Skip to main content
SpringerLink
Log in

Training Pathways in Critical Care Cardiology: Competencies and Considerations for Cardiologists

  • Cardiovascular Critical Care (A Higgins and R Lee, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Critical care cardiology (CCC) is a rapidly developing field undergoing a renaissance of interest and growth to meet the well-documented population shift in the cardiac intensive care unit (CICU). With this has come the emergence of novel training paradigms that seek to combine specialties with meaningful overlap.

Recent Findings

The benefit of having critical care expertise in the CICU has been clearly established; however, there is no formal or uniform CCC training pathway. Contemporary approaches seek to provide appropriate clinical and procedural experience while minimizing opportunity cost. The combination of additional cardiology subspecialties, specifically advanced heart failure or interventional cardiology, has been demonstrated. Educational tracks that integrate critical care training have generated interest but have not yet manifested.

Summary

CCC training strives to meet the needs of an increasingly sick and diverse patient population while preparing trainees for fulfilling and meaningful careers. The hope is for ongoing development of novel training pathways to satisfy evolving needs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •  Of importance

  1. • O’Brien CG, Barnett CF, Dudzinski DM, et al. Training in critical care cardiology within critical care medicine fellowship: a novel pathway. J Am College Cardiol. 2022;79(6):609–613. https://doi.org/10.1016/j.jacc.2021.12.009. This reference provides a suggested listed of competencies in critical care cardiology training and a curriculum to be developed within critical care medicine fellowships.

  2. Geller BJ, Fleitman J, Sinha SS. Critical Care Cardiology: Implementing a training paradigm. J Am Coll Cardiol. 2018;72(10):1171–5. https://doi.org/10.1016/j.jacc.2018.07.024.

    Article  PubMed  Google Scholar 

  3. Katz JN, Shah BR, Volz EM, et al. Evolution of the coronary care unit: Clinical characteristics and temporal trends in healthcare delivery and outcomes*. Crit Care Med. 2010;38(2):375. https://doi.org/10.1097/CCM.0b013e3181cb0a63.

    Article  PubMed  Google Scholar 

  4. Morrow DA, Fang JC, Fintel DJ, et al. Evolution of critical care cardiology: transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models. Circulation. 2012;126(11):1408–28. https://doi.org/10.1161/CIR.0b013e31826890b0.

    Article  PubMed  Google Scholar 

  5. • Miller PE, Kenigsberg BB, Wiley BM. Cardiac critical care: training pathways and transition to early career. J Am College Cardiol. 2019;73(13):1726-1730. https://doi.org/10.1016/j.jacc.2019.03.004. This reference illustrates the state of critical care training for cardiologists and some of the training paradigms that exist.

  6. • Il’Giovine ZJ, Menon V. The intersection of heart failure and critical care: the contemporary cardiac intensive care unit and the opportunity for a unique training pathway. J Card Fail. 2021;27(10):1152–1155. https://doi.org/10.1016/j.cardfail.2021.03.014. This reference argues the benefits of additional training in advanced heart failure and transplant cardiology with critical care cardiology and outlines the original pathway to obtain this training.

  7. Panhwar MS, Chatterjee S, Kalra A. Training the critical care cardiologists of the future: an interventional cardiology critical care pathway. J Am Coll Cardiol. 2020;75(23):2984–8. https://doi.org/10.1016/j.jacc.2020.05.010.

    Article  PubMed  Google Scholar 

  8. Sinha SS, Sjoding MW, Sukul D, et al. Changes in primary noncardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States. Circ: Cardiovasc Qual Outcomes. 2017;10(8):e003616. https://doi.org/10.1161/CIRCOUTCOMES.117.003616.

  9. Pronovost P, Thompson DA, Holzmueller CG, Dorman T, Morlock LL. Impact of the Leapfrog group’s intensive care unit physician staffing standard. J Crit Care. 2007;22(2):89-96.e24. https://doi.org/10.1016/j.jcrc.2006.08.001.

