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Introduction: The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease recommends adults engage in ≥ 150 minutes of moderate or ≥75 minutes of vigorous intensity aerobic activity per week to reduce cardiovascular risk. Cardiologist adherence to these guidelines is unknown. Methods: Electronic surveys were sent to 437 ACC CardioSurve cardiologists, a representative sample of current ACC members. Demographic data was collected. Respondents were asked to quantify and rate intensity of exercise in an average week. Results: Between February and March 2020, a total of 189 panelists completed the survey for a response rate of 43%, of which 13% were women. There was even representation in number of years in practice: 33% early career, 27% mid-career, and 35% late career. Cardiologists across all career stages were evenly represented; 33% early career, 27% mid-career, and 35% late career. Overall only 56% of cardiologists met exercise guidelines (Figure). Less than half participated in vigorous activity (46%) with higher prevalence among mid versus early career (58% vs 38%, p=0.035). Interventional cardiologists were less likely to meet the standards for exercise intensity compared to general cardiology (44% vs. 59%, p=0.09). Early career respondents were less likely to adhere to activity recommendations (39% vs 59%, p=0.018). Those who reported vigorous activity were more likely to strength train at least twice per week (43% vs. 15%, p < 0.001). Conclusions: Nearly half of cardiologists are not adherent to the ACC recommended guidelines for aerobic activity. The impact on cardiologists’ health was not quantified, but this study suggests there is room for improvement in prevention behaviors. Since physicians are known to serve as role models for their patients, we hypothesize lack of adherence to activity guidelines may also negatively impact our patients.

Although aortic stenosis (AS) is common, little data exist about the rate of aortic valve replacement (AVR) in patients with severe symptomatic AS. Many patients with severe symptomatic AS do not undergo AVR. Echocardiography databases for 3 large tertiary centers were searched for patients in 2005 with severe AS (mean gradient ≥ 40 mmHg, valve area of < 1.0 cm 2 , or overall clinical assessment of severe AS). Records were reviewed for symptoms, referral, surgical AVR, and outcome. Operative risk was calculated using the logistic EuroSCORE. Four hundred thirteen patients had an echocardiogram with severe AS; 44 were excluded based on additional testing or inadequate medical records. Of the remaining 368 patients, 188 (51%) underwent AVR, and 191 (49%) and were un-operated. Of 191 un-operated patients, 126 (66%, 34% of total) had symptoms consistent with AS, 182 (95%) were referred to cardiology, but 75 of 126 (60%) un-operated symptomatic patients were not referred for surgical assessment. Among un-operated symptomatic patients, operative risk was < 5% in 31 (25%) and < 10% in 59 (47%). The prevalence of un-operated patients was similar between institutions. Decisions not to operate most commonly were based on co-morbidities, patient preference, symptoms due to other conditions, and unrecognized AS. With an average follow-up of 13.9 ± 9.8 months, 52 of 191 (27%) un-operated patients died. Half of patients with severe symptomatic AS do not undergo AVR, with similar findings in multiple tertiary care environments. Some patients with severe symptomatic AS may be inappropriately denied access to potentially life-saving therapy.