The following are key points to remember from this American College of Cardiology/Heart Failure Society of America/International Society for Heart & Lung Transplantation (ACC/HFSA/ISHLT) lifelong learning statement for advanced heart failure and transplant cardiology (AHFTC) specialists:

1. This consensus document discusses the requirements to sustain and enrich competency of advanced heart failure and transplant cardiology specialists including mechanical circulatory support, cardiac resynchronization therapy, cardiac transplantation, and pulmonary arterial hypertension.
2. The aggregated lifelong learning competencies recommended in this document collectively underlie the Entrustable Professional Activities that patients and the public can reasonably expect all competent clinical cardiologists, including AHFTC specialists, to be able to perform—particularly Cardiovascular Consultation, Acute Cardiac Care, Chronic Cardiovascular Disease Management, Cardiovascular Testing, Disease Prevention and Risk Factor Control, Team Based Care, and Lifelong Learning (Table 1).
3. These recommendations are based on core Accreditation Council for Graduate Medical Education competencies including: a) Patient Care, b) Medical Knowledge, c) Practice-Based Learning and Improvement, d) Interpersonal and Communication Skills, e) Professionalism, and d) System-Based Practice (Table 2).
4. This document includes recommendations expected of all AHFTC specialists to have medical knowledge of HF including pathophysiology, epidemiology and nomenclature, presentation and evaluation, and management (Table 3).
5. It also delineates the expectations for those with practice-based focus particularly for those AHFTC specialists who manage patients with pulmonary hypertension, mechanical circulatory devices, or recipients of cardiac transplantation (Table 3).
6. This document recommends skills which AHFTC specialists must have including those pertaining to patient care and procedural skills—it delineates such skills for managing patients with each of the following: mechanical circulatory support, cardiac resynchronization therapy, cardiac transplantation, or pulmonary arterial hypertension (Table 3).
7. This document recommends common professional behavior competencies relevant to all clinical cardiovascular disease specialists (Table 4) pertaining to system-based practice, practice-based learning and improvement, professionalism, and interpersonal skills.
8. This document suggests that activities that can demonstrate competency include successful completion of a dedicated AHFTC program, American Board of Internal Medicine certification following completion of AHFTC training, certification via a maintenance of certification process, participation in ongoing continuing medical education programs, participation in quality of care measures in hospital databases and national registries including procedure-specific databases, performance of an adequate annual volume of endomyocardial biopsy and right heart catheterization to maintain skills that demonstrate proficiency as an AHFTC specialist, and possible submission of results for open scrutiny in the appropriate national databases and obtaining adequate training through coursework, proctoring, and simulation laboratories for new or revamped technology and procedures.
9. The authors of this document recognize the fact that although maintenance of some AHFTC competencies is an expectation for all clinical AHFTC specialists, the maintenance of selected AHFTC competencies and the evaluation tools to assess them can be career focused (such as management of pulmonary hypertension, recipients of heart transplantation, or mechanical circulatory support).
10. This document recommends that all AHFTC physicians should have the skills to assess new research findings and appropriately incorporate new diagnostic and treatment modalities in patient care. This document recommends referral of patients for participation in well-designed clinical trials for both academic and nonacademic cardiologists.

Perspective:

The authors of this consensus document need to be congratulated for an outstanding up-to-date comprehensive list of recommendations for AHFTC specialists.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Implantable Devices, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant, Mechanical Circulatory Support, Pulmonary Hypertension, Interventions and Vascular Medicine, Hypertension

Keywords: Biopsy, Cardiac Catheterization, Cardiac Resynchronization Therapy, Cardiomyopathies, Certification, Clinical Competence, Consensus, Education, Medical, Education, Medical, Continuing, Geriatrics, Heart-Assist Devices, Heart Failure, Heart Transplantation, Hypertension, Pulmonary, Risk Factors, Secondary Prevention, Specialization, Teaching, Transplantation

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