Almasri, Murad

Background There is a global mismatch between the number of adults with congenital heart disease and adult congenital heart disease (ACHD) cardiologists, potentially impacting patient outcomes. This survey explores factors influencing trainees and cardiologists' career choices in ACHD. Methods An online, anonymous global survey on demographics, ACHD as a career choice, encouraging and deterring factors assessed via a 5‐point Likert scale and open‐ended questions on recommending ACHD was distributed through targeted emails and social media. Responses meeting a 75% completion criterion were analyzed using descriptive statistics and thematic analysis. Results Among 811 included responses, most were from women (53.5%), aged 31 to 40 years (48.3%), White individuals (43.3%), non‐Hispanic individuals (85%), from outside the ACHD field (79.0%), and from North America (42.7%). Only 30.9% of non‐ACHD physicians considered specializing in ACHD despite 78.9% recommending it. Encouraging factors included awareness of ACHD significance, mentor influence, and clinical exposure. Key deterrents were inadequate financial incentives, limited job opportunities, and lengthy training. Regional variations showed that longer training duration and lack of compensation incentives were the main deterrents in North America. Suggested solutions included structured training programs, salary improvements, and early ACHD exposure during medical education. Conclusions Less than a third of respondents considered ACHD as a career largely due to inadequate financial incentives, limited job opportunities, and long training duration. Addressing these barriers could enhance recruitment and help meet the growing demands of the ACHD population.

INTRODUCTION: There is a significant shortage of specialized Adult Congenital Heart Disease (ACHD) cardiologists despite a rising prevalence of adults with this condition. AIM: Our study explores the specific motivations and deterrents that influence adult and pediatric cardiologists’ ACHD career decisions, which could serve as the basis for future solutions to overcome this shortage in each specific region. METHODS: An anonymous global survey was distributed to adult and pediatric cardiologists and trainees via email, social media, and medical society newsletters. The survey included demographics, ACHD exposure, career considerations, Likert scale ratings, and open-ended inquiries on ACHD career recommendations. Respondents included non-ACHD and ACHD cardiologists (defined as those caring for ACHD with or without formal training). The analysis covered regional variations across continents. Responses with less than 75% completion were excluded. RESULTS: A total of 811 valid responses were collected (53.5% female, 48.3% aged 31-40, and 43.3% White). ACHD cardiologists were 21%, mostly practicing in North America (44.1%) and Europe (32.9%). Almost all ACHD cardiologists (94.7%) recommended it as a career. Among the 641 non-ACHD cardiologists, 85.7% had been exposed to ACHD, however, only 35.1% considered pursuing it themselves. For ACHD cardiologists the top global motivators for pursuing an ACHD career were awareness of the field and its significance, mentor's influence, and sufficient clinical exposure during residency (Figure 1A). Factors that deterred non-ACHD cardiologists included a lack of compensation compared to other cardiology subspecialties, limited job opportunities, and the longer duration of training (Figure 1B). Absence of specialized training and educational programs emerged as a major deterrent in all continents except North America. The lack of mentorship or role models in ACHD was particularly pronounced in Africa and Central and South America. Limited exposure to ACHD during training was a significant issue in Europe and Africa. CONCLUSION: Most ACHD cardiologists recommend a career in ACHD. However, only a few non-ACHD cardiologists recommend it. Influential mentors, clinical exposure motivate; low compensation, lengthy training deter. Regional disparities require targeted interventions for better ACHD cardiologist recruitment.

Introduction: Patients with systemic lupus erythematosus (SLE) are at increased cardiovascular risk. Data about outcomes after cardiac surgery are scarce. Hypothesis: We sought to evaluate early and late outcomes after cardiac surgery for patients with SLE during a 27- year period at a single institution. Methods: A retrospective review of the institutional Society of Thoracic Surgeons (STS) database between 1993 and 2019 was performed. A total of 329 patients with SLE (median age, 62.4 years, and 68.4% females) had undergone cardiac surgery. Patients’ characteristics and outcomes were analyzed. A logistic regression model was used to assess factors associated with mortality. Results: Incidence of cardiac surgery in patients with SLE has steadily increased with time (0.8% from 1993-2000, 0.9% from 2001-2010, 1.4% from 2011-2019). Of 329 patients, 166 patients (50.5%) had valve surgery, 82 patients (24.9%) had coronary artery bypass grafting (CABG), 48 patients (14.6%) had CABG + valve surgery, and 24 patients (7.3%) had pericardiectomy or pericardial window +/- others procedures. Patients with SLE were more likely to be females, white, older, and have hypertension, diabetes, dyslipidemia, chronic kidney disease, prior myocardial infarction, and congestive heart failure. The requirement of corticosteroids occurred in 91% of patients. The status of surgery was urgent or emergent in 20% of patients. Operative mortality was 4.6% and length of hospital stay was 6.1 days [IQR, 5.1, 9.2]. Overall long-term survival at 1, 5, and 10 years was 89%, 73% and 52%, respectively (Figure). Older age, re-operative dialysis, chronic lung disease, prior cardiac surgery, and dialysis required after surgery were strongly associated with long-term mortality. Conclusion: Cardiac surgery in SLE patients can be performed with acceptable morbidity and mortality. These data are beneficial in risk stratification of patients with SLE referred for cardiac surgery.