Starting 2021 with new paper! Looking at longevity of 2.1Ah biventricular defibrillators (CRT-D) and perhaps help explain high rate of complications when patients need to undergo generator changes for battery depletion. More research is needed to examine the clinical and cost effectiveness of avoiding generator changes during a vulnerable physiologic time in the lives of CRT-D patients.

2.1Ah biventricular defibrillator (CRT-D) battery longevity exceeds patient survival in HFrEF patient cohort.

Key Points:

  • These data demonstrated the first reversal in ICD battery longevity versus patient survival; the 2.1-Ah ICD battery life exceeded patient survival in a typical HFrEF cohort.
  • Our results support the hypothesis that the acceleration of device OOS during the sixth to ninth years (when it is expected that roughly 98% of 1.0-Ah and 1.4-Ah CRT-D systems reach ERI) may explain the historically high rate of complications for ICD generator changes as compared with at the initial implantation.
  • During the entire study, only 5.7% of 2.1Ah devices reached the ERI point (average time to ERI: 7.8 ±1.5 years) in up to 10.3 years of follow-up.

Read full manuscript at Journal of Innovations in Cardiac Rhythm Management.

Welcome to the 4th Annual Lakeland Regional Health Cardiovascular Symposium. Tired of CV Symposiums that focus on the procedures that can be done to your patients rather than prevention of CV disease?!? This year we’ll be focusing on the PREVENTION of CV disease. Please click to attend the Symposium for 5.5 hours of free CME on Saturday February 8, 2020. I’ll be adding links to any talks the speaker has permitted so you can follow along on day of Symposium.

7:30 – 7:55A Registration and Continental Breakfast
7:55 – 8:00A Welcome Remarks
8:00 – 8:40A: Lipid management and risk panels for cardiovascular disease, Dr. Stephen Kopecky

8:40 – 9:30A: Prevention of Sudden Cardiac Death, Williams

9:30 – 10:00A: Prevention of Cardioembolic Stroke, Dr. Khanna

10:00 – 10:20A: Ask-the-Experts Refreshment Break
10:20 – 11:00A: DM2 and CV Disease, Dr. Owen

11:00 – 11:40A: Frequent Touch Primary Care and CV Disease Prevention, Drs. Ghany and Syed

11:40A – 12:20P: Applying Evidence-Based Guidelines to Lower Heart Failure Readmissions, Dr. Navin Rajagopalan

12:20 – 12:30P: Ask-the-Experts Refreshment Break
12:30 – 1:30P: Luncheon, Plant-Based Diets and Prevention of CV Disease, Dr. Monica Aggarwal

Many thanks to the faculty of the 2019 LRH Cardiovascular Symposium! We had over 200 registrants for 6 hours of great cardiovascular CME. From left to right, Dr. Parag Patel (Mayo Clinic), Dr. Anuja Dokras (University of Pennsylvania), Dr. Jeff Williams (LRH), Dr. Carl Pepine (University of Florida), Dr. Edward Tadajweski (WellSpan Health), Dr. Philip Owen (LRH), Dr. Matthew Martinez (Lehigh Valley Health Network), and Dr. Kathryn Lindley (Washington University). Dr. Denise Edwards (University of South Florida) is not pictured.

We had over 200 registrants to this year’s CV Symposium with physicians and nurses traveling from all over Florida. Our faculty was fantastic and their lectures are included below.

Anuja Dokras, MD, PhD, Associate Professor, Penn Fertility Care, University of Pennsylvania Medical Center, Philadelphia, PA. Dr. Dokras lectured about the role of obstetric and gynecologic issues and the future risk of heart disease in women.

Denise Edwards, MD, Director, Healthy Weight Clinic, Assistant Professor of Internal Medicine and Pediatrics, USF Health. Dr. Edwards lectured about the assessment and treatment of obesity in adolescents and women.

Kathryn J. Lindley, MD, Assistant Professor of Medicine, Director, Center for Woman’s Heart Disease, Washington University School of Medicine. Dr. Lindley spoke about the risks of women’s heart disease in pregnancy.

