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HFSA Heart Failure Certification (HF-Cert™)

HFSA has developed a Heart Failure Certification (HF-Cert™) program to recognize providers who have demonstrated specialized knowledge and skill to provide competent heart failure services in the United States. 

Overview 

The Heart Failure Certification (HF-Cert™) has been developed to recognize providers who have demonstrated advanced-level knowledge and skill to provide competent heart failure services in the United States. Heart failure providers demonstrate proficiency in a variety of settings including but not limited to academic medical centers, hospitals, medical group practices, ambulatory care, long term care, and military treatment facilities.

The HF-Cert professional provides assessment, treatment, and management of the patient with heart failure by ideally, or preferably, utilizing a multidisciplinary team approach in a patient-centered manner. Such a provider could include a cardiologist, internist, hospitalist, emergency physician, intensivist, family practitioner, clinical pharmacist, and an advanced practice nurse. Look below for more details on eligibility and more.


Timeline

HFSA’s HF-Cert program is expected to launch in 2021. The certification exam is currently being developed in partnership with a testing agency to ensure it is developed and maintained in a manner consistent with generally accepted psychometric principles, education testing practices, and national accreditation standards for certification programs. 

About the Heart Failure Certification

Purpose

By passing the HF-Cert examination, heart failure providers not only display their aptitude in each specialized knowledge area, but also present their expertise in heart failure with a HF-Cert credential.

The Heart Failure Certification program:

  • Validates professional expertise
  • Protects the public
  • Distinguishes the heart failure profession
  • Differentiates heart failure providers in a competitive job market
  • Encourages education providers to develop programming that will improve the knowledge and performance of heart failure providers through academic training and professional development opportunities
  • Provides a learning path that recognizes career-long professional development
  • Improves the understanding of heart failure by related disciplines
Certification

Professional certification is a process by which an entity grants formal recognition to individuals that meet predetermined, standardized criteria. The certification process involves determination of eligibility, an assessment of demonstration of competence, and requirements for regular recertification. Certification is usually voluntary and established by a non-governmental entity. HFSA’s HF-Cert is a professional certification.

Value of Certification

HF-Cert designees benefit from:

  • Increased recognition by peers and respect of colleagues in the profession
  • Improved opportunities for employability and advancement
  • Greater confidence in their professional competence
  • Increased professional trust from employers or the public
  • Increased autonomy in the workplace
  • Better compensation and career longevity

Patients/Consumers benefit from:

  • Objective, independent, third-party evaluation and assessment of professional competence
  • Commitment to public safety and/or consumer protection
  • Accountability through ethical conduct standards and/or a disciplinary process
  • Recertification requirements for continued or enhanced competence

Employers benefit from:

  • Qualified individuals for employment or advancement
  • Recertification requirements for continued or enhanced competence
  • Commitment to public safety and/or consumer protection
  • Reduced risk of errors, accidents and/or legal liability
  • Reduced employee turnover and increased job satisfaction
  • Justification for potential compensation differential

Eligibility

HFSA has developed eligibility requirements to ensure that the certification application process is fair and impartial. Membership is not a prerequisite for the HF-Cert program.

Eligibility Requirements

All individuals who seek certification must meet the established eligibility requirements in effect at the time of application.

Education

Applicants must have earned one of the following advanced degrees:

  • Nurse: A Registered Nurse plus a graduate degree (e.g. MSN, DNP, PhD)
  • Pharmacist: A Bachelor of Science in Pharmacy (BSPharm –graduated on or prior to 2005) or Doctor of Pharmacy (PharmD)
  • Physician: A Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) plus completion of a residency in family medicine or internal medicine

Licensure

Applicants must have one of the following active licenses in good standing, with no current restrictions or pending actions, in the United States:

  • Registered Nurse 
  • Pharmacist
  • Physician

Experience

Applicants must have at least three (3) years of documented experience with a minimum of 1,240 hours during the previous two (2) years with a practice focus in heart failure.

Background, Code of Ethics, and Application Accuracy Attestation

Applicants must attest to comply with the HFSA Code of Ethics and report any State Board suspensions. Any State Board suspension must be reported to HFSA within 15 days. Applicants and certificants must abide to practice heart failure specialty in a manner consist with the certification standards and responsibilities set forth in the HFSA’s Code of Ethics. Applicants must attest to the accuracy of information reported within the application.

