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Life's Essential 8™ - Cardiology Residents & Fellows Program

"The best way to learn is to teach" - Ancient proverb

Cardiology residents and fellows occupy a unique position: learners becoming experts, clinicians responsible for patient care while still in training, and future leaders who will shape cardiovascular medicine for decades. This program recognizes that comprehensive cardiovascular prevention education - grounded in Life's Essential 8™ - is essential preparation for modern cardiology practice.

Contemporary cardiology extends far beyond catheterization labs and echocardiography. Prevention is the foundation - 80% of cardiovascular disease is preventable through risk factor modification. Yet prevention receives limited attention in traditional cardiology training, which emphasizes procedural skills and acute management. This gap leaves residents ill-prepared for the reality that most of their career will involve managing chronic CV risk, not emergencies.

This program provides structured, evidence-based training in cardiovascular prevention, health behavior change, and population health - complementing procedural and acute care training to produce complete cardiologists capable of comprehensive patient care.

Program Overview

Target Audience

  • Cardiology residents (internal medicine graduates in cardiology fellowship training - typically 3 years)
  • General cardiology fellows (adult cardiology, non-interventional)
  • Advanced fellows (interventional, electrophysiology, heart failure - supplemental prevention training)
  • Internal medicine residents interested in cardiology or preventive medicine

Program Goals

Domain Learning Objectives
Knowledge • Master evidence base for Life's Essential 8™ metrics
• Understand pathophysiology linking risk factors to CV disease
• Learn guideline-directed prevention strategies
• Interpret prevention trial literature critically
Skills • Conduct comprehensive CV risk assessment
• Counsel patients on lifestyle modification effectively
• Prescribe and monitor preventive medications
• Use motivational interviewing techniques
• Navigate challenges (medication costs, adherence, health literacy)
Attitudes • Value prevention equally to intervention/treatment
• Embrace patient-centered, shared decision-making approach
• Commit to lifelong learning in prevention science
• Model healthy behaviors personally
Systems • Understand population health and health equity
• Recognize social determinants of cardiovascular health
• Collaborate with multidisciplinary teams
• Advocate for prevention at institutional/policy levels

Program Structure

12-month curriculum integrated into cardiology fellowship

Component Format Time Commitment
Didactic Sessions Monthly seminars (90 min)
Journal clubs
Grand rounds		 24 hours/year
Clinical Experience Preventive cardiology clinic
(½ day/week × 3 months)		 60 hours/year
Workshops Hands-on skills training
Motivational interviewing
Case-based learning		 16 hours/year
Self-Directed Learning Online modules
Reading assignments
Podcasts		 20 hours/year
Scholarly Project Quality improvement OR
Research project OR
Educational initiative		 40 hours/year
Total ~160 hours/year
(~3 hours/week)

Curriculum: Life's Essential 8™ In-Depth

Each metric covered with clinical focus: pathophysiology, evidence, assessment, management, patient counseling

Module 1: Diet Quality (4 sessions)

Session 1.1: Nutritional Epidemiology & CV Disease

  • Dietary patterns and CV outcomes: Mediterranean, DASH, plant-based
  • Macro/micronutrients: Effects on lipids, BP, glucose, inflammation
  • Critical appraisal: PREDIMED, Lyon Diet Heart Study, dietary trials
  • Controversies: Saturated fat, red meat, dietary cholesterol

Session 1.2: Practical Nutrition Counseling

  • Assessment: 24-hour recall, food frequency questionnaire, clinical judgment
  • Counseling frameworks: 5 A's, motivational interviewing, SMART goals
  • Cultural competence: Adapting recommendations to diverse dietary patterns
  • Referral to registered dietitians: When and how

Session 1.3: Special Populations

  • Heart failure: Sodium restriction, fluid management
  • Post-MI: Aggressive dietary modification for secondary prevention
  • Diabetic patients: Carbohydrate quality, glycemic control
  • CKD: Phosphorus, potassium restrictions

