Multisociety Lifelong Learning: Competencies for Advanced HF, Cardiology Transplant Specialists

The American College of Cardiology (ACC), the Heart Failure Society of America (HFSA), and the International Society for Heart & Lung Transplantation (ISHLT) released a Lifelong Learning Statement that focuses on learning competencies necessary for advanced heart failure and transplant cardiology (AHFTC) specialists. The report was published in the Journal of the American College of Cardiology.

Defining Core Competencies for Heart Failure and Transplant

The ACC/HFSA/ISHLT writing committee comprised AHFTC training program directors, experts at different career stages, general cardiologists, AHFTC specialists from the academic, community-based practice settings, as well as institutions, and physicians experienced with defining training standards. The committee identified lifelong learning competencies for AHFTC specialists, including competencies related to several aspects of medical knowledge, patient care and procedural skills, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal communication skills.

Medical Knowledge

AHFTC specialists should understand the principles of excitation-contraction coupling, important hemodynamic principles associated with heart failure, the role of genetics and genetic screening for cardiomyopathies, and the potential contribution of arrhythmias to heart failure and/or decompensation. In addition, specialists should have a thorough knowledge of epidemiology, natural history, ventricular dysfunction risk determinants, and heart failure classification methods.

Specialists are expected to be knowledgeable about typical and atypical presentations of patients with advanced heart failure and diagnostic studies for etiologies of heart failure, and to recognize features of heart failure. Specialists should have an understanding of the indications for percutaneous and surgical intervention for aortic valve disease and of standard risk assessment tools and methods for stratifying patients with heart failure.

Specialists should know the pharmacology of, lifestyle behavioral interventions for, and biomarkers of heart failure to ensure targeted prevention and optimal management. Specialists should also know the indications for cardiac implantable electronic device therapy. Other competencies include knowledge of mechanical circulatory support and cardiac transplantation.

Patient Care and Procedural Skills

AHFTC specialists should develop the skills to optimize guideline-based treatment regimens; estimate jugular venous pressure by signs and symptoms, as well as clinical examination; know when to hospitalize patients; and select individualized diagnostic tests for new heart failure diagnoses. Specialists should also know when to recommend genetic testing, screening, and counseling for patients and family members. In addition, it is essential for specialists to understand how to identify and stabilize patients with cardiogenic shock and patients in noncardiogenic shock who have a history of heart failure or cardiomyopathy.

Specialists are expected to know how to identify options for temporary hemodynamic support for patients who present in cardiogenic shock, should be able to identify candidates for a temporary or durable ventricular assist device, and know how to use long-term durable mechanical circulatory support in outpatients. Specialists should also be able to recognize patients who warrant assessment for cardiac transplantation and assess the suitability of donor hearts. Many of these competencies are geared toward selected AHFTC specialists with different practice focuses.

Systems-Based Practice

Specialists should know how to use a risk-benefit analysis and understand the costs, resources, and value considerations associated with the care of patients with heart disease. Specialists should also refer patients for new therapies, improve collaboration with all cardiovascular care team members, and participate in practice-based continuous safety and quality improvement initiatives.

Practice-Based Learning and Improvement

The committee suggests that specialists should continually identify and work to close their personal knowledge gaps by seeking educational and training opportunities. Clinical practice guidelines and appropriate use criteria are also recommended for specialists to improve clinical decision making. In addition, it is recommended that specialists ask for and incorporate feedback from patients, colleagues, and other team members in an effort to improve clinical performance. Hospital and registry data should also be used by AHFTC specialists to assess the appropriateness, safety, and quality of care.

Professionalism and Interpersonal Communication Skills

Specialists are encouraged to demonstrate empathy and consideration for patients, their families, and the healthcare team. Understanding subconscious bias in clinical decision making is also emphasized by the committee. Timely and culturally competent communication is also recommended. In addition, specialists should work to engage patients in a shared decision-making model that includes a discussion related to potential risks and benefits associated with different therapies.

Reference

Yancy CW, Drazner MH, Coffin ST, et al. 2020 ACC/HFSA/ISHLT lifelong learning statement for advanced heart failure and transplant cardiology specialists: a report of the ACC competency management committee [published online February 14, 2020]. J Am Coll Cardiol. doi:10.1016/j.jacc.2019.09.030