This Article Full Text Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Braunwald, E. Search for Related Content PubMed PubMed Citation Articles by Braunwald, E.

(Circulation. 1997;95:545-547.)
© 1997 American Heart Association, Inc.

Articles

Evolution of Academic Divisions of Cardiology

Eugene Braunwald, MD

the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.

Correspondence to Eugene Braunwald, MD, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.

Key Words: Editorials • cardiology

	Introduction

 
Elsewhere in this issue of Circulation, Feldman et al¹ describe how a classic academic division of cardiology is being transformed into a regional system of cardiac care, research, and education. This proposal is important and timely. Cardiology, like all components of American medicine, is in a dizzyingly rapid transition, driven largely by efforts to restrain the rising costs of medical care.

This pressure to control costs, combined with excess inpatient facilities and specialists (including cardiologists), will lead to ever fiercer competition among care providers. At the same time, if current research efforts continue, enormous further improvements in cardiac care might occur. For example, the development of safe and even more potent cholesterol-lowering and antiplatelet agents could greatly reduce the incidence of clinical coronary artery disease. Although sophisticated methods, including genetic analysis, may be necessary to identify patients at risk for developing atherosclerosis in whom these preventive measures are most appropriate, preventive cardiology is likely to be practiced largely by primary care physicians. This will further reduce the need for cardiovascular specialists.

If research continues to flourish, cardiology is likely to remain an important specialty. Highly sophisticated technical procedures, such as catheter-based gene therapy and cardiac xenotransplantation, that will offer substantial clinical benefits are likely to flow from the research laboratory. An increasingly sophisticated public will insist on obtaining these benefits, even if they are costly. Outcome research and cost-effectiveness analyses will be essential to help resolve the conflict between, on the one hand, the pressures to restrain costs, and . . . [Full Text of this Article]

This article has been cited by other articles:

				J. A. Hill and R. E. Kerber Quo Vadis? : How Should We Train Cardiologists at the Turn of the Century? Circulation, August 22, 2000; 102(8): 932 - 936. [Abstract] [Full Text] [PDF]