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HF Careers, a HFpEF Handbook, and Midlife Fitness
By Viktor Zarev, Virginia Hunt
July 27, 2026
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Together with
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“Remember this: patients in clinical trials tend to represent the most robust, ambulatory, educated, and highly motivated of those in the broader target population. This is true whether explicit inclusion/exclusion criteria are placed on these conditions or not.”
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Andrew J Foy, MD, on trial design in the RALES study.
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Whether it’s echo or EHR, cardiology innovations are chugging along, so I’ve got quite the couple of videos to share with you all today.
First up, a deep dive into the Philips cardiac ultrasound suite with Nicole Nolan and her team.
Then on the EHR AI side, I also got to have an extensive conversation about how much it helps physicians and patients with some of the people behind the Tempus ALERT trial. You can watch that here.
Cheers,
Vik
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Picture this – you graduate medical school (not easy), you do a three-year internal medicine residency, then a three-year general cardiology fellowship, and another year of fellowship, but you’re paid less than your peers in other subspecialties – congrats, you’re an advanced heart failure cardiologist (AHFTC).
With all that effort, it’s no surprise a new national survey suggests the issue isn’t that practicing physicians dislike the work.
- The AHFTC pipeline has been under strain, with clinical intensity, heavy call burdens, and perceived compensation gaps driving waning trainee interest.
To characterize career perceptions, researchers developed a 49-item survey with eight board-certified AHFTC physicians and a survey methodology expert, distributing it through the Heart Failure Society of America physician listserv in early 2025.
- 183 U.S. physicians responded, a 17.9% response rate of total HFSA members.
- Respondents were mostly university-based (69%), male (73%), and earlier in their careers than most HFSA members — a response bias the authors acknowledge.
- Most practiced at institutions with ACGME-accredited fellowships (66%), transplant programs (81%), and durable LVAD capabilities (92%).
Surprisingly, the satisfaction picture is genuinely positive.
- 81% reported overall job satisfaction, and 80% recommend the subspecialty to trainees.
- The highest satisfaction came from patient acuity, longitudinal patient relationships, intellectual stimulation, patient diversity, and multidisciplinary teamwork.
- Burnout was reported by 39% — notably lower than the national physician and cardiologist average of roughly 45%, despite the workload.
The workload numbers explain where the dissatisfaction comes from.
- 70% of respondents work more than 50 hours per week.
- 85% are on call at least four days per month, and 55% get four or fewer days off per month.
- Dissatisfaction was highest for compensation (37%) and work-life balance (32%).
Beyond compensation, time off emerged as a concrete factor. Data analysis found that having five or more days off per month was independently associated with job satisfaction (OR 3.4) — a finding with obvious structural implications given that most respondents fall below that threshold.
When asked what most contributes to unfilled AHFTC fellowship spots, respondents’ free-text answers converged on the same terms: “compensation,” “work,” “poor,” and “balance.”
The Takeaway
Heart failure cardiology has long been seen as the “ugly duckling” of cardiac subspecialties, but this survey tells us the people who do it, mostly love it. Where the sticking point is likely stems from convincing cardiology fellows to go into a less lucrative specialty for more work.
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PIA’s Post-Processing Solution
Advanced cardiac imaging often calls for a time-consuming post-processing step, requiring costly software, hardware, and training. See how PIA provides this post-processing at lower cost, improved consistency, and greater efficiency.
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The Economics of AI-Assisted HF Diagnosis
As sonographer shortages become more common, so too are diagnostic delays and missed opportunities for early heart failure treatment. Find out how task-shifting LVEF assessment to novice operators using AI-assisted ultrasound is both clinically viable and cost-saving.
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What Every Cardiologist Needs to Watch for in Heart Failure
Patients with preserved (HFpEF) or mildly reduced ejection fraction (HFmrEF) face a high risk of hospitalization for heart failure and cardiovascular death, even with guideline-directed medical treatment. Hear from Bayer’s Dr. Alanna Morris-Simon as she shares common heart failure signs to look out for.