Session 1.4: Workshop - Diet Counseling Role Play

  • Standardized patient encounters: Fast food addict, cultural dietary preferences, budget constraints
  • Feedback from faculty + peers
  • Practice using food models, visual aids

Module 2: Physical Activity (3 sessions)

Session 2.1: Exercise Physiology & CV Benefits

  • Mechanisms: Hemodynamic, metabolic, vascular, inflammatory effects
  • Dose-response: Exercise volume, intensity, type (aerobic vs resistance)
  • Evidence: Meta-analyses, RCTs, cardiac rehabilitation trials
  • Exercise testing: Indications, interpretation, prognostic value

Session 2.2: Exercise Prescription

  • Healthy adults: AHA/WHO guidelines, individualization
  • Cardiac patients: Post-MI, HF, valvular disease, arrhythmias - safety, benefits, precautions
  • Pre-participation screening: AHA/ACSM algorithms
  • Cardiac rehabilitation: Referral, structure, outcomes

Session 2.3: Barriers & Solutions

  • Common barriers: Time, motivation, access, medical conditions
  • Behavior change strategies: Goal-setting, self-monitoring, social support
  • Adaptive exercises: Joint issues, obesity, disabilities
  • Technology: Fitness trackers, apps - role and limitations

Module 3: Nicotine Exposure (3 sessions)

Session 3.1: Tobacco & CV Disease

  • Epidemiology: Prevalence, trends, disparities
  • Mechanisms: Endothelial dysfunction, thrombosis, atherosclerosis, arrhythmias
  • Quantifying risk: Dose-response, secondhand smoke, smokeless tobacco
  • Benefits of cessation: Timeline, evidence from trials

Session 3.2: E-Cigarettes & Novel Products

  • E-cigarette chemistry, toxicology, cardiovascular effects
  • Youth epidemic: Prevalence, patterns, implications
  • Harm reduction debate: Evidence, ethical considerations, policy
  • Heated tobacco products, nicotine pouches: Emerging data

Session 3.3: Cessation Strategies

  • Behavioral counseling: 5 A's, motivational interviewing, cognitive-behavioral techniques
  • Pharmacotherapy: NRT, varenicline, bupropion - efficacy, safety, selection
  • Special populations: Cardiac patients, pregnant women, psychiatric comorbidities
  • Systems approaches: Quitlines, apps, institutional tobacco-free policies

Module 4: Sleep Health (2 sessions)

Session 4.1: Sleep & Cardiovascular Disease

  • Sleep physiology: Architecture, circadian rhythms, regulation
  • Insufficient sleep: Epidemiology, CV consequences (HTN, diabetes, obesity, CVD)
  • Sleep disorders: OSA (pathophysiology, diagnosis, treatment, CV outcomes), insomnia, circadian disorders
  • CPAP therapy: Adherence challenges, CV benefits, controversies (SAVE trial)

Session 4.2: Sleep Assessment & Management

  • Screening: STOP-BANG, Epworth Sleepiness Scale, sleep history
  • When to refer for polysomnography vs home sleep testing
  • Sleep hygiene counseling: Evidence, practical recommendations
  • Insomnia management: CBT-I, pharmacotherapy (judicious use)

Module 5: Weight Management (3 sessions)

Session 5.1: Obesity & Cardiometabolic Risk

  • Epidemiology: Global obesity epidemic, trends, disparities
  • Pathophysiology: Adipose tissue as endocrine organ, inflammation, insulin resistance
  • CV consequences: HTN, diabetes, dyslipidemia, atherosclerosis, HF, AFib
  • BMI limitations: Muscle vs fat, ethnic variations, body composition

Session 5.2: Weight Management Strategies

  • Lifestyle: Diet, exercise, behavioral therapy - evidence-based approaches
  • Pharmacotherapy: GLP-1 agonists (semaglutide, liraglutide), older agents - efficacy, safety, cost, CV outcomes (SELECT trial)
  • Bariatric surgery: Indications, procedures, outcomes (weight loss, diabetes remission, CV benefits), complications
  • Realistic expectations: Modest weight loss (5-10%) = clinically meaningful

