The ACC Foundation (ACCF) along with the American Heart Association and Society for Cardiovascular Angiography and Interventions on May 8 released an updated clinical competence statement  on coronary artery interventional procedures.

The document provides a road map for the desirable core competencies and technical skills needed to optimize clinical outcomes when performing coronary-based interventions, and is an update of the initial 2007 clinical competence statement. The document was created in response to challenges presented by the changing landscape of the interventional field, and evolving views on how best to define and assess clinical competency specifically related to percutaneous coronary intervention (PCI) and other coronary-based interventions in adult patients.

Specifically, the document outlines new and adjusted benchmarks to assist with measuring and judging operator and institution performance of coronary-related procedures. According to the authors, criteria for evaluating operator competency should not just look at procedural volume, but instead include an evaluation of risk-adjusted outcomes, periodic case reviews of patient selection and other factors. They also recommend that clinicians and hospitals stay current on the latest advances in PCI through practice-based learning, formalized training and continuing education.

In addition to addressing components of physician competence, the document also provides facilities with or seeking PCI programs with recommendations to meet certain requirements, closely monitor clinical outcomes and provide quality assurance; assesses the use of coronary-based procedures in patients with structural disease; and recommends participation in local or national registries such as the ACC's NCDR Cath PCI Registry to benchmark and assess performance and to promote continued quality improvement.

"This is the first cardiovascular competency statement to fully utilize the six domains structure promulgated by the Accreditation Council of Graduate Medical Education and adopted and endorsed by the American Board of Internal Medicine," noted John Gordon Harold, MD, MACC, president of the ACC and chair of the writing committee. "It goes beyond medical knowledge and procedure performance, to include the important issues of leading an interdisciplinary team, working in a complex system, communicating effectively, engaging in continuous quality improvement at the individual and system levels, adhering to evidence-based medicine, and demonstrating the highest levels of professionalism."

The competency statement will appear in the June 11 print issue of the Journal of the American College of Cardiology.  The authors note that the operator and institutional volume discussion, conclusions and recommendations supersede the recommendations in the 2011 PCI guidelines. 

Keywords: Quality Improvement, Patient Selection, Cardiology, Clinical Competence, Coronary Vessels, Evidence-Based Medicine, United States, Percutaneous Coronary Intervention