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- Could Less Anesthesia Mean Safer TAVR? A new Journal of Clinical Anesthesia study showed less might really be more when it comes to anesthesia for TAVR. Retrospective data from nearly 3.6k patients who underwent TAVR showed those receiving non-general anesthesia had similar rates of mortality, stroke, and heart attack as those receiving general anesthesia through 120 days of follow-up. Still, one finding moved the needle: Hospital readmission rates were 38% lower with NGA after 30 days.
- A New HFpEF Handbook: The ACC’s updated ECDP helps clinicians sort through the evolving landscape of HFpEF, which makes up >50% of HF cases. The 2022 guidelines were revised using a rapidly growing body of research focusing on diagnoses, managing comorbidities, and treatment. To tackle the underdiagnosis of HFpEF, the ACC compared several scoring systems, finding H2FPEF to be clinically superior if clinicians can get their hands on echocardiographic data. The report also upholds SGLT2is and nonsteroidal MRAs as optimal treatments.
- The Epigenetics of Atherosclerosis: A JACC study revealed the epigenetic fingerprints underpinning atherosclerosis — and there were a lot of them. Nearly 1.7k methylation sites were associated with carotid atherosclerosis, with 3.1k and 5.8k sites linked to coronary and peripheral atherosclerosis, respectively. Many of these sites were isolated to just four loci. The findings aren’t just about the arteries, though: >90% of atherosclerosis-associated sites overlapped with cardiovascular risk factors like smoking (90%) and inflammation (60%), reflecting a patient’s total exposure to determinants.
- OpenAI Sued Over Medical Advice: In what could be the first lawsuit of its kind, a Florida pastor sued OpenAI over claims ChatGPT-4o discouraged him from seeking medical care for serious symptoms. Court documents detail weeks of chat logs, starting with the pastor complaining of dizzy spells and blood pressure swings. The AI allegedly downplayed his concerns, at one point alluding to his spiritual beliefs by saying God did not design his body to fail. He later landed in the ICU with a pulmonary embolism.
- Positive EU Nod for Obicetrapib: NewAmsterdam Pharma and Menarini announced that the EMA’s CHMP now recommends marketing authorization for two obicetrapib-based therapies.The EMA now supports both Ubeslo (obicetrapib 10 mg monotherapy) and Evlarco (obicetrapib plus ezetimibe fixed-dose combination), for patients with primary hypercholesterolemia and mixed dyslipidemia. The CHMP opinion now goes to the European Commission for a final decision expected later this year, while the companies continue advancing obicetrapib through additional Phase 3 trials, including the PREVAIL cardiovascular outcomes trial.
- IL-6 as CV Risk Marker: A large cohort analysis strengthens the case for interleukin-6 (IL-6) as a cardiovascular risk marker and a potential prevention target. Harmonizing data from ~60k participants, researchers found that higher IL-6 concentrations were associated with increased risk across all nine prespecified outcomes, spanning MI, stroke, AFib, HF, coronary heart disease, total CVD, and mortality measures. The strongest association was for CHD-specific mortality (aHR: 2.12 in the highest versus lowest quartile) and the weakest for MI (HR: 1.45).
- Furosemide Autoinjector Approved: MannKind won FDA approval for Furoscix ReadyFlow, an at-home autoinjector delivering subcutaneous furosemide for fluid overload in adults with HF or CKD. Billed as capable of delivering subcutaneous furosemide with IV-equivalent exposure, it provides a full 80 mg/mL dose in under 10 seconds to let patients address worsening congestion earlier, before it drives ER visits or hospitalization. The launch is timely given that fluid overload is a leading reason HF and CKD patients land in the hospital, and hospitalizations account for roughly 80% of heart failure’s costs.
- Stress Testing Asymptomatic Patients: Although it’s guideline recommended and rarely used, new research suggests that treadmill stress testing (TST) can unmask symptoms in patients with asymptomatic aortic stenosis. Of 962 screened patients, 15.2% had a positive TST result, and 105 of them enrolled in a follow-up registry. Among those with a positive test, the 2-year all-cause mortality was low at 5.7%, and aortic valve replacement rates reached 79.9% at one year and 85.9% at two. Notably, roughly 20% of these patients remained untreated at one year despite having a clear indication.
