Integrated Criteria for Cardiology Centers of Excellence Developed from key international cardiology guidelines and expert consensus.
Integrated Criteria for Cardiology Centers of Excellence
Developed from key international cardiology guidelines and expert consensus.
Source: Integrated Criteria for Cardiology Centers of Excellence
In reference to these standards, please find below a concise summary of the internationally recognized criteria for establishing and accrediting Centers of Excellence in cardiology. This framework was developed from key international cardiology guidelines and trusted expert consensus:
1. Heart Failure (HF)
2. Heart Transplantation
3. Atrial Fibrillation (AF)
4. Ventricular Arrhythmias (VT/VF)
5. Hypertrophic Cardiomyopathy (HOCM)
These standards are compiled based on evidence-based guidelines and frameworks from leading cardiology organizations including the Heart Failure Society of America (HFSA), American College of Cardiology (ACC), American Heart Association (AHA), Heart Rhythm Society (HRS), and the European Society of Cardiology (ESC).
1. Heart Failure Center of Excellence (HF CoE)
Definition:
A Heart Failure Center of Excellence is a multidisciplinary, high-quality program designed to provide comprehensive care for patients across all stages of heart failure (HF), from diagnosis through advanced therapies and palliative support.
Core Criteria:
A. Multidisciplinary HF Team
• Advanced HF cardiologists
• Heart failure nurse specialists
• Clinical pharmacists
• Nutritionists
• Psychologists or counselors
• Social workers
• Physical therapists
B. Diagnostic Capabilities
• Echocardiography (including strain imaging)
• Cardiac MRI
• Right heart catheterization
• Cardiac biomarkers (BNP, NT-proBNP)
• Genetic counseling and testing when indicated
C. Structured Clinical Pathways
• ACC/AHA/HFSA or ESC-aligned protocols
• Management by HF category: HFrEF, HFpEF, HFmrEF
• Optimization of guideline-directed medical therapy (GDMT)
• Transition of care planning and readmission prevention
D. Advanced Therapeutic Access
• CRT, ICD
• LVAD programs
• Referral or integration with heart transplant services
• Palliative care integration
E. Data & Quality Monitoring
• Participation in national or regional HF registries (e.g., GWTG-HF, ESC-HF Registry)
• 30-day readmission and mortality tracking
• Risk stratification tools: Seattle HF Model, MAGGIC
F. Patient Education and Engagement
• Structured education programs
• Self-care tools and telemonitoring
• Shared decision-making models
G. Research and Innovation
• Clinical trials participation
• Quality improvement projects
• HF training and fellowships
References:
https://www.hfsa.org
https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2022/12/14/14/59/2022-aha-acc-hf-guideline
https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Heart-Failure
2. Heart Transplant Center of Excellence
Definition:
To establish and accredit a Heart Transplant Center of Excellence, the following key criteria—adopted from CMS, UNOS, and OPTN—must be met.
Core Criteria:
1. Minimum Annual Case Volume
Perform at least 10–12 heart transplants annually to ensure institutional experience and procedural proficiency.
2. Survival Rates
Maintain ≥85% 1-year survival rate and high 3-year survival outcomes.
3. Multidisciplinary Transplant Team
Includes transplant surgeons, advanced HF cardiologists, transplant coordinators, anesthesiologists, infectious disease experts, immunologists, psychologists, social workers, dietitians, and rehabilitation specialists.
4. Comprehensive Pre- and Post-Transplant Support
Access to LVAD, immunologic evaluation, psychosocial screening, and lifelong structured outpatient follow-up.
5. Organ Allocation and Ethical Compliance
Strict adherence to national organ allocation policies and transparent, equitable listing procedures.
6. Data Reporting and Quality Monitoring
Submit outcome data (waitlist mortality, readmissions, complications) to CMS/OPTN registries.
7. Participation in Registries and Research
Engage in transplant research and continuous quality improvement using national transplant databases.
8. Accreditation and Peer Review
Maintain active accreditation and undergo regular performance evaluation via SRTR or CMS.
9. Patient and Family Education
Provide structured transplant education covering lifestyle, medications, rejection signs, and long-term management.
10. Infrastructure and Facilities
Fully equipped ICU, immunology labs, tissue typing, and surgical support.
References:
https://optn.transplant.hrsa.gov
https://unos.org
https://www.cms.gov
3. Atrial Fibrillation Center of Excellence (AF CoE)
Definition:
A comprehensive center offering full-spectrum care for patients with AF—from early diagnosis to catheter ablation, stroke prevention, and long-term management.
