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Evolution of academic divisions of cardiology.

Elsewhere in this issue of Circulation , Feldman et al1 describe how a classic academic division of cardiology is being transformed into a regional system of cardiac care, research, and education. This proposal is important and timely. Cardiology, like all components of American medicine, is in a dizzyingly rapid transition, driven largely by efforts to restrain the rising costs of medical care.

This pressure to control costs, combined with excess inpatient facilities and specialists (including cardiologists), will lead to ever fiercer competition among care providers. At the same time, if current research efforts continue, enormous further improvements in cardiac care might occur. For example, the development of safe and even more potent cholesterol-lowering and antiplatelet agents could greatly reduce the incidence of clinical coronary artery disease. Although sophisticated methods, including genetic analysis, may be necessary to identify patients at risk for developing atherosclerosis in whom these preventive …