This post was authored by Mary Norine Walsh, MD, FACC, medical director of Heart Failure and Cardiac Transplantation at St. Vincent Heart Center of Indiana, a former member of the ACGME Residency Review Committee for Internal Medicine and a former member of the ACC Board of Trustees.

July 2013 signals a change in training of future heart failure and transplant cardiologists. The subspecialty of advanced heart failure and transplantation cardiology (AHFTC) has recently joined clinical cardiac electrophysiology and interventional cardiology as the third subspecialty of cardiovascular disease. In the fall of 2010 the American Board of Internal Medicine offered the initial certification examination in AHFTC. This was to a large extent the culmination of a major effort on the part of many leaders in our field who for years had worked toward defining the field of AHFTC as a subspecialty of cardiology. To be eligible to take the examination the applicant must have current, valid ABIM certification in cardiovascular disease and have either completed formal training in the field or demonstrate requisite practice experience.  This so-called ‘practice pathway’ is only available to candidates who completed the training required for certification in cardiovascular disease prior to July 1, 2011. The last certification examination in AHFTC available to those on the ‘practice pathway’ will be offered in 2014.

In the wake of the ABIM’s action, the Accreditation Council for Graduate Medical Education (ACGME) moved forward and developed program requirements for training in AHFTC.  Programs that submitted applications for accreditation were notified of their accreditation decisions this past fall and the first class of AHFTC fellows will begin training at these institutions in July.  The fellowship is 12 months in duration and follows the same common requirements of all one year subspecialty fellowships with regard to resources, faculty, program personnel and resources.  Some of the requirements specific to AHFTC fellowship training include gaining experience and demonstrating competence in the care of heart failure patients, pre- and post-transplant patients, and patients with ventricular assist devices, implantable cardioverter-defibrillators, and/or cardiac resynchronization therapy.

The requirements outline many other areas of competence that must be demonstrated including those of:

• using and interpreting the results of maximal and sub-maximal exercise testing and cardiopulmonary exercise testing.
• assigning methods of surveillance for transplant rejection and immune status
• recognizing the indications for and prescribing immunomodulating drugs, and managing their adverse effects, therapeutic levels, and interactions with other drugs
• treatment of acute decompensation of chronic heart failure, acute cellular and antibody mediated rejection and cardiac allograft vasculopathy

A complete list of the program requirements for AHFTC fellowship programs can be found on the ACGME website, as can a list of accredited AHFTC programs.

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