The modern cardiovascular intensive care unit (CICU) has dramatically evolved from the classic coronary care unit. Over the past few decades, the prevalence of non-cardiovascular comorbidities in the CICU has increased — particularly sepsis, acute kidney injury and respiratory failure — while the proportion of traditional ST segment myocardial infarction has decreased.

Supporting this transformation, an observational study of a single CICU even suggests that dedicated cardiac intensivist care was associated with a reduction in CICU mortality. Accordingly, there has been increasing awareness of the changing clinical skill set needs and optimal training pathways for providers in the modern CICU.

The ACC has developed Core Cardiovascular Training Statement (COCATS) recommendations for training in critical care cardiology, which defines Level III training as requiring the completion of an additional clinical fellowship in critical care medicine (CCM) in addition to the three-year cardiovascular medicine fellowship.

However, despite the recognition of the importance of critical care medicine training, there has been no systematic assessment of the availability of critical care fellowship programs for cardiovascular fellows or practitioners. Instead, cardiology fellows interested in this career must typically create a novel training program within their own institution or individually contact critical care medicine programs in the hope of being considered for fellowship training. As such, we conducted a survey to assess the availability of cardiac critical care training pathways.

Methods

We surveyed all publicly available Accreditation Council for Graduate Medical Education (ACGME) accredited critical care medicine training programs. The email survey included only one embedded question: “Would your program consider accepting a cardiologist into a 12- or 24-month ACGME approved critical care medicine fellowship?” The survey allowed for three potential responses: “Yes, a 12-month fellowship,” “Yes, a 24-month fellowship,” or “No.” Data collection took place from May 21, 2018 through June 24, 2018. The survey was approved by the MedStar Health institutional review board.

Results

The program directors of 186 ACGME accredited critical care medicine fellowship programs (35 dedicated internal medicine CCM programs and 151 combination pulmonary disease and critical care medicine programs [PCCM]) were contacted. Fifty-seven (31 percent) program directors responded, including 17 (49 percent) of the CCM programs and 40 (26 percent) of the combination PCCM programs.

Overall, 42 (74 percent) of responding program directors were willing to offer CCM training to a cardiologist, including all 17 responding CCM program directors and 25 (44 percent) responding PCCM programs. Regarding the duration of available critical care training programs, 33 (79 percent) program directors would offer a 12-month critical care fellowship while the remaining 9 (21 percent) offered a 24-month critical care fellowship. The offered duration of critical care fellowship for a cardiologist was similar for CCM and PCCM program directors.

Discussion

Nearly three out of four critical care medicine fellowship program directors were willing and able to offer critical care fellowship training to a cardiologist. Strikingly, 100 percent of dedicated CCM programs were willing to offer a training pathway for cardiac critical care. While there was program-level variability for duration of training, the majority followed the Level III COCATS critical care cardiology training requirements of an additional one-year clinical fellowship.

Notably, the majority of surveyed program directors did not complete the one question survey, which may limit the generalizability of the results. Additionally, graduate medical education funding, clinical mentorship and institutional resources can be dynamic and some responding programs may only temporarily be able to offer critical care fellowship training to cardiologists. Nonetheless, the list of responding programs offers a novel resource for cardiologists interested in pursuing additional training in critical care medicine and a career in critical care cardiology.

Conclusion

A wide array of critical care fellowship training programs is available to cardiologists. Below you'll find a list of critical care fellowship opportunities for cardiologists as of June 2018.

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This article was authored by Benjamin B. Kenigsberg, MD, and Christopher F. Barnett, MD, from the MedStar Heart and Vascular Institute at MedStar Washington Hospital Center in Washington, DC.