    Article  PubMed  Google Scholar 

  10. Pronovost PJ, Thompson DA, Holzmueller CG, Dorman T, Morlock LL. The organization of intensive care unit physician services*. Crit Care Med. 2007;35(10):2256. https://doi.org/10.1097/01.CCM.0000281860.37528.F8.

    Article  PubMed  Google Scholar 

  11. Jha AK, Orav EJ, Ridgway AB, Zheng J, Epstein AM. Does the Leapfrog program help identify high-quality hospitals. JT Comm J Qual Patient Saf. 2008;34(6):318–25. https://doi.org/10.1016/S1553-7250(08)34040-9.

    Article  PubMed  Google Scholar 

  12. Gasperino J. The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review. Health Policy. 2011;102(2):223–8. https://doi.org/10.1016/j.healthpol.2011.02.005.

    Article  PubMed  Google Scholar 

  13. Parikh A, Huang SA, Murthy P, et al. Quality improvement and cost savings after implementation of the Leapfrog intensive care unit physician staffing standard at a community teaching hospital. Crit Care Med. 2012;40(10):2754. https://doi.org/10.1097/CCM.0b013e31825b26ef.

    Article  PubMed  Google Scholar 

  14. Na SJ, Chung CR, Jeon K, et al. Association between presence of a cardiac intensivist and mortality in an adult cardiac care unit. J Am Coll Cardiol. 2016;68(24):2637–48. https://doi.org/10.1016/j.jacc.2016.09.947.

    Article  PubMed  Google Scholar 

  15. Kapoor K, Verceles AC, Netzer G, et al. A Collaborative cardiologist-intensivist management model improves cardiac intensive care unit outcomes. J Am Coll Cardiol. 2017;70(11):1422–3. https://doi.org/10.1016/j.jacc.2017.07.739.

    Article  PubMed  Google Scholar 

  16. Brusca SB, Barnett C, Barnhart BJ, et al. Role of critical care medicine training in the cardiovascular intensive care unit: survey responses from dual certified critical care cardiologists. J Am Heart Assoc. 2019;8(6):e011721. https://doi.org/10.1161/JAHA.118.011721.

  17. Batchelor WB, Anwaruddin S, Wang DD, et al. The multidisciplinary heart team in cardiovascular medicine. JACC: Advances. 2023;2(1):100160. https://doi.org/10.1016/j.jacadv.2022.100160.

  18. Metkus TS, Lindsley J, Fair L, et al. Quality of heart failure care in the intensive care unit. J Cardiac Fail. 2021;27(10):1111–25. https://doi.org/10.1016/j.cardfail.2021.08.001.

    Article  Google Scholar 

  19. Vallabhajosyula S, Kapur NK, Dunlay SM. Hybrid training in acute cardiovascular care. Circ: Cardiovasc Qual Outcomes. 2020;13(8):e006507. https://doi.org/10.1161/CIRCOUTCOMES.120.006507.

  20. O ’Gara Patrick T, Adams JE, Drazner MH, et al. COCATS 4 task force 13: training in critical care cardiology. J Am College Cardiol. 2015;65(17):1877–1886. https://doi.org/10.1016/j.jacc.2015.03.027.

  21. Bernard S, Kadosh MD, David D, Berg MD, Erin A, Bohula MD, et al. Pulmonary artery catheter use and mortality in the cardiac intensive care unit. Heart Failure. Published online August 1, 2023. https://doi.org/10.1016/j.jchf.2023.04.007.

  22. Starling RC, Bozkurt B. The emergence of the heart failure and critical care medicine specialist: an unmet need that needs a rapid solution. J Cardiac Fail. 2022;28(2):343–5. https://doi.org/10.1016/j.cardfail.2021.10.005.

    Article  Google Scholar 

  23. American College of Cardiology AIRE Pilot for cardiovascular disease and clinical cardiac electrophysiology programs. Help Center. Published May 12, 2022. Accessed August 7, 2023. https://acgmehelp.acgme.org/hc/en-us/articles/6046007356567-American-College-of-Cardiology-AIRE-Pilot-for-cardiovascular-disease-and-clinical-cardiac-electrophysiology-programs.

