Charting the Course for Careers in Interventional Heart Failure: Training, Challenges, and Future Directions

Interventional heart failure (IHF) has emerged as a critical subspecialty due to the increasing complexity of heart failure (HF) treatment now spanning both pharmacological and nonpharmacological device-based therapies. Although initially existing at the intersection of interventional cardiology and advanced HF, IHF has expanded to encompass multiple domains of cardiology including cardiogenic shock (CS), transcatheter valve therapies, relief of increased left atrial pressures, and coronary intervention in low ejection fraction and after heart transplant. Although rapidly growing, training pathways remain elusive, and existing training pathways are not well equipped to deliver necessary training components and encourage growth in the field. Those with a career in IHF can be divided into 3 main phenotypes. Those who are not formally interventional trained, but might implant pressure sensors, perform endomyocardial biopsies, and place nonlarge bore devices. Those who have formal interventional cardiology training might focus on coronary interventions, shock calls, and large-bore devices. Those with structural training might focus on transcatheter valve therapies and structural procedures in HF. There are several possible training pathways for IHF and we propose 5 focuses for training. Finally, we describe areas of interest and growth for careers in IHF. The field of IHF has been misunderstood as one of "jack of all trades" but actually represents the trend of increasing specialization for careers within cardiology due to the increasing complexity of therapeutic options within cardiovascular disease. By addressing current training challenges, the field is poised to make significant strides. Trainees entering this specialty will have the opportunity to be at the forefront of cardiovascular care, contributing to innovative treatments and improving outcomes for patients with complex HF.