Session 5.3: Obesity Stigma & Communication

  • Weight bias in healthcare: Impact on patient care, provider attitudes
  • Person-first language: "Patient with obesity" not "obese patient"
  • Compassionate communication: Motivational interviewing, non-judgmental approach
  • Addressing barriers: Cost, access, psychological factors

Module 6: Blood Lipids (4 sessions)

Session 6.1: Lipoproteins & Atherosclerosis

  • Lipid metabolism: Synthesis, transport, clearance
  • Lipoprotein particles: LDL, HDL, VLDL, Lp(a) - structure, function, atherogenicity
  • Atherosclerosis pathogenesis: LDL penetration, oxidation, foam cells, plaque formation/rupture
  • Advanced lipid testing: ApoB, LDL particle number, size - when useful

Session 6.2: Lipid-Lowering Therapy

  • Statins: Mechanism, efficacy (CTT meta-analysis), safety (myalgias, diabetes risk), selection, dosing
  • Non-statin therapies: Ezetimibe (IMPROVE-IT), PCSK9 inhibitors (FOURIER, ODYSSEY), bempedoic acid (CLEAR Outcomes), icosapent ethyl (REDUCE-IT)
  • Combination therapy: Rationale, sequencing, achieving LDL goals
  • Statin intolerance: True vs nocebo, management strategies

Session 6.3: Lipid Guidelines & Risk Assessment

  • 2018 ACC/AHA Cholesterol Guideline: Risk-based approach, treatment thresholds, targets
  • ASCVD risk calculator: Use, limitations, risk enhancers
  • Primary vs secondary prevention: Differing goals, intensities
  • Familial hypercholesterolemia: Recognition, genetic testing, aggressive treatment

Session 6.4: Triglycerides & HDL

  • Hypertriglyceridemia: Causes, CV risk, pancreatitis risk, management (lifestyle, fibrates, omega-3)
  • Low HDL: Epidemiology, risk, pharmacologic interventions failed (niacin, CETP inhibitors) - why?
  • Metabolic syndrome: Definition, prevalence, management approach

Module 7: Blood Glucose (4 sessions)

Session 7.1: Diabetes & CV Disease

  • Epidemiology: Prevalence, incidence, disparities
  • Pathophysiology: Insulin resistance, β-cell failure, glucotoxicity
  • CV consequences: Atherosclerosis acceleration, microvascular disease, heart failure, diabetic cardiomyopathy
  • Risk quantification: "CV equivalent" concept, absolute risk in diabetics

Session 7.2: Diabetes Prevention

  • Prediabetes: Definition, prevalence, progression risk
  • Diabetes Prevention Program (DPP): Lifestyle intervention (58% reduction), metformin (31%), long-term follow-up
  • Practical implementation: DPP-based programs, scalability, digital interventions
  • Gestational diabetes: Long-term implications, postpartum screening/prevention

Session 7.3: Glycemic Management in CVD

  • Glucose targets: Individualization (age, duration, comorbidities, hypoglycemia risk)
  • Intensive glycemic control: ACCORD, ADVANCE, VADT - benefits, harms, implications
  • CV-beneficial medications: GLP-1 agonists (LEADER, REWIND - 12-26% CV event reduction), SGLT2 inhibitors (EMPA-REG, CANVAS - HF benefit)
  • Comprehensive diabetes care: Beyond glucose - BP, lipids, aspirin, smoking, ACE-I/ARB

Session 7.4: Hypoglycemia & CV Risk

  • Epidemiology: Frequency, risk factors (tight control, sulfonylureas, insulin)
  • CV consequences: Arrhythmias, ischemia, falls, sympathetic activation
  • Severe hypoglycemia and mortality: Associations, causality debates
  • Prevention: CGM, patient education, medication selection, relaxed targets if high risk

Module 8: Blood Pressure (5 sessions)

