SCAI 2018 Interview: Why Interventional Cardiology Fellowship

August 20, 2019

Dr. Briana Costello: Why I chose interventional cardiology

In this Fellows Portal interview from SCAI Fellows 2018, Dr. Briana Costello, a cardiovascular disease fellow at the Texas Heart Institute, discusses why she chose to become an interventional cardiologist as well as topics related to women, cardiology, and heart disease.

Dr. Costello explains that she was drawn to cardiology and fascinated by interventions from a young age, after her father had his first heart attack at age 44. "I was always interested in not only cardiology, but how did they fix him?"

She describes the importance of early mentorship in medical school, describing her first mentor as embodying her ideal cardiologist: a patient advocate, kind to patients, and kind to staff. "He made a difference in all the patients that he interacted with." She also describes fabulous mentors, who she tried to emulate, in her training in internal medicine at Rush University in Chicago. Currently at Texas Heart, she continues to find tremendous support for her decision to go into interventional cardiology, which as a female she emphasizes, is very important.

Interviewer Dr. Chadi Alraies states that 20-25% of the attendees at SCAI Fellows 2018 were women. Dr. Costello notes that while there's room for growth, that percentage is impressive, especially given that fewer than 10% of interventionalists are female. She explains that currently many social media outlets are bringing to light the lack of women in specialties such as cardiology and, in particular, interventional cardiology. She notes that fostering an environment that is welcoming to females is vital to the growth of women in interventional cardiology. "It lies on us, the people who have decided to go into intervention, and the people who have mentored us, to encourage other women to do the same."

On the topic of improving outcomes in women with heart disease, Dr. Costello explains that we all have inherent biases. "When we see a woman with chest pain, we don't automatically think heart attack." She emphasizes that widespread education is needed to understand heart attacks in women, especially for emergency and internal medicine physicians who are on the frontlines of care for these patients.

Another hurdle to overcome is that there are fewer women enrolled in clinical trials in cardiology. Dr. Costello explains that this is a symptom of the need for education and that women may not be getting enrolled in trials because they present nonspecifically, and they don't present soon enough.

With regard to self-care as a busy interventional cardiology fellow with a family, Dr. Costello explains that she thinks it start with healthy eating. She also emphasizes mental health and prioritizing fitness. "When I come home from work, whatever time it is, if my child is still awake, I'll take her on a walk or a run."

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