title: Cardiology-cardiothoracic subspeciality training in South Africa: a position paper of the South Africa Heart Association.
abstract: Over the past decades, South Africa has undergone rapid demographic changes, which have led to marked increases in specific cardiac disease categories, such as rheumatic heart disease (now predominantly presenting in young adults with advanced and symptomatic disease) and coronary artery disease (with rapidly increasing prevalence in middle age). The lack of screening facilities, delayed diagnosis and inadequate care at primary, secondary and tertiary levels have led to a large burden of patients with heart failure. This leads to suffering of the patients and substantial costs to society and the healthcare system. In this position paper, the South African Heart Association (SA Heart) National Council members have summarised the current state of cardiology, cardiothoracic surgery and paediatric cardiology reigning in South Africa. Our report demonstrates that there has been minimal change in the number of successfully qualified specialists over the last decade and, therefore, a de facto decline per capita. We summarise the major gaps in training and possible interventions to transform the healthcare system, dealing with the colliding epidemic of communicable disease and the rapidly expanding epidemic of non-communicable disease, including cardiac disease.
authors.affiliation: Hatter Institute for Cardiovascular Research in Africa, MRC Inter-University Cape Heart Group, Department of Medicine, Faculty of Health Sciences, University of Cape Town; Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa. Email: Karen.Sliwa-Hahnle@uct.ac.za.
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
authors.affiliation: Departments of Paediatric Cardiology and Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
authors.forename: Liesl
authors.initials: L
authors.lastname: Zühlke
authors.affiliation: Cardiothoracic Surgery, Ethekwini Hospital and Heart Centre, Durban, South Africa.
authors.forename: Robert
authors.initials: R
authors.lastname: Kleinloog
authors.affiliation: Division of Cardiology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa.
authors.forename: Anton
authors.initials: A
authors.lastname: Doubell
authors.affiliation: Netcare Unitas Hospital, Lyttleton Manor, Pretoria, South Africa.
authors.forename: Iftikhar
authors.initials: I
authors.lastname: Ebrahim
authors.affiliation: Division of Cardiology, Baragwanath Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Essop
authors.affiliation: St Dominic's Hospital, and Frere Hospital, East London, South Africa.
authors.forename: Dave
authors.initials: D
authors.lastname: Kettles
authors.affiliation: Netcare Linksfield Hospital, Linksfield West, Johannesburg, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Jankelow
authors.affiliation: Department of Cardiology, Faculty of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
authors.forename: Sajidah
authors.initials: S
authors.lastname: Khan
authors.affiliation: Netcare Sunninghill Hospital, Sunninghill, Johannesburg, South Africa.
authors.forename: Eric
authors.initials: E
authors.lastname: Klug
authors.affiliation: Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Lecour
authors.affiliation: Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Marais
authors.affiliation: Mediclinic Heart Hospital, Arcadia, Pretoria, South Africa.
authors.forename: Martin
authors.initials: M
authors.lastname: Mpe
authors.affiliation: Department of Cardiology, Faculty of Health Sciences, University of Cape Town, South Africa.
authors.forename: Mpiko
authors.initials: M
authors.lastname: Ntsekhe
authors.affiliation: Zuid-Afrikaans Hospital, Muckleneuk and Department of Cardiology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
authors.forename: Les
authors.initials: L
authors.lastname: Osrin
authors.affiliation: Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
authors.forename: Francis
authors.initials: F
authors.lastname: Smit
authors.affiliation: Wilgers Medical Consortium, Die Wilgers, Pretoria, South Africa.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Snyders
authors.affiliation: Interventional Cardiology Unit, Netcare Union Hospital, Alberton, South Africa.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Theron
authors.affiliation: Netcare Sunninghill Hospital, Sunninghill, Johannesburg, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Thornton
authors.affiliation: Department of Cardiology, Faculty of Health Sciences, University of Cape Town, South Africa.
authors.forename: Ashley
authors.initials: A
authors.lastname: Chin
authors.affiliation: Mediclinic Bloemfontein, Bloemfontein, South Africa.
authors.forename: Nico
authors.initials: N
authors.lastname: van der Merwe
authors.affiliation: South African Heart Association, Tygerberg, South Africa.
authors.forename: Erika
authors.initials: E
authors.lastname: Dau
authors.affiliation: Department of Cardiology, Faculty of Health Sciences, Steve Biko Academic Hospital and University of Pretoria, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Sarkin
mesh_terms: D006348:Cardiac Surgical Procedures / Q000193:education*; D000072096:Cardiologists / Q000193:education* / Q000600:supply & distribution; D002309:Cardiology / Q000193:education*; D003479:Curriculum; D003695:Delivery of Health Care; D004503:Education, Medical, Graduate / Q000379:methods* / Q000592:standards; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D010372:Pediatrics / Q000193:education*; D000071836:Professional Practice Gaps; D012955:Societies, Medical / Q000592:standards; D013019:South Africa; D013038:Specialization; D066231:Surgeons / Q000193:education* / Q000600:supply & distribution; D013903:Thoracic Surgery / Q000193:education*