CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Philip B. Adamson, MD, FACC*,
William T. Abraham, MD, FACC,
Charles Love, MD, FACC and
Dwight Reynolds, MD, FACC
* Heart Failure Treatment Program, Cardiovascular Disease, P.O. Box 26901, 920 S.L. Young Boulevard, WP3120, Oklahoma City, OK 73190 (Email: philip-adamson{at}ouhsc.edu).
We appreciate the comments by Dr. Ahmed regarding our recent study (1). Dr. Ahmed eloquently addresses the issue of appropriate care for the older patient with heart failure (HF). Indeed, a close collaboration among primary care givers, cardiologists, and HF specialists is certainly more likely to be successful in improving overall outcomes from the complex comorbidities commonly associated with the diagnosis of HF. We agree that the pervasiveness of HF in the adult population requires, for optimal patient outcomes, greater awareness and expertise among primary care physicians. This is one of the most important reasons why our training program included a one-year fellowship for board-eligible internists. We certainly hoped that outlining our curricula would not only stimulate discussion about training goals but would also clearly state the fact that contemporary HF management is complex and requires special expertise. This is especially true for therapeutic and monitoring devices, which represent the newest "class" of HF treatment options.
Our curricula outline training pathways that specifically provide expertise in implantation of devices used for HF treatment and/or sudden death prevention. We feel strongly that such devices should be implanted by specially trained individuals according to published guidelines. Furthermore, the internal medicine fellowship offered at our institutions instructs HF internists in management of device-derived physiologic information. It is also very reasonable for geriatric trainees and, perhaps, other primary care physicians to receive specific training in HF management, as outlined by Dr. Ahmed. Overall, our goal was to stimulate thought and discussion about how HF training can be accomplished to meet the growing demand for more practitioners with expertise in this area. We fully expect that the "form" of that training may be varied, but should be recognized as a unique knowledge set suitable for certification or stipulation of added competencies.
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References
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1. Adamson PB, Abraham WT, Love C, Reynolds D. The evolving challenge of chronic heart failure managementa call for a new curriculum for training heart failure specialists. J Am Coll Cardiol 2004;44:1354-1357.[Abstract/Free Full Text]
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