Session 8.1: Hypertension Fundamentals

  • Hemodynamics: Cardiac output, systemic vascular resistance, determinants of BP
  • Pathophysiology: Primary HTN (genetic, environmental), secondary HTN (causes, screening)
  • Target organ damage: Heart (LVH, HF), brain (stroke, dementia), kidneys (CKD), eyes (retinopathy)
  • 2017 ACC/AHA Guideline: Definition changes (≥130/80), treatment thresholds, goals

Session 8.2: BP Measurement & Diagnosis

  • Office measurement: Proper technique, common errors, automated devices
  • Out-of-office BP: Home monitoring (protocol, interpretation), ambulatory monitoring (indications, patterns)
  • White coat vs masked hypertension: Prevalence, risk, management
  • Practical workshop: BP measurement technique (residents practice on each other, faculty feedback)

Session 8.3: Lifestyle Management

  • DASH diet: Original trial, components, efficacy (8-14 mmHg reduction)
  • Sodium reduction: Evidence, targets, practical strategies
  • Weight loss, exercise, alcohol moderation: Magnitude of effects
  • Combining interventions: Additive effects, realistic expectations

Session 8.4: Pharmacotherapy

  • First-line agents: Thiazides, ACE-I, ARBs, CCBs - mechanisms, efficacy, side effects, selection
  • Combination therapy: Rationale, preferred combinations, single-pill combinations
  • Resistant hypertension: Definition, evaluation (adherence, secondary causes), management (spironolactone - PATHWAY-2 trial)
  • Special populations: Elderly, Black patients, diabetes, CKD, CAD, pregnancy

Session 8.5: Hypertensive Emergencies

  • Definition: Severe HTN (>180/120) + acute target organ damage
  • Clinical presentations: Hypertensive encephalopathy, acute pulmonary edema, ACS, aortic dissection, eclampsia
  • Management: IV antihypertensives (selection, dosing, monitoring), BP lowering pace (gradual vs urgent), complications
  • Hypertensive urgency vs emergency: Distinction, outpatient vs inpatient management

Clinical Integration

Preventive Cardiology Clinic Rotation

3-month rotation (½ day/week) in outpatient preventive cardiology clinic

Clinic Structure

  • Patient population: Primary prevention (risk factor modification), post-MI/stroke secondary prevention, familial hypercholesterolemia, resistant hypertension, women's cardiology, young adults with premature CAD
  • Multidisciplinary team: Preventive cardiologist, registered dietitian, exercise physiologist, pharmacist, nurse educator
  • Resident role: See patients independently, present to attending, develop management plans, follow-up longitudinally

Learning Activities

  • Comprehensive risk assessment: Calculate ASCVD risk, assess LE8 metrics, identify modifiable risk factors
  • Lifestyle counseling: Practice motivational interviewing, set SMART goals, provide written action plans
  • Medication management: Initiate/titrate statins, antihypertensives, diabetes medications; manage side effects, drug interactions, costs
  • Interdisciplinary collaboration: Coordinate with dietitians (meal plans), exercise physiologists (personalized programs), pharmacists (medication reviews)
  • Social determinants: Navigate insurance, medication assistance programs, community resources

Case Mix (Typical 3-month Rotation)

  • ~30 new patients (initial consults - comprehensive assessment, ~60 min each)
  • ~20 follow-up visits (monitoring progress, adjusting treatments, ~30 min each)
  • Diverse cases: Age range 25-80, primary/secondary prevention, varied socioeconomic backgrounds, multiple comorbidities

Competencies Developed

Competency Assessment Method
Risk assessment Direct observation, case presentations
Counseling skills Standardized patient encounters (OSCEs), patient feedback surveys
Guideline application Chart review, treatment plan evaluation
Professionalism 360-degree evaluations (patients, nurses, team members)

Scholarly Project

Each resident completes one of the following during program:

Option 1: Quality Improvement Project

  • Examples:
    • Improve tobacco screening/cessation referral rates in cardiology clinic
    • Increase cardiac rehabilitation enrollment post-MI
    • Implement automated BP measurement protocol
    • Develop lipid management clinical pathway
  • Methodology: PDSA cycles, run charts, balancing measures
  • Deliverables: Project report, presentation at departmental QI forum

