PREVENTIVE CARDIOLOGY CURRICULUM
Overview
The primary goal of the Preventive Cardiology curriculum for the University of Wisconsin
Cardiovascular Medicine Fellowship is to provide the knowledge and skills necessary to
successfully initiate and maintain long-term preventive therapies in a general clinical cardiology
practice. Additional educational, clinical, and research opportunities are available for fellows
interested in a cardiology career with an emphasis in prevention.
All successful Preventive Cardiology programs use a multidisciplinary team approach including
nurses, exercise physiologists, nutritionists, and clinical psychologists. Cardiologists must be
familiar with the resources and skills of each team member in order to formulate and reinforce a
successful Preventive Cardiology and cardiac rehabilitation program for individual patients.
The Preventive Cardiology curriculum will be integrated into the training of the fellow at a time
when the knowledge obtained during this curriculum can be practiced and later reinforced. The
Preventive Cardiology curriculum consists of an initial orientation week in the first year of
training and then ongoing didactic and/or clinical experiences in each of the next three years. A
half or full year of specific Preventive Cardiology training is available for interested fourth-year
fellows. The Preventive Cardiology lecture series is comprehensive and includes several
interactive methods such as case management and problem solving, in addition to didactic and
written support materials. This is the major Preventive Cardiology experience of the UW
Cardiovascular Medicine Fellowship.
The Preventive Cardiology curriculum meets the program requirements for the ACGME as
follows:
A. Patient Care. Learned as part of the Preventive Cardiology orientation week experience
and evaluated by an attending supervision.
B. Medical Knowledge. Obtained as part of the Preventive Cardiology orientation week
experience and lecture series, and evaluated by informal quiz.
C. Practice-Based Learning and Improvement. Obtained as part of the Preventive
Cardiology orientation week experience, supplemented by case-based learning during
the lecture series, and evaluated by quizzes.
D. Interpersonal Communication Skills. Emphasized and role-modeled during the
Preventive Cardiology orientation week experience.
E. Professionalism. Emphasized and role-modeled during the Preventive Cardiology
orientation week experience.
F. Systems-Based Practice. Emphasized and role-modeled during the Preventive
Cardiology orientation week experience and supplemented by the lecture series.
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Clinical Experience - Preventive Cardiology Orientation Week for First-Year Fellows
A one-week block during the first year of the cardiology fellowship will be dedicated to in-depth
participation in the care of patients in the Preventive Cardiology and cardiac rehabilitation
programs. Fellows will be exposed to, and when appropriate, manage patients with direct
observation by Preventive Cardiology faculty. Fellows will work in the inpatient rehabilitation
(Phase I), outpatient rehabilitation (Phase II-III), and specialty programs in Preventive
Cardiology. Experience with patients recovering from myocardial infarction, percutaneous
coronary intervention, coronary artery bypass graft surgery, cardiac transplantation, and with
other cardiac problems will be managed. The fellows will
1. Learn to implement comprehensive primary and secondary prevention strategies
including management of cardiovascular risk factors, exercise prescription, behavioral
change, and management of new/emerging risk factors.
2. Develop a working knowledge of all phases cardiac rehabilitation.
3. Learn how to provide individualized exercise and activity prescriptions to patients with
cardiovascular disease.
The one-week experience will specifically consist of:
1. One-half day of Inpatient Cardiac Rehabilitation. The fellow will meet for one hour with
the Manager of Cardiac Rehabilitation, followed by three hours with inpatient cardiac
rehabilitation exercise physiologists. The minimum experience with the exercise
physiology staff includes of implementation of Phase I rehabilitation for a patient with an
acute myocardial infarction and a patient who has recently had coronary artery bypass
graft surgery.
2. Two half-days in Outpatient Cardiac Rehabilitation. This will involve observing at least
one intake/initial cardiac rehabilitation visit, and several ongoing rehabilitation sessions,
supplemented by exercise monitoring sessions performed by exercise physiology staff.
