Leadership in Healthcare Transformation
Hypertrophic cardiomyopathies, including cardiac amyloidosis, represent the next frontier in cardiology. With new treatments now available unlike in the past early detection is more critical than ever. Yet symptoms are often subtle or nonspecific, making diagnosis challenging. I think Cardiologists must take on a leadership role, coordinating multidisciplinary teams and establishing hospital-wide screening protocols to ensure timely diagnosis and intervention, ultimately transforming outcomes for patients with these complex conditions.
1. You mentioned that hypertrophic cardiomyopathies and cardiac amyloidosis represent the next frontier in cardiology. Could you elaborate on what makes these conditions particularly critical for future focus ?
In recent years, we have come to understand that hypertrophic cardiomyopathies and especially cardiac amyloidosis are not as rare as previously believed.
Advances in diagnostic modalities—ranging from cardiac MRI to advanced echocardiography with strain imaging, bone scintigraphy, genetic testing, etc — have enabled us to identify an increasing number of patients. These diseases are critical areas of focus because, when diagnosed early, we now have both pharmacological and interventional treatments that can significantly alter prognosis. In the past, late diagnosis left patients with few therapeutic options.
2. Historically, treatment options for cardiac amyloidosis were limited. What recent advancements have changed the landscape of care for this condition, and how have they impacted patient outcomes?
Cardiac amyloidosis, particularly transthyretin amyloidosis, has shifted from an inexorably progressive disease to one for which we now have targeted therapies—such as tafamidis—that can stabilise or slow progression. Earlier detection has allowed us to intervene before irreversible myocardial damage occurs. Clinical outcomes are improving in terms of survival and quality of life, with more patients maintaining good functional capacity for years after diagnosis.
3. Given the subtle and often nonspecific symptoms, what are the most common diagnostic pitfalls that clinicians face with hypertrophic cardiomyopathies today?
The primary challenge lies in the overlap of symptoms with more common conditions such as hypertension or ischemic heart disease. Common pitfalls include overlooking specific echocardiographic markers, recognising the extracardiac symptoms, and failing to implement family screening. Many patients with unexplained ventricular hypertrophy were historically labeled in a nonspecific manner, when in fact they were affected by specific forms of hypertrophic cardiomyopathy.
4. In your view, what should be the defining role of a cardiologist when it comes to leading multidisciplinary teams in complex cardiac cases ?
The cardiologist must act as the clinical director, integrating expertise from genetics, imaging, internal medicine, and for example, in the case of amyloidosis, hematology and neurology. This role is not purely technical—it is also one of leadership: guiding discussions, setting diagnostic and therapeutic priorities, and keeping the team unified around a common goal.
5. You stress the need for hospital-wide screening protocols. What key elements should such protocols include to be effective and sustainable ?
An effective protocol must include clear clinical suspicion criteria, streamlined access to second-line diagnostics, ongoing staff training, and a feedback system for diagnosed cases. Sustainability depends on embedding the pathway into standard clinical workflows, avoiding the perception of it as an “extra” initiative.
6. Can you share how your department at Victor Jousselin Hospital Center has approached implementing or piloting such screening system ? Any success stories or challenges ?
Initially, within our Cardiology Department, we implemented a comprehensive, department-wide screening protocol for all forms of left ventricular hypertrophy (LVH), including mild presentations, in patients with heart failure and preserved ejection fraction (HFpEF). This first phase yielded encouraging results, enabling earlier detection.
Building on these outcomes, we expanded our inclusion criteria to patients with arrhythmias or valvular heart disease, especially individuals younger than the mean age for this type of disease.
The next step, which we are now preparing to implement, involves the development of risk scores in the form of structured questionnaires capturing extracardiac manifestations of amyloidosis. These will be distributed across other hospital departments to facilitate screening of patients who have not yet developed overt cardiac symptoms. Patients whose scores exceed a predefined threshold will be referred to cardiology for further diagnostic work-up. This approach aims to enable the earliest possible diagnosis and initiation of treatment for this condition, maximising the window for effective intervention.
One initial challenge was securing full engagement from all departments, but the discovery of “hidden” cases persuaded even the most sceptical colleagues.
7. What kind of leadership mindset is required to drive early detection initiatives in a traditionally reactive healthcare environment ?
A proactive, prevention-oriented mindset is essential—one that communicates the “earlier is better” philosophy to the entire team. Leaders must be able to overcome institutional inertia by demonstrating, with concrete data, that investing in early diagnosis reduces both costs and patient suffering in the long term.
8. How do you align and engage non-cardiology departments, such as internal medicine, radiology, or primary care, around the urgency of detecting cardiac amyloidosis?
Through targeted training and the sharing of real clinical cases. Showing colleagues from other specialities how subtle findings in their observations can change a diagnosis is highly effective. Sharing success stories—patients who received life-saving therapies thanks to their input—helps foster a sense of ownership in the project.
9. Multidisciplinary collaboration often faces institutional or cultural barriers. What strategies have you found effective in overcoming resistance and fostering seamless team integration ?
The key is building mutual trust and respect for each discipline’s expertise. Starting with low-risk pilot projects that clearly demonstrate the added value of collaboration helps reduce resistance. Regular, structured communication—short but frequent meetings—is also essential.
10. From a health systems perspective, how can leadership accelerate the transformation from episodic to anticipatory cardiac care ?
By implementing early-warning systems based on clinical and imaging parameters, and by incentivising rapid diagnostic pathways. The shift to anticipatory medicine requires that organisational decisions be evidence-driven, with measurable objectives and shared accountability.
11. How do you balance the need for precision diagnostics with resource constraints in smaller or regional hospitals ?
Through a tiered strategy: initial screening with more accessible methods, followed by selective referral to specialised centres for advanced testing. This “hub-and-spoke” model ensures diagnostic precision without overburdening local resources.
12. Cardiology is evolving rapidly with AI and digital tools. What role do you foresee these technologies playing in future diagnostic or care pathways for hypertrophic cardiomyopathies ?
AI will be able to analyze large datasets of images and tracings to detect early patterns invisible to the human eye, suggest probable diagnoses, and stratify risk in a personalized way. When integrated into hospital systems, AI can support faster and more accurate clinical decision-making.
13. In your leadership journey, what has been the most significant shift in how cardiologists contribute to broader hospital transformation strategies ?
The transition from being organ-specific specialists to leaders of complex care processes. Today’s cardiologist must help shape hospital strategies, bringing a long-term vision grounded in prevention, technology, and interdisciplinary integration.
14. Finally, what advice would you give to emerging cardiologists aiming to lead healthcare transformation in complex disease areas like cardiac amyloidosis ?
Invest in continuous learning, cultivate strong leadership and communication skills, and don’t be afraid to challenge the status quo. True transformation arises from combining clinical expertise with the ability to positively influence the organisation in which you work.
