Increasing Rate of Unfilled Training Positions in the Advanced Heart Failure and Transplant Cardiology Match

Advanced Heart Failure and Transplant Cardiology (AHFTC) is a vital subspecialty addressing the growing burden of heart failure and the increasing need for advanced therapies such as mechanical circulatory support and heart transplantation. Despite rising clinical demand, interest in AHFTC fellowship training appears to be declining. This study evaluated trends in applicants, training positions, match rates, and unfilled positions in the AHFTC match from 2020 to 2025. We performed a national, cross-sectional analysis of all AHFTC fellowship applicants during this period. Primary outcomes included the annual number of applicants and training positions, match rates, and the percentage of unfilled positions. Temporal trends were analyzed using linear regression. Between 2020 and 2025, 470 applicants competed for 737 training positions, resulting in an overall fill rate of 58%. Matched fellows included 52% US allopathic and 48% non-US allopathic graduates. The number of training positions per year increased by 10% (115 to 127) while the number of applicants per year decreased by 24% (84 to 64). The applicant-to-position ratio decreased significantly from 0.7 to 0.5 (p < 0.001), and unfilled positions rose from 30% to 52% (p < 0.001). The proportion of applicants matching at their first-choice program increased from 67% to 83% (p < 0.001). These findings highlight a growing mismatch between AHFTC training capacity and applicant interest. To preserve the future workforce needed to address the rising burden of heart failure, efforts are needed to stimulate interest in AHFTC training.