From Multidisciplinary to Interdisciplinary: Formalizing the Interventional Heart Failure Specialty

Many are still unfamiliar with the term “interventional heart failure.” How would you define the subspecialty in a way that differentiates it from advanced heart failure (HF) cardiology and traditional interventional cardiology?

The prevalence of advanced HF patients is increasing with primary percutaneous coronary intervention (PCI) for myocardial infarction (MI) and with improved pharmacologic therapies for reduced ejection fraction. Simultaneously, interventional procedures have moved rapidly toward supporting cardiogenic shock and treating valvular and structural lesions in HF patients. In many ways, interventional heart failure (IHF) runs parallel to the growth of procedural therapies in electrophysiology, akin to interventional cardiology emerging from general cardiology in the 1990s.

What are some common misconceptions about IHF, and how do they differ from the reality of practicing in this space?

A common misconception is that IHF specialists are a jack-of-all-trades, or that IHF closes some sort of gap between HF and interventional cardiology. Rather, the field represents the same increasing subspecialization seen across medicine. As treatments for HF become more device-heavy, it is not as reasonable for the general HF physician to be current with transcatheter therapies; and, as patients become increasingly complex, shock is increasingly nuanced and pharmacologic therapies continue to grow, so it is also unreasonable for interventional cardiologists to remain masters in the decision-making of these patients. Therefore, the practice of IHF encompasses interventional cardiologists who have made a commitment to this specific patient population.

Over the past decade, how has HF care evolved to create the need for a more integrated IHF specialty? What changes in technology, patient complexity, or care delivery have made this field increasingly relevant?

Temporary mechanical circulatory support (MCS) is increasingly employed to support patients with cardiogenic shock, either for heart recovery after acute MI or as a bridge to heart transplantation. Heart transplantation itself has seen robust growth due to increasing donor pool, improved preservation technologies, and ability to transplant sicker patients on mechanical support. Structural heart interventions veered into HF with transcatheter edge-to-edge repair for patients with secondary mitral regurgitation and have not left. New structural therapies for tricuspid and aortic regurgitation, HF with reduced ejection fraction, HF with preserved ejection fraction, pulmonary hypertension, and other cardiovascular disease are all increasingly applied for HF patients. The center of the Venn diagram between HF and interventional cardiology continues to grow.

Device innovation—from percutaneous MCS to advanced structural therapies—is central to this field. Which emerging technologies do you believe will most accelerate the maturation of IHF over the next decade?

Technologic advancements are often iterative, but sometimes these advances may cause larger leaps than anticipated. For example, patients supported by temporary MCS to heart transplant or myocardial recovery often need surgical access and vascular grafts to support larger support devices. If these devices become smaller than a set biological cutoff for feasibility, they might be placed entirely percutaneously by IHF.

In structural heart, iterative improvements in transcatheter valves and repair devices may lead to maturation of mitral and tricuspid interventions—as we’ve seen in the aortic stenosis space, where transcatheter therapies became the default option. Other larger advances might come from breakthrough therapies with large treatment effect sizes that change the paradigm for treatment in HF. These technologies might therefore be intercalated with titration of pharmacologic therapies, as opposed to offered only with their failure.

You were lead author on a comprehensive review published in JSCAI highlighting and addressing training gaps to advance the specialty of IHF.¹ In the article, you outline the urgent need for more integrated training pathways and propose five key pillars that should anchor an IHF curriculum. What was missing from traditional fellowship models that made it necessary to rethink training in this more structured way?

Advanced HF and interventional cardiology are often siloed, and faculty in their respective training programs are likely to present only their perspectives. An integrated IHF training pathway demands efforts from faculty to specifically teach the intersection of advanced HF and interventional cardiology.

In the review, you describe three main phenotypes of IHF specialists—those with an invasive HF focus, those with a cardiogenic shock/interventional focus, and those with a structural HF focus. As IHF matures, do you envision these three phenotypes remaining distinct or eventually converging into a more unified model of training and practice?

In the short term, the required technical skill sets are sufficiently different between these three phenotypes; they will remain distinct, as they are too broad for the existing training pathways to completely cover. IHF is still growing, maturing, and finding its final, more clarified form. Training pathways would also mature toward an integrated and dedicated training pathway that should cover all phenotypes of IHF specialists we see today.

If you were designing the ideal IHF fellowship today, what would be its nonnegotiable components, and how would you integrate HF and interventional training without unnecessarily prolonging training or diluting core competencies?

Nonnegotiable components of a competency-based IHF fellowship must include didactics in cardiogenic shock, cardiorenal syndrome, and advanced hemodynamics, alongside technical mastery of high-risk PCI in low-ejection fraction states and large-bore access management. These foundational skills prepare specialists for emerging endovascular therapies, including novel hemodynamic pumps, venous decongestion systems, and denervation catheters. A critical core competency is the strategic timing of these interventions—understanding how they integrate with pharmacologic therapies and where they fall on the timeline of a patient’s HF severity and reversibility.

What aspects of IHF make it particularly compelling for trainees, and what type of physician might be especially well-suited for this field?

IHF is a rapidly evolving field perfectly suited for a career in lifelong learning. It fundamentally encourages thinkers to be doers and doers to be thinkers. IHF is highly collaborative and interdisciplinary. It provides interventionalists with the reward of longitudinal patient care beyond the procedural event, while empowering HF specialists to comprehensively treat their patients through advanced, device-based interventions. IHF is the specialty where physiological insight meets technical mastery.

1.  Cheng R, Alvarez Villela M, Masoumi A, et al. Charting the course for careers in interventional heart failure: training, challenges, and future directions. J Soc Cardiovasc Angiogr Interv. 2025;4:102569. doi: 10.1016/j.jscai.2025.102569