Examination

Applicants must achieve a passing score on the HF-Cert examination.

Eligibility Rationale

Each eligibility requirement has been established to ensure that certified individuals have an acceptable level of knowledge, as evidenced by the examination and education requirements, and skill, as evidenced by the experience requirement, needed to provide heart failure services at an advanced proficiency level.

A rationale for each eligibility requirement has been established as follows:

Education

Applicants must have earned an advanced degree. The level of education required for the HF-Cert credential is consistent with the level of education required to practice as a registered nurse, pharmacist or physician.

A graduate degree for RN’s (e.g. MSN, DNP, PhD); or Bachelor of Science in Pharmacy (BSPharm –graduated on or prior to 2005) or Doctor of Pharmacy (PharmD); or Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) plus completion of a residency in family medicine or internal medicine granted by a US regionally accredited college/university or foreign equivalent is required as a basic measure of the quality of the registered nurse’s, pharmacist’s or physician’s education.

License

The requirement for a current, active registered nurse, pharmacist or physician license in good standing is consistent with the state requirements to practice as a registered nurse, pharmacist or physician in the US. Requiring that the license is full, current and unrestricted is necessary to demonstrate that the registered nurse, pharmacist or physician has no unresolved disciplinary issues as a measure to increase public protection.

Experience

The minimum three (3) years requirement is necessary to ensure applicants have adequate post-graduate experience for the advanced proficiency of the HF-Cert examination.

The 1,240-hours, during the previous two (2) years, ensures that applicants have adequate clinical work experience. All hours must be related to the four (4) domains of the HF-Cert examination content outline. The Certification Council acknowledges that accumulating 1,240 hours represents a minimum of 30% direct clinical practice in the care of patients with heart failure.

Background, Code of Ethics, and Application Accuracy Attestation

HFSA candidates and certificants have the obligation to: maintain and demonstrate high standards of integrity and professional conduct; accept responsibility for their actions; continually seek to enhance their professional capabilities; practice with fairness and honesty; and, encourage others to act in a professional manner. The requirement for adherence to the Code of Ethics provides increased awareness of expected ethical behaviors as well as increased public protection through a process that provides a reporting and investigation mechanism for Code of Ethics violations.

Examination

Applicants are required to pass the HF-Cert examination to demonstrate that their education, experience, and training have resulted in sufficient understanding of the knowledge, skills, and abilities required to provide safe and competent evidence-based heart failure services as determined by the job analysis studies and represented on the examination content outline.

Eligibility Verification

Only complete certification applications will be accepted. Incomplete applications will be returned to the applicant who may address the deficiencies and resubmit the application for review, adhering to established application deadlines. Candidates who fail the examination and wish to retake it must complete the certification application in full again (a discounted retest fee will apply). Verification of each eligibility requirement will be conducted by HFSA certification staff as follows:

Education: Physicians and pharmacists: no documentation required as verification of current, active license will also serve as verification for this criterion. RNs: Applicant will provide a copy of the diploma for the graduate degree granted by a US regionally accredited college/university or foreign equivalent.

License: Applicant will provide license number, expiration date, and state of license on the application. License will be verified with the relevant board.

Experience: To document the 1,240 hours of heart failure practice in the previous two years, applicants will complete the Experience Attestation section within the certification application. When completing the section, the applicant will attest to the experience hours claimed related to the HF-Cert examination domains. Applications will be reviewed to ensure that experience attestation section is completed to satisfy the requirement and completed properly.

Background, Code of Ethics, and application accuracy attestation:

Applicants will attest on the certification application, and the application will be reviewed by HFSA certification staff to ensure the attestation is complete.

HFSA reserves the right to verify any information provided on the certification application and/or as part of the application process.

Preparing for the Examination

How the Examination is Developed

The HFSA Certification Council and Exam Development Committee (EDC) participate in and provide oversight for the development and ongoing maintenance of the HF-Cert examination. The Council works in partnership with the testing vendor to ensure the examination is developed and maintained in a manner consistent with generally accepted psychometric principles and education testing practices for certification programs.

