New guidelines published in the July 27 edition of the Journal of the American College of Cardiology (JACC) outline the specific methods needed to properly manage heart failure (HF) and heart transplant patients, including practicing at an institution with the proper infrastructure to necessitate care, working in a multidisciplinary team-based approach and utilizing a disease management approach to care.
The guidelines were put forth by the American College of Cardiology Foundation, the American Heart Association, American College of Physicians Task Force in collaboration with the Heart Failure Society of America and the International Society for Heart & Lung Transplantation.
The 32-page document outlined specific approaches and the clinical knowledge and training necessary for the proper care of this patient population and to gain reimbursement approval from the Centers for Medicare & Medicaid Services from performing transplants.
The guidelines stated that for those performing transplants or treating HF patients, it is necessary to be able to properly identify transplant patients. “The HF specialist will be expected to develop competence in all validated forms of therapy for patients with advanced HF and heart transplantation.”
Because HF is becoming more common among the pediatric population, it is now necessary for pediatric cardiologists to become more in tune with this specialty and be able to be board certified by the American Board of Pediatrics Sub-Board of Cardiology with an additional fellowship year at a pediatric transplant center.
The guidelines also stated that specialists should be aware of the comorbidities that may be associated with HF patients including hypertension, diabetes and coronary artery disease, along with preventive lifestyle measures including lower blood pressure, increased exercise and smoking cessation that may help prevent them.
The task force also recognized the importance of specialists to be knowledgeable and able to identify complications that commonly appear after left ventricular assist device implantation including: mechanical device problems; supraventricular and ventricular arrhythmias; bleeding and thrombosis and infections; and nutritional deficiencies.
A multidisciplinary disease management approach to care may not only alleviate cost but also reduce hospital readmission, the guidelines stated. These approaches center around use of home visits and telehealth subsequent to hospital discharge, focusing on transitioning patients from the hospital to the home.
According to the guidelines, specialists should be knowledgeable in educating the patient and their family on proper medication administration, self-management and dietary restrictions, which all may help reduce hospital readmission after discharge. Additionally, practicing under a multidisciplinary team approach that includes primary care physicians, internists and nurses is important and beneficial to prevent readmission.
In conclusion, the guidelines stated that “to maintain competence in heart transplantation, the committee recommends participation as a member of a team in an institution with a robust transplant program, one that cares for patients during all phases of the transplant process—pretransplant, perioperatively and post-transplant."