Matthew W Martinez, MD FACC, Associate Professor of Medicine, University of South Florida, Medical Director – Sports Cardiology and Hypertrophic Cardiomyopathy Program, Lehigh Valley Health Network. Dr. Martinez discussed the current state-of-the-art in the management of cardiovascular disease in sports participation.

Phil Owen, MD, FACC, Interventional Cardiology, Lakeland Regional Health. Dr. Owen gave a nice summary on the potential risks and management of CV disease with cancer therapies.

Parag Patel, MD, Mayo Clinic, Program Director for the Advanced Heart Failure/Transplant Fellowship. Dr. Patel described issues and techniques to decrease readmission rates for congestive heart failure.

Carl J Pepine, M.D., MACC, Professor Emeritus of Medicine, University of Florida Health. Dr. Pepine discussed the management of resistant hypertension including common treatment issues.

Edward Tadajweski, MD, FACC, Director of Cardiology, WellSpan Health (Good Samaritan Hospital, Lebanon, PA). Dr. Tadajweski spoke about acute coronary syndromes in women.

Jeffrey L. Williams, MD, MS, FACC, FHRS, Co-Director, LRH Heart Rhythm Center, Course Director, 2019 Lakeland Regional Health Cardiovascular Symposium. Dr. Williams lectured on the diagnosis and treatment of common supraventricular tachycardias.

Join us on February 9, 2019 for 6 hours of free CME. You’ll have the chance to hear topics ranging from acute coronary syndromes and resistant hypertension in women to cardio-oncology as well as management of CHF. We will have speakers from Washington University, Lehigh Valley Health System, WellSpan Health, University of Florida, and others. To register, call 863-687-1190 or online at

Atrioventricular nodal tachycardia (AVNRT) is one of the most common supra ventricular tachycardias (SVT) that we find during electrophysiology studies. Fifteen to thirty percent of the population has “dual AV-node physiology.” Most day-to-day conduction is from “fast” AV node pathway. Patients with “dual AV node physiology” may occasional use the “slow” AV node pathway and this can set up the reentrant arrhythmia.

Atrioventricular nodal tachycardia (AVNRT) is one of the most common arrhythmias. This short video gives an introduction to the mechanism and treatment options that are available.

Wondering how you as a doctor or nurse can make a difference? Join us on February 9, 2019 for 6 hours of free CME.

We are excited to have Dr. Denise Edwards (Assistant Professor of Internal Medicine and Pediatrics, Director of the Healthy Weight Clinic at USF Health) speaking about Weight Management in Women and Adolescents. To register, call 863-687-1190 or online at

2019 Lakeland Regional Health Cardiovascular Symposium: Special Focus on Women’s and Adolescent Heart Disease

We are excited to have Dr. Anuja Dokras the Director, Penn Polycystic Ovary Syndrome Center speaking about role of obstetric and
gynecologic issues and the future risk of heart disease in women. To register, call 863-687-1190 or online at 

A recent publication from the National Center for Health Workforce Analysis  predicted a shortage of 7080 cardiologists by 2025. Another publication reported recruitment incentives for cardiologists are at “unprecedented levels.”   I decided to revisit a paper I published in 2007 (JLW AHHJ 2007) predicting a general cardiology workforce shortage. [1]

I developed this model to project the need for general Cardiologists from 2005-2050 using Matlab (Mathworks, Inc., Natick, MA). The growth in need for General Cardiologists was estimated by incorporating the effect of retirement, prevalence of heart disease, and patient per physician load. At the peak demand in the year 2038, the model projected a need for 62,452 General Cardiologists. Current training durations would result in 29043 General Cardiologists and Fast-Tracking (e.g., third year of Internal Medicine training counted as first year of cardiology) would result in 32533 General Cardiologists. There was evidence of an impending shortage of General Cardiologists that will peak in 2038 resulting in only 46.5% of the projected need for General Cardiologists. This may result from a complex cascade of declining US medical graduates and those matching in Internal Medicine residencies, combined with an increasingly complex cardiovascular disease patient requiring the care of multiple, distinct cardiovascular specialists.