Job Analysis and Content Outline The job analysis study includes a survey developed by a group of subject matter experts and validated by a national survey. Results of the analysis define the content and provide the foundation for the exam. The HF-Cert job analysis study was conducted in 2019 by HFSA and the testing vendor to ensure that the certification program is current with modern practice. The purpose of this study was to describe the job activities of heart failure providers in sufficient detail in order to provide a basis for the continued development of a professional, job-related, evidence-based certification examination. 
Item Development and Form Assembly
 
Test items are writen and approved by trained and qualified practitioners under the gudance of a psychometrician. All test items undergo multiple levels of review and editing. Test items are assembled into a test form using the content outline specifications. The test form is reviewed by the Exam Development Committee before being finalized.
The Passing Score The passing point for each exam is established using a criterion-reference technique. The passing score is based on the difficulty rating for each item established by a panel of subject matter experts under the guidance of a psychometrician. A statistical analysis is performed by the psychometrician following each administration of the examination.
Ongoing Development and Maintenance Content of the examination is reviewed regularly to ensure that items remain accurate and relevant. New forms of the exam will be developed to ensure exam integrity and security. A job analysis study is typically performed every 5 years to ensure the exam specifications reflect the current scope of practice. 
Examination Content

The HF-Cert examination consists of 150 multiple-choice questions (125 scored questions and 25 non-scored, pretest questions). Pretesting is conducted to evaluate the performance of an item before being used as a scored item. Candidates will have three (3) hours to complete the computer-based examination. The exam covers the topic areas detailed in the content outline. All exam content is developed based on practice in the United States. The HF-Cert exam is offered only in English.

The HFSA’s role is in developing and administering certification examinations to determine the qualifications of candidates for certification. The HFSA does not require, provide, accredit, or endorse any specific study guides, training or review courses, or other examination preparation products. The HFSA, Council, certification staff, certification committee members, and certification subject matter experts do not have involvement in the creation, accreditation, approval, endorsement or delivery of examination review courses, preparatory materials, educational programs, or training programs/products that prepare candidates for the HF-Cert certification examination. Purchase of review materials is not a requirement for testing, nor does use of any review materials imply successful performance on the HF-Cert certification examination. 

Candidates are encouraged to review the HF-Cert content outline in preparation for the examination.

HF-Cert Exam Content Outline

HF-Cert Examination Content Domain Weight
I. Prevention 19 items
II. Assessment 42 items
III. Management 54 items
IV. Systems of Healthcare 10 items
Total 125 items

 

I. Prevention (19 items)
A. Understand risk factors and comorbidities and their contribution to heart failure (HF) (e.g. age, Chagas disease, hypertension, renal dysfunction, venous thromboembolism).
B. Educate patients regarding positive health behaviors that promote optimal clinical outcomes (e.g. compliance with medication, diet adherence, flexible diuretic regimen, self-care skills).
C. Educate patients and caregivers regarding risk of HF symptoms.
D. Enhance provider and patient communication in discharge planning and care transitions to reduce hospital readmissions among patients with heart failure.
E. Train transitioning HF patients and caregivers in self-monitoring and record keeping (e.g. blood pressure, edema, heart rate, weight gain).

 