3. Two half-days in the Preventive Cardiology Outpatient Clinic supervised by Preventive
Cardiology faculty. This focuses on lipid management, hypertension management, highrisk primary prevention, and secondary prevention.
4. One-half day experience in Vascular Medicine Clinic with cardiologists and vascular
surgeons, when available.
5. One-half day of smoking cessation, to be conducted either in the Smoking Cessation
Clinic at the Center for Tobacco Research Intervention or in the UW Preventive
Cardiology Smoking Cessation Clinic.
6. One or two one-half day of dietary counseling with a senior nutritionist that is part of the
Preventive Cardiology Program.
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Preventive Cardiology Goals and Objectives
1. Lipids
Goal: To understand clinical aspects of lipoprotein metabolism, and diagnosis and
management of lipid disorders as they relate to cardiovascular disease.
Objectives: Fellows will be able to
1. Describe basic mechanisms of atherogenesis and atherosclerosis.
2. Describe clinical aspects of lipid and lipoprotein metabolism.
3. Understand the National Cholesterol Education Program Adult Treatment guidelines.
4. Describe dietary treatment of lipid disorders.
5. Describe pharmacologic treatment of lipid disorders.
6. Describe the major clinical trials that affect lipid therapy and guidelines.
7. Evaluate clinical dyslipidemias and recommend treatment strategies based on case
presentations.
8. Understand the methodology and appropriate use of advanced lipoprotein testing.
2. Hypertension Management
Goal: To understand clinical aspects of the diagnosis and management of hypertension.
Objectives: Fellows will be able to
1. Understand the major secondary causes of hypertension and their initial evaluation.
2. Describe key aspects of management of patients with hypertension.
3. To understand the approach to the diagnosis and treatment of the patient with resistant
hypertension.
3. Diabetes Mellitus, Metabolic Syndrome, and Obesity
Goal: To understand the prevalence, cardiovascular implications, and treatment of obesity,
metabolic syndrome, and diabetes mellitus.
Objectives: Fellows will be able to
1. Describe the pathophysiology of obesity and metabolic syndrome (insulin resistance
syndrome).
2. Describe the mechanisms by which obesity and metabolic syndrome increase
cardiovascular risk.
3. Describe lifestyle management of obesity and metabolic syndrome.
4. Describe pharmacological therapy of obesity and metabolic syndrome.
5. Describe treatment of diabetes mellitus and diabetic lipid disorders.
4. Smoking Cessation
Goal: To understand the cardiovascular effects of tobacco exposure and strategies for
physician-assisted smoking cessation.
Objectives: Fellows will be able to
1. Describe the effects of smoking on cardiovascular disease incidence.
2. Describe primary methods for smoking cessation.
3. Describe the key components of office-based smoking management systems.
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5. Exercise and Cardiac Rehabilitation
Goal: To understand the physiological principles and processes of cardiac rehabilitation for
patients with a wide range of cardiovascular diseases.
Objectives: Fellows will be able to
1. Describe cardiovascular and pulmonary responses to exercise in patients with
cardiovascular disease.
2. Understand exercise testing protocols and accurately determine functional capacity.
3. Provide the basic components of an exercise prescription for patients with
cardiovascular disease.
4. Understand principles of early mobilization and cardiovascular response to low-level
exercise following myocardial infarction, coronary artery bypass surgery, and cardiac
transplant.
5. Understand guidelines for home activities upon hospital discharge.
6. Understand physiology of exercise training in patients with cardiovascular disease.
7. Understand the metabolic cost and cardiovascular response to activities of daily living.
8. Incorporate secondary prevention into cardiac rehabilitation goals of the patient.
9. Work with a multi-disciplinary team to achieve treatment and rehabilitation goals.
6. Nutrition
Goal: To understand the metabolic, epidemiological, and clinical rationale for nutritional
recommendations for patients with cardiovascular disease.