- A Digital Nudge for Cholesterol Control: A randomized trial in Brazil found that a digitally enabled quality-improvement intervention modestly improved LDL cholesterol control in patients with ASCVD. The intervention was applied to 1.4k patients and bundled previsit screening, decision support, and patient engagement tools into routine workflows, which lowered mean LDL-C to 76.3 mg/dL at 6 months versus 85.6 mg/dL for usual care. Intervention patients were also more likely to hit an LDL-C below 50 mg/dL (23.5% vs. 13.4%) and to achieve a 50% or greater reduction, though no difference in MACE emerged over the study follow-up.
- Midlife Fitness, Longer Health Span: Who would have thought that better midlife cardiorespiratory fitness (CRF) leads to a longer health span? Drawing on 24.5k participants from the Cooper Center Longitudinal Study, researchers examined maximal treadmill testing before age 65, and linked it to Medicare claims. Compared with low-fit men, high-fit men had a 2% longer health span, 9% fewer diseases, and a 3% longer lifespan, with similar patterns in women. The results held consistently across patient subgroups reinforcing CRF as a target tied to both longevity and years lived free of disease.
- Flu Shots and the Heart: New findings published in EHJ link influenza vaccination to a range of cardiovascular benefits, including a reduced risk of AFib. By comparing 138k adults from the TriNetX Global Collaborative Network to matched controls, researchers found that vaccinated patients had a lower yearly AFib rate (0.89% vs. 1.12%). This also came with significantly lower risks of all-cause mortality, myocardial infarction, and heart failure. Given AFib’s prevalence and vaccination’s strong safety profile, even small relative reductions could have meaningful population-level benefits.
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Staying ALERT with Tempus
Undertreatment and time to treatment of valvular heart disease are among the biggest challenges health systems face today, but Tempus’ AI-driven EHR notifications can change that. Read the results of Medtronic and Tempus’ ALERT trial which found that delivering data directly to providers resulted in a 40% relative increase in life-saving valve procedures.
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From Fetal to Adult Cardiovascular Ultrasound
Continuity of care is critical when it comes to a patient’s cardiovascular health. That’s why cardiologists across America are picking Fujifilm’s Lisendo 880 cardiovascular ultrasound for its versatility and precise imaging starting at a patient’s fetal development to adulthood.
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Telemedicine Isn’t About Technology. It’s About People.
With temporary telehealth rules expiring, millions of Medicare patients may lose their ability to see their doctors remotely. Read why Monebo and the Alliance for Connected Care are urging Congress to make telemedicine a permanent part of the healthcare system.
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- Circle CVI’s CAD-RADS Rundown: Ever wondered how CAD-RADS enhance the communication of coronary artery disease findings from imaging studies? Check out this guide from Circle Cardiovascular Imaging about the evolution of CAD-RADS and how to incorporate them into your practice.
- State-of-the-Art Cardiac Monitoring at Scale: Cleared for 13 different heart rhythm interpretations, AccurKardia’s AccurECG 2.0 shortens the time from an arrhythmia incident to clinical intervention. Watch here to find out how AccurKardia and Specialized Medical are teaming up to bring the AccurECG 2.0 technology to clinicians across the U.S.
- How AI Expands the Role of CMR Experts: If you’re an MRI technologist, AI could be the best thing that ever happened to your career. Read here to learn about the benefits of AI for CMR experts and how it can accelerate both your training and career.
- 9 Merge Cardio Features to Change Your Cardiology Workflows: Having the right tools is essential for efficient cardiology imaging workflows and delivering exceptional patient care. Read this article on how Merge Cardio can make the biggest difference to your imaging workflows, care team user experiences, and patient care delivery.
- The Power of AI in Cardiovascular Imaging: Cardiac labs are under more pressure than ever to deliver more with greater speed and precision. Hear from ACUSON Origin customer, Tony Gallagher about how Siemens Healthineers’ cardiovascular ultrasound system is improving exam efficiency and showing positive impact on ROI.
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