II. Assessment (42 items)
A. Assess to determine appropriate treatment plan.
B. Evaluate risk of HF decompensation in patients with cerebrovascular and peripheral vascular disease.
C. Evaluate risk of HF decompensation in patients with acute coronary syndrome and valve disease.
D. Evaluate risk of HF decompensation in patients with elevated BP.
E. Evaluate risk of HF decompensation in patients with CAD.
D. Evaluate risk of HF decompensation in patients with atrial fibrillation.
F. Determine needs for HF treatment interventions (e.g., diagnostic tests, medications, palliative, preventive, surgical).
G. Determine differential diagnoses by prioritizing/recognizing urgent and emergent conditions.
H. Determine differential diagnoses by synthesizing and analyzing subjective/objective information.
I. Determine nutritional causes of cardiomyopathy leading to HF (e.g. sodium and fluid balance, thiamine deficiency from chronic alcoholism).
J. Determine criteria for hospital discharge of acute HF decompensation patients.
K. Determine criteria for hospital discharge of acute HF decompensation patients.
L. Evaluate candidacy for cardiac rehabilitation.
M. Evaluate candidacy for referral to advanced care center.
N. Establish final diagnoses by ordering, performing, or interpreting additional diagnostic tests.
O. Establish final diagnoses by performing or interpreting additional physical examinations.
P. Identify relevant changes in clinical status.
Q. Identify contraindicated drugs based on patient specific parameters.
R. Identify lab-based diagnostic tests for diagnosis and identification of disease stage of HF.
S. Interpret multivariable risk scores (e.g. ADHERE, Seattle).
T. Obtain comprehensive HF patient history that includes symptoms, social history, family history, past medical history, medications, allergies.
U. Review and apply the results of cardiac catheterization.
V. Review and apply the results of cardiac imaging (CT, MRI, PET).
W. Review and apply the results of cardiac stress test.
X. Review and apply the results of echocardiography.
Y. Review and apply the results of Holter monitor.
Z. Review and apply the results of laboratory test.
AA. Review and apply the results of X-ray.
BB. Perform a comprehensive physical examination.
CC. Prescribe lab-based diagnostic tests for diagnosis and identification of disease stage.
DD. Provide medication reconciliation.
EE. Review discharge follow-up for errors or discrepancies in medications.
FF. Review prescription history for adverse reactions (recognize and report).
GG. Review prescription history for allergic reactions.
HH. Review prescription history for avoidance of drug interactions and complications.

 

III. Management (54 items)
A. Advise patient and/or caregiver on guideline directed medical therapy and self-care plan.
B. Demonstrate knowledge of social determinants and barriers to implementation of appropriate HF management.
C. Assess patient eligibility for advanced therapies.
D. Assess patient eligibility for hospice care coordination.
E. Assess patient eligibility for recognition of futility in care.
D. Evaluate risk of HF decompensation in patients with atrial fibrillation.
F. Participate in shared decision-making and advanced directives.
G. Coordinate patient, caregiver, and/or surrogate to implement discharge plan.
H. Coordinate palliative care for HF patients (e.g. counseling, cultural activities, homecare, medication to reduce pain/suffering, patient education, spiritual activities).
I. Determine the effectiveness of the plan of treatment and care based on outcomes by assessing patient response(s).
J. Determine the effectiveness of the plan of treatment and care based on outcomes by collecting additional subjective and/or objective information as needed.
K. Recognize the importance of health-related quality of life (HRQOL) in patients with HF (e.g. cognitive dysfunction, chronic alcoholism, depression, symptom burden, functional status).
L. Establish a patient-centered treatment and care plan that includes considering comorbidities.
M. Establish a patient-centered treatment and care plan that includes making referrals to other health professionals and community resources.
N. Establish a patient-centered treatment and care plan that includes ordering, performing, supervising, or interpreting results of further tests.
O. Establish a patient-centered treatment and care plan that includes prescribing, ordering, or administering non-pharmacologic therapies and/or procedures.
P. Establish a patient-centered treatment and care plan that includes prescribing, ordering, or administering pharmacological therapies.
Q. Establish a patient-centered treatment and care plan that includes providing for appropriate follow-up.
R. Establish a patient-centered treatment and care plan that includes providing relevant education and/or counseling.
S. Evaluate the mechanisms of action, pharmacologic features, and dosing of existing and new agents for treating and managing HF.
T. Identify drug-drug and drug-disease interactions.
U. Recognize appropriate use criteria of specialized procedures specific to a given population(s) (e.g. endomyocardial biopsy, CPX).
V. Provide education and or counseling for HF patients (e.g. diet/fluid intake, self-management, self-monitoring, weight).
W. Utilize in-patient physical and occupational therapy for HF.

 

IV. Systems of Healthcare (10 items)
A. Demonstrate knowledge of quality, safety, performance, value measures, and ethics in HF.
B. Apply culturally sensitive methods with transitioning HF patients.
C. Comply with Core Measures and best practice standards.
D. Develop administrative roles, policies, and protocols for HF treatment and diagnosis.
E. Participate in the development of formal and informal educational programs for appropriate health care professionals.
Sample Question

All examination questions are single select, multiple-choice with four options.

1. The PRIMARY goal of therapy in patients with chronic heart failure and atrial fibrillation is

A. prevention of thromboembolism and symptom control.

B. immediate restoration of sinus rhythm.

C. to control heart rate to a minimum of 70 beats per minute.

D. to prevent worsening heart failure.

Answer: A