Objectives: Fellows will be able to
1. State the primary dietary elements related to atherosclerosis prevention.
2. Describe dietary interventions for hypertension and dyslipidemia.
7. Stroke and Peripheral Arterial Disease
Goal: To review the associations between coronary artery disease, peripheral arterial
disease, and cerebrovascular disease and the implications for treatment.
Objectives: Fellows will be able to
1. Describe the primary prevention of ischemic stroke.
2. Understand the major tests for identifying cerebrovascular and peripheral arterial
disease.
3. Identify key primary and secondary prevention strategies in patients with peripheral
arterial and cerebrovascular disease.
8. Psychosocial and Behavioral Aspects of Cardiovascular Diseases
Goal: To understand how depression, anxiety, and patient behavior affect cardiac
outcomes, as well as interventions to motivate behavioral change.
Objectives: Fellows will be able to
1. Describe the effects of depression and anxiety on cardiovascular outcomes.
2. Describe strategies for motivating behavior change in patients with heart disease.
3. Outline treatment strategies for cardiovascular disease patients with concomitant
depression and/or anxiety.
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9. Screening Tests
Goal: To understand proper use of new/emerging serological and imaging tests for
evaluating cardiovascular risk and detecting subclinical atherosclerosis.
Objectives: Fellows will be able to
1. Describe the appropriate clinical use of screening tests such as lipoprotein(a), high
sensitivity C-reactive protein, and advanced lipoprotein testing.
2. Understand imaging tests for screening such as measurement of carotid intima-media
thickness, ankle-brachial index, exercise stress testing, coronary calcium scoring, and
others.
10.
Special Populations
Goal: To review differences in cardiovascular prevention strategies between men and
women, young and old patients, and people of different racial backgrounds.
Objectives: Fellows will be able to:
1. Identify sex-related differences in risk factors for heart disease.
2. Consider differences in prevention strategies among young and older patients.
3. Consider differences in evaluation of patients of different racial backgrounds.
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CVM Fellow Preventive Cardiology Knowledge Base
The fundamental knowledge base in Preventive Cardiology will be provided by a
didactic/interactive lecture series (see A. below), reading materials (see B. below), and a first
year rotation in preventive cardiology (see p.2 “Clinical Experience - Preventive Cardiology
Orientation Week for First-Year Fellows”).
A. Preventive Cardiology Didactic/Interactive Lecture Series
The Preventive Cardiology lecture series is the major Preventive Cardiology experience of the
UW Cardiovascular Medicine Fellowship. This lecture series is repeated such that each fellow
participates in the lecture twice during their fellowship. All fellows are required to attend and
sign in, indicating their attendance. They will receive a written quiz 1-2 weeks before the lecture
series with feedback provided. The quiz will be repeated after the lecture series, as well. The
information presented as part of the lecture series will be reinforced during their general
cardiology clinical training.
Based on 2010 test results and a focus group with all of the fellows, the lecture series has been
revised and in 2012-2013 will be as follows:
Stein
Stein
Stein
McBride
McBride
McBride
Stein
Keevil
Stein
Atherogenesis and Atherosclerosis
Lipid Metabolism I
Lipid Metabolism II
Pharmacological Treatment of Lipid Disorders
(including Clinical Trials)
NCEP ATP III Guidelines and Update
Obesity and Metabolic Syndrome
Diabetes and Diabetic Dyslipidemia
CVD Risk Assessment – Global Burden, Risk Factors and Framingham
Assessment
Emerging CVD Risk Factors- Approach, with focus on hsCRP,
Advanced Lipoprotein testing, and Lp(a)
Stein
New Imaging Tests for Cardiovascular Disease Risk Prediction
Exercise Physiology Basics & CVD Prevention: How to Write an
Zasadil
Exercise Prescription
Nutrition, Diet and Cardiovascular Disease – Science Behind the Diets
Underbakke and Practical Tips for Patients with CVD
Freitick
McBride
Johnson
Johnson
Jorenby
McBride
Decreasing Cardiac Risk with Lifestyle Change
Cardiac Rehabilitation/Case Management
Hypertension – Guidelines
Resistant and Secondary Causes of Hypertension
Smoking Cessation
Comprehensive Secondary Prevention of CAD, PAD, and Stroke
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Note that “Vascular Medicine” is covered during the Echocardiography unit (imaging) and the
Catheterization Lab (management and intervention) lectures.
