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ACC/AHA/ACP Define Key Clinical Competencies for Managing Patients with Advanced Heart Failure and those Undergoing Heart Transplantation

New report provides roadmap to emerging specialty for medical centers and physicians

July 19, 2010

PHILADELPHIA, July 19, 2010 – Recent advances in cardiac care are helping more people live well and longer with heart disease, including heart failure (HF)—a condition in which the heart functions abnormally. This trend also means the demand for specialty care to manage heart problems is on the rise, especially for patients with the most advanced forms of HF and those undergoing heart transplantation.

To help define the tools necessary to care for these patients, who often represent the most complex cardiac cases, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), and the American College of Physicians (ACP) today issued the first clinical report outlining the competencies and skill sets required of treating physicians.

“For the first time, we clearly spell out the skill set that is required of health care providers involved in the management of advanced heart failure and heart transplantation,” said Gary S. Francis, M.D., F.A.C.P., professor of medicine, University of Minnesota, and chair of the writing committee. “Our expectation is that [by using this report] the care delivered to these patients will be aligned with the skills necessary to manage them and better meet their unique needs.”

The full text of the report will be published in the July 27, 2010, issue of the Journal of the American College of Cardiology and co-published in the August 10, 2010, issue of Circulation: Journal of the American Heart Association and the Journal of Heart & Lung Transplantation. The report will also be available on the ACC (www.cardiosource.org) and AHA (www.americanheart.org) websites.

HF is a serious condition, effecting five million people in the United States and accounting for 300,000 deaths each year. Heart transplantation—now the third most common organ transplant in the United States—is often the last resort for people with HF when all other treatments have failed.

The clinical competencies detailed in the report apply specifically to the care of patients with Stage D/4 HF who are frequently hospitalized and often require specialized interventions (for example, intra-aortic balloon counterpulsation or other external pumping devices, high-risk experimental surgery, medications, dialysis, mechanical support devices, transplantation and end-of-life care. The authors explain that this patient population often receives complicated drug regimens and typically have implanted defibrillators or specialized pacemakers, making their care even more challenging.

“Because these patients are often extremely complex, there was a perceived need to better define the competencies and skill sets that highly trained, specialized teams of physicians and others ancillary medical personnel should have to best care for them,” explained Dr. Francis.

He adds that the process of evaluating physicians’ knowledge and skills has become more complex as subspecialties continue to evolve. The report is designed to give hospital administrators, credentialing bodies and others a guide for recruiting and hiring cardiologists with special expertise and training in advanced HF and heart transplantation. It also provides a roadmap for physicians who anticipate training in this area, providing a benchmark of what is expected in terms of clinical experience and skill sets they will need should they decide to train in this area.

“This in no way is meant to be exclusionary, as we recognize that the vast majority of patients with heart failure are cared for by non-specialists,” said Dr. Francis. “However, once advanced heart failure ensues, there is a sense that the level of competency needed to make decisions regarding mechanical assisted devices and heart transplantation requires the competencies outlined in this document.”

In the report, the committee is quick to recognize that there are very capable cardiologists who do not have formal training in advanced HF and heart transplantation, but who currently render excellent care to these patients. To accommodate these clinicians, the committee has defined various alternative pathways to becoming credentialed in advanced HF based on cumulative training and experience.

The joint clinical report addresses complex drug use, use of mechanical devices, pre- and post-transplant care, management of advanced HF in patients with congenital heart disease, and end-of-life issues.

The authors stress that advanced HF specialists should ideally work in association with hospitals and institutions to offer other services important to integrated HF management, including educational and counseling materials, social services and financial counseling, clinical information systems that facilitate transfer of information among providers, dietary counseling and cardiac rehabilitation, and the involvement of specialized nurses/nurse practitioners.

Dr. Francis cautions that this document is separate and distinct from documents that cover training requirements and/or guidelines for the treatment of HF. The report was authored by representatives of the ACCF, AHA, ACP, Heart Failure Society of America, and the International Society for Heart and Lung Transplantation.

About the American College of Physicians
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 130,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults. Follow ACP on Twitter and Facebook.

Note: Dr. Francis reports no conflicts of interest.

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