Baseline Data for Modeling the Cardiologist Workforce:

The 35th Bethesda Conference [2] revealed that only 120 of 173 Clinical Cardiac Electrophysiology (EP) spots and 229 of 269 Interventional spots are filled per year.  These baseline partial fill rates were used to assess the effect completely filling these subspecialty fellowship positions would have on overall number of General Cardiologists. In 2001, there were 2160 total trainees and 709 first year fellows.  In the baseline conditions of the model, the number of first year fellows was taken as 709, 2nd year fellows numbered 726, and 3rd year fellows numbered 725.

There are an estimated 6 cardiologists per 100,000 U.S. residents.  This was used as the basis for calculating the number of cardiologists in the US at 16800 in 2005.

Determining Growth in Need for General Cardiologists: 

Effect of Retirement:  I estimated that 10% of Cardiologists would retire by 2015.  Thus, the model uses 1%/year increase in need due to retirement.

Effect of Prevalence of Heart Disease (HD):  Heart disease deaths indicate a need for cardiologists however, prevalence of HD is more important than death in determining workforce requirements.  In this model, it was assumed the prevalence of HD will grow by 1.7%/year until 2030.  As the baby boomer population passes away, the prevalence of HD will decrease by 0.58%/year from 2030-2040 and 0.39%/year from 2040-2050.

Effect of Decreasing Physician-Patient Load:  The average physician’s patient load in cardiovascular medicine declined by over a third from 1980-1995.  There are a higher proportion of patients who require the care of more than one cardiovascular specialist (e.g., a General Cardiologist, Electrophysiologist, Interventionalist, and/or Heart Failure Specialist).    For every 10% decrease in average patient load, 20% more physicians are required. The model uses 2%/year increase in demand due to decreasing physician-patient load.

Effect of Cardiovascular Subspecialty “Fast-Tracking”:  

1.The 8th Working Group of the 35th Bethesda Conference suggested a means to allow a 5-year short-track to train general cardiologists. The trainee would complete 2 years of general internal medicine then 3 years of cardiology.  This short-track would increase the number of general cardiologists, free up more money for additional trainees, and permit trainees to begin paying on student loans.  However, they did not discuss the possibility of “Fast-Tracking” for Interventional or Electrophysiology Fellowships for those who have already completed a 3-year Internal Medicine residency.
2. In this model, “Fast-tracking” would comprise 2 years of a General Cardiology Fellowship then 2 years of either Interventional or Electrophysiology training. This concept of “Fast-Tracking” was incorporated into the model to assess its effect on the General Cardiology Workforce numbers.

Growth in Need for General Cardiologists from 2005-2050 :

Gen Cardiology Workforce Model

Projections of Cardiology Workforce from 2005-2050. This model incorporates a decrease in heart disease prevalence by 0.58%/year from 2030-2040 and 0.39%/year from 2040-2050.  Current training duration (blue line) and Fast-Track (red line) would still result in deficit when compared with model projection of need for General Cardiologists (green line).  At the peak demand in the year 2038, there is a projected need for 62,452 General Cardiologists.  Current training durations would results in 46.5% (n=29043 total cardiologists) the projected need and Fast-Tracking would result in 52.1% the projected need for General Cardiologists (n=32533).

Current training duration (blue line) and Fast-Track (red line) would still result in deficit when compared with model projection of need for General Cardiologists (green line) from 2005-2050.  See Figure.  At the peak demand in the year 2038, current training durations and Fast-Tracking would result in 46.5% (n=29043) and 52.1% (n=32533) the projected need for General Cardiologists. Doubling the number of General Fellows trained and incorporating Fast-Track for EP and Interventional fellows would help offset the predicted shortage in General Cardiologists (green line) by year 2020.  However, this would result in an oversupply in General Cardiologists by the year 2050.


How accurate was my model predicting the cardiology workforce as of 2015?

