To frame the background of this article, I want to first share some words about myself. I was raised in Germany and completed medical school in Dusseldorf, Germany, before relocating to the U.S. for residency and cardiology fellowship. After seven years of U.S. medical training, I had never attended a conference in Europe. However, this past year I finally had the chance to attend a series of European Cardiology and Heart Failure conferences (ESC-HFA). My participation proved to be valuable and eye-opening in many regards. Apart from the opportunity to present research that I was involved in to an international audience, I also connected with European Fellows in Training (FITs) and early career cardiologists.

Similar to American trainees, Europeans rarely cross the Atlantic to attend U.S. conferences, thus limiting the opportunity for interaction. In-person interaction during on-site FIT sessions, as well as social gatherings outside the conference vicinity, are crucial to build bridges between the continents as it leads to the exchange of ideas and new scientific collaborations.

However, one can argue that the cross-Atlantic collaboration can and should be more far-reaching, expanding from heart failure education to the delivery of care. In the U.S., heart failure specialization is defined by the framework of one-year training in advanced heart failure and transplantation, which is followed by an official board review exam. In Europe, the Heart Failure Association (HFA) has published a heart failure curriculum that runs over two years. The first year is dedicated to general heart failure training, while the second one expands into individual modules like imaging, devices, mechanical circulatory support or research. There are two pathways to receive an HFA-certification: through the Zurich Heart House postgraduate course and through an accreditation exam during HFA congresses. In spite of this progress, training in Europe remains vastly heterogeneous. Accreditation of heart failure specialists, integration into health care systems and resource allocation depends on national regulations and priorities. In terms of practice, a large majority of global transplants and LVAD implantations are performed in the U.S. while Europe is underrepresented.

Of course, the challenges that today's FITs and tomorrow's heart failure specialists face are the same worldwide. Taking into account the high priority of effective heart failure management to mitigate the impact of this devastating syndrome, we need to combine our forces. The importance of this collaboration is demonstrated by the recent creation of the International Heart Failure Collaboratory at HFSA 2018 in Nashville TN, where the inaugural lecture was given by the ESC-HFA Past President Gerasimos S. Filippatos, MD. The goal of this high-level committee will be to harmonize heart failure guidelines across the U.S. and Europe.

For the purpose of international alignment of guideline recommendations, research initiatives and education, early career cardiologists can play a pivotal role. Interdisciplinary committees starting with FITs may move the needle forward. Also, broader access to international travel supported by travel grants would be desirable. A high-level, cross-continent collaboration would upgrade the role of a heart failure specialist and leverage the faster integration of heart failure-specialized cardiologists across diverse health care systems for the ultimate benefit of our patients.

This article was authored by Marat Fudim, MD, Fellow in Training (FIT) at Duke University Medical Center in Durham, NC, and in conjunction with Efstratios Apostolou, MD, a European heart failure colleague from Athens, Greece.