ESC statement: Competency-based cardiac imaging delivery needed for effective patient care

Competency-based cardiac imaging delivery is needed for effective and efficient patient care, according to a European Society of Cardiology (ESC) statement published today in European Heart Journal, a journal of the ESC.

All seven ESC subspeciality associations have endorsed the document, namely the European Association of Cardiovascular Imaging (EACVI), Association of Cardiovascular Nursing & Allied Professions (ACNAP), Association for Acute CardioVascular Care (ACVC), European Association of Preventive Cardiology (EAPC), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Heart Rhythm Association (EHRA) and Heart Failure Association (HFA) of the ESC.

Cardiac imaging is integral to the field of cardiology and to the patients we serve, and cardiologists are trained and competent to deliver all imaging methods. The ESC and EACVI support the delivery of competency-based cardiac imaging services delivery to improve the availability and quality of such services."

Professor Steffen Petersen, EACVI President and report author

Cardiovascular imaging is integral to managing all aspects of heart disease, including diagnosis, risk assessment, early detection and prevention, therapeutic decision making, guidance of invasive therapies, and long-term monitoring. The types of imaging include: 1) echocardiography; 2) cardiovascular magnetic resonance; 3) invasive coronary angiography and cardiac computed tomography; 4) advanced invasive imaging (optical coherence tomography and intracardiac echocardiography).; and 5) nuclear cardiology

Delivery of high-quality cardiac imaging services requires expertise in imaging methodology and an in-depth knowledge of heart disease. Cardiologists are well positioned to meet both of these needs.

First, imaging is a core competency of all cardiologists. In the ESC Core Curriculum for the Cardiologist, the EACVI outlines how to assess patients using the different imaging modalities which is then formally assessed by the European Examination in Core Cardiology (EECC). The ESC and the EACVI have also created a successful education and certification programme for all non-invasive cardiac imaging modalities. This equips cardiologists to provide high quality, competency-based cardiac imaging services.

Second, cardiologists have a deep understanding of cardiovascular pathology, complex physiology, and the consequences of imaging findings for the management of heart health and cardiovascular disease. This puts them in a unique position to select the most appropriate imaging test for each clinical scenario, taking patient preferences into account.

In addition to this knowledge, clinical practice guidelines and clinical consensus statements for the diagnosis and management of cardiovascular disease developed by the ESC and EACVI include recommendations on which cardiac imaging modality to select and how to act on relevant findings. Cardiologists are well-equipped to interpret imaging findings and report them to referring physicians, and can advise on the need for additional testing (e.g. genetic testing or myocardial biopsy) or therapies (e.g. revascularisation or cardiac device implantation).

A focus on specialty-based rather than competency-based delivery of cardiac imaging services has been one of the major barriers to the wider adoption of fundamental diagnostic tests in many countries. In a report published this year, the European Society of Cardiovascular Radiology and European Society of Radiology outlined their vision of cardiac radiology in Europe which emphasized the need to increase cardiac imaging expertise and capacity amongst radiologists. The report failed to acknowledge the integral role of cardiologists in cardiac imaging.

The ESC and EACVI disagree with the implied view that radiology alone is critical and always required for cardiac imaging. Together with the ESC Patient Forum, they advocate multidisciplinary working where desired and possible. According to the ESC Patient Forum, patients assign little importance to which speciality (cardiology, radiology, nuclear medicine, critical care) provides the investigations; patients just want to receive the best care possible. Today's paper states: "Cardiology is both central and integral to cardiac imaging, and while collaboration with cardiac radiologists and nuclear cardiology physicians can be useful and is encouraged, it is not essential as long as the required expertise is covered by the imaging cardiologist, which is often the case."

Professor Petersen said: "The demand for cardiac imaging is increasing as its role in diagnosing patients and guiding treatment continues to expand. A clearly defined competency framework for cardiac imaging standards can ensure that all medical specialists, including cardiologists, have the necessary expertise."