Core Criteria:
A. Specialized AF Team
• Cardiac EPs
• AF nurse coordinators
• Stroke team
• Clinical pharmacists
• Imaging specialists (CT/MRI)
• Anticoagulation service
B. Integrated Care Pathway
• CHA₂DS₂-VASc and HAS-BLED scoring
• ESC 2020 or AHA/ACC/HRS 2019 pathway alignment
• Lifestyle interventions: weight loss, sleep apnea, smoking cessation
C. Ablation Services
• RFA, Cryoballoon, PFA
• Mapping systems (e.g., CARTO, EnSite)
• ICE-guided procedures
• Same-day discharge when appropriate
D. Stroke Prevention
• DOAC/Warfarin management
• Watchman device or other LAAO interventions
E. Monitoring and Follow-up
• Holter, mobile ECG, loop recorders
• Remote arrhythmia detection and EMR integration
F. Patient Engagement
• Educational resources
• Shared decision-making tools
• Virtual visits and structured telemonitoring
G. Metrics and Quality Indicators
• AF burden reduction
• EHRA score improvement
• Recurrence rate post-ablation
• Anticoagulation adherence
H. Accreditation and Registry Participation
• GWTG-AFIB or national AF registries
• HRS CoE framework compliance
References:
https://www.hrsonline.org/AFCoE
https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Atrial-Fibrillation
https://www.jacc.org/doi/10.1016/j.jacc.2019.01.011
4. Ventricular Arrhythmia / Tachycardia Center of Excellence (VT/VF CoE)
Definition:
A VT/VF CoE is designed for high-risk patients with life-threatening ventricular arrhythmias. These centers integrate emergency care, ablation, device management, and long-term follow-up.
Core Criteria:
A. Specialized EP Infrastructure
• High-volume EP team
• Advanced 3D mapping systems (e.g., CARTO, RHYTHMIA)
• Contact force catheters, ICE, magnetic navigation
B. Multidisciplinary Team
• EPs, heart failure specialists, interventional cardiologists
• ICU physicians, cardiac surgeons
C. Advanced Procedural Options
• Epicardial and scar-related VT ablation
• Management of VT storm and electrical storms
• Sympathetic denervation in select cases
D. Device Expertise
• ICD/CRT implantation
• Programming for ATP/shock minimization
• Remote monitoring with arrhythmia alerts
E. Emergency Systems
• 24/7 EP response protocols
• Structured management for sudden cardiac arrest
• Post-resuscitation rehab
F. Long-Term Management
• Standardized follow-up
• Psychosocial support and lifestyle counseling
• Recurrence tracking
G. Research and Registry Reporting
• Inclusion in multicenter VT trials
• Outcomes tracking: acute success, VT-free survival, mortality
References:
https://www.hrsonline.org
https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
https://www.acc.org/latest-in-cardiology/articles/2022/03/03/20/26/hrs-guidance-on-catheter-ablation-of-ventricular-arrhythmias
5. Hypertrophic Cardiomyopathy (HOCM) Center of Excellence – Comprehensive Criteria
Introduction
This document outlines the internationally recognized criteria for establishing a Hypertrophic Cardiomyopathy (HOCM) Center of Excellence. These criteria are based on clinical guidelines and expert consensus from leading cardiology societies including the European Society of Cardiology (ESC), the American College of Cardiology (ACC), and major HCM referral programs.
Definition
A Hypertrophic Cardiomyopathy (HOCM) Center of Excellence is a multidisciplinary center designed to provide comprehensive evaluation, genetic counseling, advanced imaging, risk stratification, and personalized management for patients and families affected by hypertrophic cardiomyopathy.
Core Criteria
A. Multidisciplinary HCM Team
• Cardiologists specialized in HCM
• Cardiac imaging experts (echocardiography and MRI)
• Geneticists and genetic counselors
• Electrophysiologists
• Cardiac surgeons with experience in septal myectomy
• Nurses and allied health staff trained in inherited cardiac conditions
B. Advanced Diagnostic Capabilities
• Echocardiography with strain imaging
• Cardiac magnetic resonance imaging (MRI)
• Exercise stress testing
• Holter monitoring and inpatient telemetry
• Comprehensive genetic testing and family screening programs
C. Comprehensive Risk Stratification
• Use of ESC HCM risk score for sudden cardiac death (SCD)
• Evaluation for ICD therapy
• Assessment of apical aneurysm, LVOT obstruction, or mid-ventricular gradients
D. Specialized Treatment Pathways
• Medical therapy optimization (e.g., beta-blockers, calcium channel blockers, disopyramide)
• Septal reduction therapy:
• Surgical septal myectomy
• Alcohol septal ablation
• ICD implantation for SCD prevention
• Management strategies for non-obstructive and restrictive HCM variants
E. Family and Genetic Services
• Cascade screening of first-degree relatives
• Genetic counseling and follow-up
• Psychosocial support for patients and families
F. Long-Term Follow-Up and Registry Participation
• Enrollment in HCM registries for outcome tracking
• Structured adolescent-to-adult transition care
• Ongoing follow-up with periodic imaging and rhythm monitoring
• Remote surveillance when appropriate
G. Research and Innovation
• Participation in multicenter HCM clinical trials
• Contribution to genotype-phenotype correlation studies
• Research on risk stratification, new therapies, and patient-reported outcomes
References
• ESC Guidelines on Hypertrophic Cardiomyopathy:
https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Hypertrophic-Cardiomyopathy
• ACC Expert Consensus on HCM:
https://www.acc.org/guidelines/hypertrophic-cardiomyopathy
• Johns Hopkins HCM Center of Excellence:
https://www.hopkinsmedicine.org/heart_vascular_institute/clinical_services/centers_excellence/hcm_center
• Mayo Clinic HCM Program:
https://www.mayoclinic.org/diseases-conditions/hypertrophic-cardiomyopathy/care-at-mayo-clinic/mac-20350230
