August 2022 | Issue 66
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The time for change is now: Call for action over age and gender profile of global cardiothoracic surgery community Analysis of the global make-up of the four largest global societies for cardiothoracic surgery suggest that the field is currently dominated by an older and predominantly male workforce.
T
he future of the specialty depends on its ability to evolve and grow and efforts must be made to attract trainees that represent a diverse patient population, the author of the analysis, Barbara Hamilton (University of California, San Francisco, San Francisco, USA), writes in The Annals of Thoracic Surgery this month. Hamilton and colleagues examined membership data from the directories of the Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the European Association for CardioThoracic Surgery (EACTS), and the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS) to gain a better understanding of the global composition of the cardiothoracic surgery community. Previous attempts to map out the make-up of the specialism have relied on survey data, which are potentially biased or limited by low response rates, Hamilton noted. The analysis looked at variables including gender, age, academic rank and practice area, which were categorised to include adult cardiac, general thoracic, cardiac and thoracic, congenital and other. A total of 12,053 membership profiles were captured in the analysis, the bulk of which (6,365) belonged to STS, followed by EACTS (3,661), AATS (1,495), and ASCVTS (532). Most members were located in the USA and Europe. Age data were available for STS and EACTS, and reflected a median age in both societies of 57 (interquartile range [IQR] 45,61). When stratified by society, STS was older with a median age of 60 (IQR 50,71). The largest area of practice was found to be adult cardiac surgery (31%), while more members practiced a combination of cardiac and thoracic surgery (20%), and over a quarter (26%) of members practiced combinations including vascular surgery and critical care. Of note, the data paint a picture of an overwhelmingly male community, with a 93% male membership across the four societies. EACTS had the highest proportion of women (9%), with ASCVTS (3%) the lowest. For the STS and the EACTS, the median age of female members was 48 (IQR 41, 57), which was younger than males (median 58, IQR 48, 68). When stratified in five-year increments, female members were mostly in the younger categories
(35‒39, 40‒44, 45‒49, and 50‒54). Among the 788 female members, the most common practice area was adult cardiac surgery (27%), and when stratified by academic rank, 21% identified as assistant, 29% as associate, and 50% as full professor. Of all full professors, 5% (n = 141/2,569) are female. Most females practiced academic medicine (60%), and 45% of females (n=160/358) were in their early career stage. Additionally, most members were in the late stage of their careers (64%), with the AATS (94%) having the highest proportion of late-stage career members, and the STS (38%), the lowest. Commenting on the findings in The Annals of Thoracic Surgery, Hamilton writes: “We are a global community representing a broad scope of practice and a variety of careers. However, our current society members are mostly
12,053
31%
members profiled
Cardiothoracic surgery community in numbers
cardiac surgeons
9%
93%
EACTS has the highest proportion of female members
male
64%
in later stages of career
It is crucial that we wake up to these issues and create action on both individual and leadership levels”
Barbara Hamilton
New data at EuroPCR 2022
A new dawn for renal denervation? Latest data to feature in fresh guidelines A new consensus statement—in development from the European Society of Cardiology (ESC) and the European Association of Cardiovascular Interventions (EAPCI)—will take into account latest evidence of the safety and efficacy of renal denervation as a devicebased treatment for hypertension from sham controlled trials. THIS COMES AFTER A HOST OF NEW data were presented at EuroPCR 2022 (17–20 May, Paris, France) highlighting the potential of renal denervation as an adjunctive hypertension therapy, complementing existing treatments such as lifestyle changes and antihypertensive medications, researchers say. The release of data from three clinical studies—the Global Symplicity Registry, SPYRAL HTN-ON MED and a pooled analysis of ultrasound renal denervation from the RADIANCE HTN SOLO and TRIO trial cohorts—add to renewed interest in renal denervation as a novel treatment modality for patients with hypertension, after a first generation of clinical trials showed mixed results following the procedure. Speaking at the four-day EuroPCR meeting, Felix Mahfoud (Saarland University Hospital, Hamburg, Germany) commented that renal denervation represents a device-based treatment option to tackle a potentially unmet clinical need for some patients. “Despite all advances in care we still have a significant proportion [of patients] that are either undiagnosed or not sufficiently controlled to target blood pressure, and that holds true for almost all regions and geographies around the world,” Mahfoud said. “We know from large meta-analyses and prospective randomised clinical trials that reducing blood pressure is impactful for patients,” he added. “The problem is not that we do not know that blood pressure is a serious issue, the problem is that we have available drugs that work quite well but patients do not like them and do not take them. There is obviously an unmet need, and renal denervation represents a device-based treatment option to tackle that problem.” In a hot-line session at EuroPCR, Mahfoud presented the three-year Global Symplicity Registry results, assessing blood pressure and Continued on page 4
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