The ESC Heart Failure Association postgraduate course in heart failure

How an advanced HF training program changed the clinical practice of two European cardiologists Becoming heart failure (HF) specialists means having a wide and comprehensive background to this complex cardiac disease, moving every day through concepts and issues belonging to different fields of cardiology. As a result, HF patients need a cardiologist not only competent in clinical medicine and pharmacotherapy, but also in cardiac devices, cardiac imaging and management of the advanced stages of the disease.1 The Postgraduate Course in Heart Failure (PCHF), at the moment in its second-ever course, is an advanced training program organized by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the Zurich Heart House and University of Zurich, in partnership with the Heart Academy of the ESC.2 The course aims to improve diagnostic and therapeutic HF management referring to the HF specialist curriculum3 of the HFA and a certificate of advanced studies is awarded to successful participants. The first course started in January 2014 and we were among the 52 participants coming from many different European and worldwide countries aiming to improve and define our clinical practice in HF management. The aim of this brief report is to review our experience at PCHF and to describe to other young colleagues why it has been so fundamental on our journey to become HF cardiologists. The first course of PCHF lasted 2 years from January 2014 to October 2015, consisting of eight modules of 2.5 days each, covering all the fields of HF from pathophysiology to acute and advanced stages of the disease, passing through imaging and devices. Every module consisted of theory and practical courses, interactive discussions, clinical cases and rapid fire sessions. The faculty members were the major European and worldwide experts for each specific HF topic. The first feature that made this course unique is that it has been the first successful attempt in Europe to provide advanced and high quality education in HF. In Italy, as in many other European countries, specific Fellowships or residencies in the topic are not available. Some local postgraduate courses in HF are ongoing but specific HF training is mainly by clinical practice. The methods of learning are still mostly left to the individuals’ desire to attend courses and in focusing their own training on the topic. However, defining the specific role and skills of the HF specialist is necessary in order to improve the quality and define our daily work. The aim of the PCHF organizing committee was to form a new professional figure in cardiology: a specialist with expertise in all the different fields of cardiology converging on HF, capable of linking the different subspecialties on every single patient, and accompanying the patient during his journey through the different stages of the disease. This target was completely fulfilled. During the course we had the priceless opportunity to attend excellent speeches; we also experienced hands-on sessions and were constantly and directly in contact with the Faculty members. We learned from them, not only much about the technical issues, but also from their enthusiasm and passion in the topic of interest. We had the unique opportunity to discuss practical clinical issues with the leading personalities in the field, receiving interesting point of views that changed our way of thinking. This 2-year journey also established a powerful network between participants, both from the human and professional point of view. We finished the course with new friends and many contacts, and ideas to start working together in the future. PCHF changed our way of approaching patients affected by HF. The main message that we received is that a HF team is necessary to manage this syndrome. A HF specialist alone is not able to provide all the patients’ clinical needs. As reported in the HF specialist curriculum of the HFA,3 interaction with a multidisciplinary team is one of the mainstays of HF diagnostic and therapeutic management. A HF specialist should be able to provide multi professional inputs to the patient and to foster a team approach to the management of the patients and their families. Moreover, the management of comorbidities can only be carried out by effectively communicating with other healthcare professionals and a team approach is needed to deliver treatments, and for drug titrations and monitoring of side effects. During the course we had the opportunity to interact with many different HF specialists, from HF imaging experts to HF electrophysiologists, HF nurses and pharmacists, and had the opportunity to observe how complementary professional figures work together to achieve the best standards of patient care. We are now transferring at least some aspects of this organization into our daily practice. In addition, the PCHF gave us a rigorous method to approach the disease. Managing a patient affected by such a complex disease cannot be a linear process and many aspects, beyond the diagnostic phase, should be considered. Having a clear priority on how to proceed and follow a methodology is necessary in most cases to avoid confusion and mistakes. We now always proceed trying to follow some main issues such as, remembering the pivotal role of an accurate diagnosis and of identifying an underlying aetiology, in planning future analysis and therapies. Also for understanding and analysing availability, cost-effectiveness and the rationale for choosing suitable diagnostic tests, when considering all available therapeutic options and side-effects. From the initial stage of the disease we establish a comprehensive relationship with the patient that should always be involved in our management plan. Last, but of course not least, the PCHF experience gave us an appropriate degree of self-confidence in HF patient management. We are now HF specialists and we are not afraid of the disease (at least, not always!). With the support of adequate equipment, guidelines, clinical trials, clinical expertise, multiprofessional collaboration and continuous medical education, we can approach and manage patients at our best, in order to improve outcomes and quality of life. Furthermore, we now feel part of a network linking ourselves to other HF specialists in Europe and to the members of the faculty, enabling us to gain more confidence in trying to achieve the best standards of care for our patients. Organization, education, and training all around Europe in the field of HF are still very heterogeneous. Major efforts should be made to adopt training programs referred to the ESC HF curriculum3 in each individual country. Moreover, initiatives to develop specific skills should be more easily available to young cardiologists with a special interest in HF and Postgraduate Courses on specific diagnostic and therapeutic techniques should become more easily accessible.4 Efforts made by the PCHF committee will be rewarded in the form of young HF specialists able to improve, first of all, patient outcomes and to create a European network of physicians involved in the continuous progress of HF management. References are available as supplementary material at European Heart Journal online.