Option 2: Research Project

  • Examples:
    • Retrospective cohort: Statin adherence and CV outcomes
    • Survey study: Cardiologist knowledge/practices in diabetes management
    • Systematic review: Effectiveness of digital health interventions for HTN
  • Mentorship: Faculty advisor, statistical support
  • Deliverables: Manuscript draft (aim for publication), presentation at regional/national conference

Option 3: Educational Initiative

  • Examples:
    • Develop patient education materials (videos, handouts) on LE8 metrics
    • Create online curriculum module for medical students
    • Design community health screening program
    • Organize Grand Rounds series on prevention topics
  • Evaluation: Learner feedback, knowledge assessments (pre/post)
  • Deliverables: Educational materials, implementation report, presentation

Assessment & Certification

Formative Assessment (Ongoing)

  • Direct observation in clinic (mini-CEX - mini-Clinical Evaluation Exercise)
  • Case-based discussions during didactic sessions
  • Journal club presentations (critical appraisal skills)
  • 360-degree feedback (attendings, peers, patients, team members)

Summative Assessment (End of Program)

  • Written examination: 50 multiple-choice questions covering all modules (pass: ≥70%)
  • OSCE (Objective Structured Clinical Examination): 4 stations
    • Station 1: Standardized patient - smoking cessation counseling (10 min)
    • Station 2: Standardized patient - dietary counseling (Mediterranean diet for post-MI) (10 min)
    • Station 3: Case scenario - lipid management (interpret labs, develop treatment plan) (10 min)
    • Station 4: BP measurement technique demonstration (5 min)
  • Scholarly project: Poster/oral presentation, written report evaluation
  • Clinic evaluations: Attending assessments, portfolio of clinical encounters (minimum 10 detailed case write-ups demonstrating competencies)

Certification

"EPA Bienestar Certificate in Cardiovascular Prevention" awarded upon:

  • Completion of all didactic sessions (≥80% attendance)
  • Satisfactory clinic rotation evaluations
  • Pass written exam and OSCE
  • Completion of scholarly project

Recognition: Certificate suitable for CV, listing on institutional website, letter of recommendation from program director, CME credits (40 Category 1 credits - accredited by relevant medical education body)

Faculty & Resources

Core Faculty

  • Program Director: Preventive cardiologist with academic appointment, expertise in CV prevention, medical education
  • Clinical Faculty: 3-4 preventive cardiologists providing clinic supervision, lecturing
  • Interdisciplinary Faculty:
    • Registered dietitians (nutrition modules)
    • Exercise physiologists (physical activity modules)
    • Behavioral psychologists (motivational interviewing, health behavior change)
    • Endocrinologists (diabetes management)
    • Nephrologists (HTN, CKD)
    • Sleep medicine specialists (sleep disorders)

Learning Resources

  • Online platform: Learning management system (LMS) with lecture recordings, readings, quizzes
  • Simulation center: Standardized patient program, skills labs (BP measurement, motivational interviewing practice)
  • Library access: Full-text journals, UpToDate, DynaMed, guideline repositories
  • Clinic space: Dedicated preventive cardiology clinic with exam rooms, team workspace

Recommended Textbooks

  • Preventive Cardiology: Companion to Braunwald's Heart Disease (Elsevier)
  • Clinical Lipidology: A Companion to Braunwald's Heart Disease (Ballantyne)
  • Hypertension: A Companion to Braunwald's Heart Disease (Black & Elliott)
  • Motivational Interviewing in Health Care (Rollnick, Miller, Butler)
  • ACC/AHA Guidelines (free online - all relevant prevention guidelines)

Integration with Fellowship Curriculum

Alignment with ACGME Competencies

ACGME Competency How Program Addresses
Patient Care Hands-on clinic experience, comprehensive CV risk management, longitudinal patient relationships
Medical Knowledge Didactic curriculum, journal clubs, self-directed learning, written exam
Practice-Based Learning Critical appraisal of prevention literature, QI projects, reflective practice
Interpersonal & Communication Skills Motivational interviewing training, OSCEs, patient counseling, interdisciplinary teamwork
Professionalism Compassionate communication about sensitive topics (weight, smoking), health equity awareness
Systems-Based Practice Navigation of healthcare systems, cost-conscious care, population health concepts, QI projects

