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Certification, additional expertise encouraged for new HF subspecialty
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The American Board of Medical Specialties recently approved a proposal from the American Board of Internal Medicine that established a secondary subspecialty of Advanced HF and Transplant Cardiology.
The approval was the culmination of a five-year effort on behalf of several professional societies, including the Heart Failure Society of America and the American College of Cardiology. The subspecialty was approved by the American Board of Internal Medicine in September 2008.
According to an editorial co-published in the Journal of the American College of Cardiology and the Journal of Cardiac Heart Failure, the combination of the expansion of therapeutic options for patients with HF, the increasing complexity of the disease and the increasing prevalence of HF evolved into “de facto subspecialty with more than 40 cardiology programs in the United States providing training in the area of advanced HF.”
Vast HF skill set required
“Currently, when a primary care physician or cardiologist refers a patient to a specialist, really neither the referring physician nor the patient has any kind of assurance that the individual has achieved any kind of prespecified competencies that justify that specialized label,” Marvin A. Konstam, MD, professor of Medicine at Tufts University School of Medicine and chief physician executive of The Cardiovascular Center of Tufts Medical Center in Boston, told Cardiology Today. “The standard of care is enormously varied, so this really is a critical step for standardizing those proficiencies and providing both referring patients and families assurance that when they go to a board-certified specialist in Advanced HF and Transplant Cardiology, that the individual really has passed muster.”
The editorial lists skill sets and areas of expertise required for certification including expertise in HF in a variety of patient populations, in care for patients with implanted devices and transplants and other areas like pulmonary hypertension and expertise in endocardial biopsies.
“The secondary subspecialist in Advanced HF and Transplant Cardiology will be required to have a very broad knowledge and skill set across all of the care needed for all patients with the diagnosis of HF,” Konstam said. “It might just be an individual consultation, or there might be interfacing with a management plan within a delivery setting, but it would not be that every patient with HF will be followed by a physician with this certification.”
Care coordination role
In addition to the added expertise and improved care physicians certified as experts in advanced HF and transplant cardiology could bring to patients, Mariell Jessup, MD, a professor of medicine at the University of Pennsylvania School of Medicine in Philadelphia, and director of HF and Transplantation at the University of Pennsylvania Health System, foresees additional roles for the specialists.
“Another area in which advanced HF specialists will need to do more is in the direction of patient communication that is necessary to deliver optimal care to a patient with HF,” Jessup said in an interview. “There may be many physicians taking care of a patient at one time, and there often needs to be communication and coordination of care between those physicians.”
Jessup also said that physicians trained in the subspecialty would be more sensitive to prognostic indicators.
“The advanced HF specialist has a much better chance of being able to interpret clinical signs and symptoms and recognize earlier that a different treatment plan has to begin,” she said. – by Eric Raible
This is a good thing. It provides recognition and legitimacy to an area that is clearly a subspecialty of cardiology that has been evolving over the last 20 years. HF, though common, has a wide range of issues that are associated with it. With the many options on the shelf in terms of therapeutics and polypharmaceutical drug protocols, as well as a wide variety of devices, these patients really deserve to have a corner of the profession that focuses a lot of attention into caring for them, and will hopefully drive education and research as well. I am enthusiastic about this, and the people championing this deserve a great deal of applause and appreciation for getting this across the goal line.
– James B. Young, MD
Cardiology Today Section Editor