ABC Heart Fail Cardiomyop 2021; 1(1): 11-14
The Role of the Heart Failure Specialist: Benefits for Both the Patient and the Cardiology Community
Livia A. Goldraich
, Jefferson L. Vieira
, Nadine Clausell
In recent decades, the advancement of knowledge of cardiovascular diseases has been remarkable. Heart failure (HF) has a prominent role among the conditions of greatest epidemiological relevance for the population, given its high prevalence and incidence worldwide, including Brazil.– Thus, mastery of this condition is key to cardiologist training. However, the understanding of the complexity of the different diseases and pathophysiological mechanisms potentially involved in the development, progression, and prognosis of HF has advanced, and a broad and intricate spectrum of therapeutic options has emerged, especially in the past two decades. These advances allowed a significant improvement in the clinical outcomes of HF patients; however, as knowledge and consequent therapeutic challenges became more complex, it was clear that a new type of training and expertise in the field of Cardiology was needed.
The American Heart Association (AHA) and the European Society of Cardiology (ESC) were the first to encourage the growth and strengthening of the HF specialty, with the creation of study groups, departments, and journals focused on this condition.– Several specific HF congresses have been organized and brought together a growing number of participants for about 20 years. Concomitantly, several cardiology centers of worldwide relevance have developed fellowship programs in HF and heart transplantation, many of which more recently also cover mechanical circulatory support. Finally, certification examinations for HF specialist by the American Board of Internal Medicine (ABIM) and the ESC Heart Failure Association were created in 2013 and 2014, respectively., In 2020, an expert consensus of the American College of Cardiology (ACC) together with the Heart Failure Society of America (HFSA) and the International Society for Heart and Lung Transplantation (ISHLT) introduced a list of requirements for HF specialist training, based on the core competencies of the Accreditation Council for Graduate Medical Education (ACGME). This document outlines, in particular, the expectations for physicians who treat advanced HF patients or heart transplant recipients, and recommends specific skills in mechanical circulatory support, cardiac resynchronization therapy, heart transplantation, and pulmonary hypertension. The authors also recommend that there be a maintenance of certification process based on participation in continuing medical education programs and collaboration with national databases and registries. exemplifies and adapts the HF training model used at Brigham and Women’s Hospital, Harvard University, Boston, United States.
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