CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Marvin A. Konstam, MD*
* Tufts—New England Medical Center, Box 108, 750 Washington Street, Boston, MA 02111 (Email: mkonstam{at}tufts-nemc.org).
I appreciate the comments of Dr. Ahmed regarding my recent report advocating developing subspecialty training in heart failure (1). I interpret Dr. Ahmed’s remarks as acknowledging the need for more formalized training and certification in this area, given the expanding population with heart failure (HF), and given the increasing complexity of available diagnostic and treatment options. However, Dr. Ahmed raises some important caveats. He rightfully points out that a large percentage of patients with HF will continue to be treated by physicians who are not cardiologists. He also correctly emphasizes the value of primary care physicians and geriatricians in managing patients who carry an HF diagnosis but have a high prevalence of comorbidity.
As I state in my report, various steps are needed to meet the needs of patients with HF. These steps include guideline-driven educational efforts, disease-management strategies, and "more efficient systems of referral and communication, with sharing of care management between the specialist and the primary care provider."
However, these points do not negate the value of encouraging specialization within this increasingly complex field, as a critical step toward improving quality of care for HF patients. Further, as I mention in my report, "All of the skills obtained through general cardiology training are invaluable as an underpinning for subspecialization in heart failure." These skills include a detailed understanding of hemodynamics, cardiac imaging, cardiac arrhythmias, valvular and ischemic heart disease, the indications for complex cardiovascular procedures, and management of patients who have undergone such procedures.
Improving quality of care in HF, as in any area, requires a multi-pronged approach. We need both improved systems and improved education of all physicians and nurses who will contribute to the care of these patients. Educational and training programs directed toward general internists, family medicine specialists, and geriatricians are essential, given the important role these physicians play in HF management. Beyond these steps, formalizing the training and certification within the field of HF, as a subspecialty of cardiology, represents an important piece of the puzzle.
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References
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- Konstam MA, Executive Council of the Heart Failure Society of America Heart failure traininga call for an integrative, patient-focused approach to an emerging cardiology subspecialty. J Am Coll Cardiol 2004;44:1361-1362.[Abstract/Free Full Text]
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