription and counseling, smoking cessation, stress management and several other clinical, research and educational programs. The educational and research programs are nationally recognized in the fight against premature cardiovascular disease through prevention. The highly skilled Preventive Cardiology team includes six physicians, three nurses, over ten clinical exercise physiologists, four dietitians, a psychologist and clinical support staff. Each year, this team of experts assists thousands of patients from Wisconsin and surrounding states.

HISTORY
The University of Wisconsin Preventive Cardiology program was one of the nation’s first and remains on the “cutting-edge.” Research and educational advances developed by Preventive Cardiology faculty and staff are presented at national meetings and published in peer-reviewed medical journals every year.Clinical Cardiology Innovations Essay

The Preventive Cardiology program started with Dr. Bruno Balke’s founding of the Cardiac Rehabilitation program in 1966. Peter G. Hanson, MD, Professor Emeritus of Medicine, was the program’s first Medical Director. He added the inpatient cardiac rehabilitation program, the first at an academic medical center in the United States, and he significantly expanded the outpatient program. He made important contributions in exercise physiology and preventive cardiology research, including seminal research on the effects of exercise on patients with heart failure, the effects of resistance training on cardiac function and the effects of lipid-lowering therapy on atherosclerosis. The second Medical Director, Patrick McBride, MD, MPH, expanded the program’s services to include Preventive Cardiology clinics as well as outreach education and research. His research team received federal funding for innovative projects to educate health care providers and improve heart disease prevention services in primary care practices and hospitals. Dr. McBride is a national expert on the prevention of heart disease and has served on several national guidelines committees. James Stein, MD, is the current Medical Director. He has pioneered innovative screening programs for subclinical atherosclerosis and other forms of vascular disease. Under his leadership, Preventive Cardiology has further expanded the scope and volume of itsoutreach efforts, as well as educational efforts for trainees. He also has served on national guidelines and consensus panels. His federally-funded Atherosclerosis Imaging Research Program program focuses on non-invasive evaluation of atherosclerosis.Clinical Cardiology Innovations Essay

CLINICAL SERVICES
Cardiac, pulmonary, and vascular rehabilitation are comprehensive programs that include rehabilitation, exercise, monitoring, risk factor assessment and management, education and counseling. Ambulatory rehabilitation services are performed at the UW Health Research Park and UW Health East Side Clinics in Madison, Wisconsin. Our state-of-the-art facilities include aerobic exercise and weight-training equipment, telemetry monitoring, a track, swimming pool, and other training tools. A wide range of services are available for patients recovering from cardiothoracic surgery, acute coronary syndromes, and percutaneous coronary interventions, as well as for patients with congestive heart failure, or those requiring pulmonary and vascular rehabilitation.Clinical Cardiology Innovations Essay

Our programs use a case management approach to focus efforts on helping patients reach their clinical and functional goals. Behavior change strategies are emphasized. We work closely with each patient’s doctors, to help ensure the best outcomes and their long-term health. The programs offer support in clinical management, diagnostic testing, and efforts to maximize the patient’s physical, psychological and spiritual health. The inpatient program assists hospitalized patients recovering from heart or vascular disease; the outpatient program focuses on optimizing health and reducing risk. Preventive Cardiology staff assists patients in maintaining and continuing long-term recovery. The staff also provides clinical nutrition intervention and exercise prescription. Psychological evaluation is a standard component of the patient assessment. A psychologist and counselor offer individualized and group programs to enhance health outcomes and screen for significant anxiety or depression. A comprehensive stress management program recently became affiliated with the UW Mind-Body Institute. Clinical Cardiology Innovations Essay