The Association of American Medical Colleges (AAMC) publishes a biannual report on the most current data available about active physicians and physicians in training. [3]  The AAMC estimated 22038 active cardiologists whereas my model predicted 20515 active cardiologists in 2015.  Certainly, care delivery models and market forces (e.g., 2008-2009 recession leading to decreased retirement rates) have affected the cardiology workforce projections.  My estimates of the prevalence of heart disease continue to be accurate. In 2012, The Trust for America’s Health [4] found that at present growth rates “the number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension and arthritis could increase 10 times between 2010 and 2020—and double again by 2030.”  Finally, it is difficult to get an accurate trend in cardiologist patient loads over time. The recent Medscape Cardiologist Compensation Report 2016 [5] reported that only a quarter of cardiologists have seen an influx of patients due to the Affordable Care Act (ACA) while three-quarters have not.

Is there an impending shortage of general cardiologists? I suspect my model is accurate though has overestimated the shortage of general cardiologists we can expect moving forward. Several reasons included delayed retirement of current cardiologists, the move towards primary-care directed delivery, and the use of physician extenders.  That being said, there have been a host of studies examining the cardiology workforce using a variety of analyses that all point to a shortage of cardiologists moving forward.

It is clearly difficult to place a number on any “shortage” of cardiologists however, there is a common theme to the various studies looking at the future cardiology workforce.  The most recent study [6] reported a shortage of 7080 cardiologists by the year 2025.  “Projections were developed using the Health Resources and Services Administration’s (HRSA) Health Workforce Simulation Model (HWSM), an integrated microsimulation model that estimates current and future supply and demand for health care workers in multiple professions and care settings.” The 2009 American College of Cardiology Board of Trustees Workforce Task Force [7] reported a deficit of 16000 cardiologists by 2025 and best case scenario of 8000 cardiologist deficit with pointed interventions. The CV workforce model I developed estimated a deficit of 17865 general cardiologists by the year 2025.


It continues to be reasonable to estimate a general cardiologist shortage by the year 2025. There is consensus of a likely deficit in the general cardiologist workforce using a disparate set of studies including those looking at practice-level demand, prevalence of CV disease, and implications from recruitment incentives for general cardiologists. Regional variation is to be expected but health systems should be cognizant of the likelihood of a general cardiologist shortage in the near- to mid-term.


1  Williams JL, “Projecting the General Cardiology Workforce Shortage,” American Heart Hospital Journal, V. 5 (Fall 2007), pp. 203-209.

2  Fye WB, Hirshfeld JW. Cardiology’s workforce crisis: a pragmatic approach. Presented at the 35th Bethesda Conference, Bethesda, Maryland, October 17–18, 2003. J Am Coll Cardiol 2004;44:215–75.

3  American Association of Medical Colleges, “2016 Physician Specialty Data Report,” Accessed online at

4  ”F as in Fat: How Obesity Threatens America’s Future”; Trust for America’s Health Issue Report, Sept 2012; Robert Wood Johnson Foundation. Accessed at

5 Peckham C, “Medscape Cardiologist Compensation Report 2016,” April 1, 2016. Accessed at:

6  U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce National Center for Health Workforce Analysis, “National and Regional Projections of Supply and Demand for Internal Medicine Subspecialty Practitioners: 2013-2025,” December 2016. Accessed online at

7  Rodgers GP, Conti JB, Feinstein JA, Griffin BP, Kennett JD, Shah S, Walsh MN, Williams ES, Williams JL. ACC 2009 survey results and recommendations: addressing the cardiology workforce crisis: a report of the ACC Board of Trustees Workforce Task Force. J Am Coll Cardiol 2009;54:1195–208.





This is the final podcast in the What are Palpitations? series and we will be discussing how patients can adjust to living with heart rhythm disorders. We will start with adjusting to life after being diagnosed with heart-rhythm abnormalities. Next, we’ll talk about the quality of life in heart-rhythm patients and how do arrhythmias affect you and your family. Arrhythmias in children and young adults can be challenging and we’ll spend time on this issue. Finally, we’ll examine patients that have palpitations without arrhythmias.

Please check back with the Heart Rhythm Center as we begin the new series What is a Defibrillator?