Scheduling

Designed to fit within standard cardiology fellowship without extending training duration:

  • Didactic sessions: Monthly seminar (1.5 hours) - typically protected academic time already in schedule
  • Clinic: ½ day/week × 3 months (one rotation block) - substitutes for or supplements standard outpatient cardiology clinic
  • Workshops: 4 half-day workshops throughout year - scheduled on conference/education days
  • Scholarly project: Work done during elective time, research blocks, independent study periods

Flexibility: Program adaptable to 1-year or 3-year fellowship format. Can be concentrated (primarily PGY4) or longitudinal (spread across PGY4-6).

Program Outcomes & Impact

Expected Fellow Outcomes

  • Knowledge: Comprehensive understanding of CV prevention evidence, guidelines, and controversies
  • Skills: Competent in CV risk assessment, lifestyle counseling, preventive medication management
  • Practice patterns: Incorporate prevention into all patient encounters, not just "prevention clinic"
  • Career: Prepared for comprehensive cardiology practice, potential subspecialization in preventive cardiology

Institutional Impact

  • Clinical: Improved quality metrics (statin prescribing, BP control, smoking cessation rates) in cardiology clinics/inpatient services where residents rotate
  • Educational: Fellows become prevention champions, teaching medical students/residents during rotations
  • Research: Scholarly projects generate data, publications, QI initiatives benefiting institution
  • Reputation: Program enhances fellowship prestige, attracts prevention-minded applicants

Societal Impact

  • Workforce: Cardiologists trained in prevention → better population health, reduced CVD burden
  • Equity: Emphasis on social determinants, cultural competence → address disparities
  • Prevention culture: Graduates champion prevention at future institutions, multiplying impact

Continuous Improvement

Program Evaluation

  • Fellow feedback: Mid-program and end-of-program surveys, focus groups
  • Faculty feedback: Teaching effectiveness evaluations, curriculum review meetings
  • Outcome metrics:
    • Exam pass rates, OSCE performance
    • Clinic metrics (patient satisfaction, clinical outcomes - BP control, LDL reduction in panel)
    • Scholarly project productivity (presentations, publications)
    • Graduate follow-up surveys (1 year, 5 years post-fellowship - practice patterns, career satisfaction)

Curriculum Updates

  • Annual review: Core faculty revise curriculum based on: New evidence (updated guidelines, landmark trials), Fellow/faculty feedback, Emerging topics (e.g., SGLT2i, GLP-1 agonists cardiovascular benefits - update diabetes module accordingly)
  • National standards: Align with ACC Core Cardiovascular Training Statement (COCATS), AHA prevention guidelines

Join the Cardiology Residents & Fellows Program

EPA Bienestar IA partners with cardiology fellowship programs to deliver this comprehensive prevention curriculum.

For Fellowship Program Directors:

  • ✅ Enhance your fellowship with structured prevention training
  • ✅ Fulfill ACGME competency requirements with evidence-based curriculum
  • ✅ Access to expert faculty, standardized patient program, online platform
  • ✅ Turnkey implementation - we provide curriculum, faculty support, assessment tools
  • ✅ Flexible integration - adaptable to your fellowship structure

For Individual Fellows:

  • ✅ Distinguish yourself with prevention expertise
  • ✅ Earn EPA Bienestar Certificate + 40 CME credits
  • ✅ Hands-on clinical experience in preventive cardiology
  • ✅ Scholarly project for CV, publications
  • ✅ Network with prevention-focused cardiologists
Inquire About Program Partnership →

Contact: Dra Giovanna Sanguinetti Colón
Program Director, Cardiovascular Prevention Training
EPA Bienestar IA
Email: info@epa-bienestar.com