B. Core reading materials (to be provided to the fellow):
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Primary reference: Contemporary Diagnosis and Management in Preventive
Cardiology, 2nd edition. McBride PE, Underbakke G, Stein JH. Handbooks in Health
Care, Newton, PA, 2006.
Smith Jr SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, Gibbons R,
Grundy S, Hiratzka L, Jones D, Lloyd-Jones D, Minissian M, Mosca L, Peterson E,
Sacco R, Spertus J, Stein JH, Taubert KA. AHA/ACC secondary prevention and risk
reduction therapy for patients with coronary and other vascular disease: 2011 update.
Circulation 2011;124 2458-2473.
Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor RJ, Ganiats TG, Gomes
AS, Gornik HL, Gracia C, Gulati M, Haan CK, Judelson DR, Keenan N, Kelepouris E,
Michos ED, Newby LK, Oparil S, Ouyang P, Oz MC, Petitti D, Pinn VW, Redberg RF,
Scott R, Sherif K, Smith SC, Jr., Sopko G, Steinhorn RH, Stone NJ, Taubert KA, Todd
BA, Urbina E, Wenger NK. Evidence-Based Guidelines for Cardiovascular Disease
Prevention in Women: 2007 Update. Circulation 2007.
Executive Summary of The Third Report of The National Cholesterol Education
Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood
Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285:2486-2497.
Grundy SM, Cleeman JI, Merz CN, Brewer HB, Jr., Clark LT, Hunninghake DB,
Pasternak RC, Smith SC, Jr., Stone NJ. Implications of recent clinical trials for the
National Cholesterol Education Program Adult Treatment Panel III guidelines.
Circulation 2004; 110:227-239.
UW Health “2008 Guideline for the Diagnosis and Management of Dyslipidemia for
Adults > 18 Years of Age”
Brunzell J, Davidson M, Furberg CD, Goldberg RB, Howard BV, Stein JH, Witzum JL.
Lipoprotein Management in Patients with Cardiometabolic Risk: Consensus Statement
of the American Diabetes Association and the American College of Cardiology. Journal
of the American College of Cardiology 2008; 51:1512-1524; simultaneously published in
Diabetes Care 2008; 31:811-822.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., Jones DW,
Materson BJ, Oparil S, Wright JT, Jr., Roccella EJ. The Seventh Report of the Joint
National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure: the JNC 7 report. JAMA 2003; 289:2560-2572.
UW Health “Recognizing and Treating Hypertension 2007 Clinical Practice Guideline for
Adults > 18 Years Old”
UW Health Smoking Cessation Guidelines, 2007
Thompson PD. Exercise prescription and proscription for patients with coronary artery
disease. Circulation 2005; 112:2354-2363.
Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, Thompson PD,
Williams MA, Lauer MS. Cardiac rehabilitation and secondary prevention of coronary
heart disease: an American Heart Association scientific statement from the Council on
Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention)
and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on
Physical Activity), in collaboration with the American association of Cardiovascular and
Pulmonary Rehabilitation. Circulation 2005; 111:369-376.
Wenger NK. Current Status of Cardiac Rehabilitation. Journal of the American College
of Cardiology 2008; 51:1619-1631.
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Fellow Evaluation
Evaluations will include reviews of:
1. Fellow participation in Preventive Cardiology activities described above, as observed by
faculty.
2. Evaluations of Preventive Cardiology case management in the Preventive Cardiology
Clinic (such as management of lipids and hypertension) as well as interpretations of
exercise monitoring during cardiac rehabilitation, exercise stress tests, and risk
assessment during patient encounters.
3. A brief quiz will be provided prior to and after the lecture series and a score of 75%
correct will be required to pass.
Updated 6/12/2012, JHS
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