  24. Sims DB, Kim Y, Kalininskiy A, et al. Full-time cardiac intensive care unit staffing by heart failure specialists and its association with mortality rates. J Cardiac Fail. 2022;28(3):394–402. https://doi.org/10.1016/j.cardfail.2021.09.013.

    Article  Google Scholar 

  25. Carnicelli AP, Blumer V, Genovese L, et al. The road not yet traveled: distinction in critical care cardiology through the advanced heart failure and transplant cardiology training pathway. J Card Fail. 2022;28(2):339–42. https://doi.org/10.1016/j.cardfail.2021.07.014.

    Article  PubMed  Google Scholar 

  26. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369(23):2197–206. https://doi.org/10.1056/NEJMoa1310519.

    Article  CAS  PubMed  Google Scholar 

  27. Dankiewicz J, Cronberg T, Lilja G, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med. 2021;384(24):2283–94. https://doi.org/10.1056/NEJMoa2100591.

    Article  PubMed  Google Scholar 

  28. Holgersson J, Meyer MAS, Dankiewicz J, et al. Hypothermic versus normothermic temperature control after cardiac arrest. NEJM Evidence. 2022;1(11):EVIDoa2200137. https://doi.org/10.1056/EVIDoa2200137.

  29. Grinstein J, Sinha SS, Goswami RM, et al. Variation in hemodynamic assessment and interpretation: a call to standardize the right heart catheterization. J Card Fail. 2023;0(0). https://doi.org/10.1016/j.cardfail.2023.06.009.

  30. Ranka S, Mastoris I, Kapur NK, et al. Right Heart Catheterization in cardiogenic shock is associated with improved outcomes: insights from the nationwide readmissions database. J Am Heart Assoc. 2021;10(17):e019843. https://doi.org/10.1161/JAHA.120.019843.

  31. Ismayl M, Hussain Y, Aboeata A, et al. Pulmonary artery catheter use and outcomes in patients with ST-elevation myocardial infarction and cardiogenic shock treated with impella (a Nationwide Analysis from the United States). Am J Cardiol. 2023;203:304–14. https://doi.org/10.1016/j.amjcard.2023.06.117.

    Article  PubMed  Google Scholar 

  32. Khera R, Cram P, Lu X, et al. Trends in the use of percutaneous ventricular assist devices: analysis of national inpatient sample data, 2007 Through 2012. JAMA Intern Med. 2015;175(6):941–50. https://doi.org/10.1001/jamainternmed.2014.7856.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Garan AR, Kanwar M, Thayer KL, et al. Complete hemodynamic profiling with pulmonary artery catheters in cardiogenic shock is associated with lower in-hospital mortality. JACC: Heart Fail. 2020;8(11):903–913. https://doi.org/10.1016/j.jchf.2020.08.012.

Download references

Acknowledgements

The authors would like to thank Clare Il’Giovine for her assistance with the design of the figure.

Author information

Authors and Affiliations

  1. Centennial Heart, Tristar Centennial Medical Center, 2400 Patterson St Ste 502, Nashville, TN, 37203, USA

    Zachary J. Il’Giovine

  2. Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Andrew Higgins & Ran Lee

  3. Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, TN, USA

    Aniket S. Rali

  4. Inova Fairfax Medical Center, Inova Heart and Vascular Institute, Falls Church, VA, USA

    Ahmad A. Abdul-Aziz

Authors
  1. Zachary J. Il’Giovine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Higgins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aniket S. Rali
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmad A. Abdul-Aziz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ran Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zachary J. Il’Giovine.

Ethics declarations

Conflict of Interest

The authors declare no conflict of interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Il’Giovine, Z.J., Higgins, A., Rali, A.S. et al. Training Pathways in Critical Care Cardiology: Competencies and Considerations for Cardiologists. Curr Cardiol Rep 25, 1381–1387 (2023). https://doi.org/10.1007/s11886-023-01952-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-023-01952-0

Keywords

Search

Navigation