Mandeep Mehra, MD: Team-Based Care in Heart Failure

Mandeep Mehra, MD: The classic heart team approach began in the field of heart failure 30 years ago, or 40 years ago, when these teams were assembled for the care of patients with heart transplantation. So that's the classic evolution of heart teams. Then, left ventricular assist devices emerged and these unique teams had to be deployed for them, so a lot of programs combined left ventricular assist device teams and heart transplant teams together into usual teams.

Transcatheter aortic valve repair is another example of our heart team approach, where surgeons and physicians and imaging experts and nurses and physicians assistants have to come together to care for these complex patients. We believe very strongly that for a chronic disease, like heart failure, one has to, in fact, take a team approach.

That's partly why the HFSA is creating its own competency certification initiative where we actually want to administer tests and adjudicate competency in all team members, not just a physician. Because, traditionally the American Board of Internal Medicine only certifies physicians, but what about clinical pharmacists, who have an equal stake in the care of these patients? What about nurses and nurse practitioners, who have more than an equal stake in these patients? So, I think the heart team concept is critical in heart failure. I don't think we can succeed without it. It is one of the important things that we already have in our possession in the United States, whereas outside the United States, finding heart teams is not yet a fully endorsed strategy.