Physician task force sets out knowledge criteria for clinicians who want to consider themselves experts in this growing field

The American College of Cardiology (ACC), the American College of Physicians (ACP), the Society for Cardiovascular Angiography and Interventions, the Society for Vascular Medicine and Biology, and the Society for Vascular Surgeons have developed a new set of competency criteria for physicians who wish to practice vascular medicine and catheter-based peripheral vascular interventions.

The goal: to ensure practitioners have the appropriate knowledge base and training to provide excellent care.

The document has huge implications for practice in this fast-growing and important area of medicine, said Mark A. Creager, MD, FACC, Chair of the ACC/AHA/ACP Task Force on Clinical Competence as well as Chair of the ACC/ACP/SCAI/SVMB/SVS Writing Committee that developed this document. “It’s the first of its kind to provide standards for the cognitive knowledge and the clinical and technical skills that physicians must have if they wish to consider themselves expert in vascular medicine and endovascular interventions,” he said.

The document is a multidisciplinary effort on the part of several specialty groups, including internists, vascular medicine physicians, vascular surgeons, and cardiologists, who all treat non-coronary vascular disease. These groups bring different skills and perspectives to the care of patients with vascular disease, added vascular surgeon, Jerry Goldstone, MD, co-chair of the writing committee. “This is why this document is so important, and also why it was quite an accomplishment to get such broad consensus on key areas,” Dr. Goldstone said.

Vascular disease management is a very important component of the cardiovascular field because atherosclerosis and thrombosis cause the majority of diseases and clinical problems that cardiologists encounter. “It’s therefore important cardiovascular physicians who wish to evaluate and manage patients with these problems really have the skills to do so,” Dr. Creager said.

The report will also help hospitals determine whether physicians who want credentials at their institutions have the necessary training and the right skills to perform these procedures. “Medical liability issues are forcing hospitals to pay close attention to their physicians’ skills and training, because ultimately, they become the deep pocket in a law suit. Helping credentials committees determine whom they should allow to do these procedures was one of the reasons we wrote this document,” Dr. Goldstone said.

Importantly, this report brings peripheral vascular disease to the forefront, said Rebecca Rainer Pauly, MD. “Peripheral vascular disease is very common in the U.S., and as our population ages, its prevalence will increase. Patients tend to be very aware of the symptoms of a heart attack, but I don’t think symptoms that are typical for peripheral vascular disease, such as pain in the lower extremities secondary to decreased blood flow, have been particularly emphasized. It’s important to educate the public,” Dr. Pauly, who represented the ACP on the task force, said.

Patients with coronary artery disease frequently have co-existent atherosclerosis in other circulations. That is why it is important for the cardiovascular physician to consider the entire patient, not simply the heart, when it comes to atherosclerosis, Dr. Creager noted.

“Cardiologists have outstanding skills in performing vascular interventions, particularly in the coronary arteries. Cardiologists with catheter skills for coronary interventions may wish to treat significant atherosclerotic conditions in other parts of the body. However, these cardiovascular physicians must have the knowledge base and clinical and technical skills to manage disease in other circulations. It’s not simply a matter of moving the catheter from one part of the body to another,” he said.

“Right now, the perception is that many doctors are moving their catheter from one area to another just to treat a narrowing in an artery, but with limited understanding of what they are doing, or why they are doing it. This document will provide them with an outline of the information they must have, and tell them what they must know, so that they can confidently deliver the highest quality of patient care and have the credibility required to take care of patients with vascular disease,” Dr. Creager added.

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