Advanced Heart Failure and Transplant Fellowship Program

Clinical Experience (Inpatient & Outpatient) and Proficiencies (Required for Eligibility for Secondary Subspecialty Certification in Advanced Heart Failure and Transplant Cardiology):

• Heart Failure with Dilated or Nondilated LV
• New-onset heart Failure
• Acute decompensation of chronic heart Failure
• Heart Failure in a geriatric population
• Heart Failure associated with cancer chemotherapy
• Heart Failure patients who are pregnant or recently postpartum
• Heart Failure and congenital heart disease
• Heart Failure in patient from diverse ethnic groups, with attention to specific diagnostic and therapeutic issues within these groups
• Heart Failure in men and women
• Pulmonary hypertension
• Heart Failure pre- and post-cardiac and noncardiac surgery
• Inherited forms of cardiomyopathy
• Hypertrophic cardiomyopathies
• Infiltrative and inflammatory cardiomyopathies
• Heart Failure and arrhythmias
• Heart Failure in patients with other organs transplanted
• Evaluation of patients for cardiac transplant or mechanical assist devices
• Care of patients who have undergone cardiac transplant
• Care of patients with mechanical assist devices
• Evaluation of patients for ICDs and for CRT
• Device interrogation and interpretation in patients with implanted ICD or ICD-CRT devices
• Endomyocardial biopsies

The PGY7 fellows are expected to refine management skills learned in their general cardiology fellowship:

• Manage Advanced Heart Failure patients
  1. Learn how and when to initiate inotropes

  2. Learn how and when to initiate evaluations for advanced therapies such as transplant and durable mechanical assist device

• Manage Heart Transplant patients
  1. Gain a complete understanding of immunosuppression, medication management, and rejection monitoring
  2. Be able to evaluate and treat different forms of transplant rejection
  3. Manage transplant patients in the peri-operative period
  4. Be able to perform echo-guided and fluoroscopy-guided endomyocardial biopsies proficiently by the end of their fellowship

  5. Manage patients in both the inpatient and outpatient setting

• Manage mechanical circulatory support systems

  1. Be able to manage and troubleshoot a durable mechanical device
  2. Be able to appropriately use and manage/troubleshoot a percutaneous device
  3. Manage patients both in the outpatient and inpatient setting

• Manage pulmonary hypertension patients
  1. Evaluate and treat patients from WHO groups 1-5.
  2. Become familiar with current modalities of therapy for pulmonary hypertension.
  3. Be able to initiate and follow patients with IV therapy, including complications.
  4. Understand indications for lung transplant or heart/lung transplantation.

AHF/PH = (AHF) Training in advanced stages of heart failure/complex medical management of, device therapies and consideration of heart transplantation. (PH) Training and management of pulmonary hypertension involving medical therapies, including consideration for advanced interventions.

• Week 1: IP1 = IP Transplant
• Week 2: IP2 = IP + CATH
• Week 3: OP = AHTI Clinic (AM only); PM (Research/Conference or CATH)
• Week 4: CATH
• Week 5: Pulmonary Hypertension (PH) (Clinic or Outpatient Alternating)

Inpatient (IP) Months: 1,3,5,7,9,11,13
Outpatient (OP) Months: 2,4,6,8,10, 12

Notes for Ambulatory: The fellow will rotate through this series 4.5 times (45 weeks total- 14 weeks of which are spent in outpatient clinic (31%). When Cath lab is light, the fellow will flex into the transplant clinic for a small percentage of time (approximately 5%) for a total of (36%).

1. Patient Review Committee meeting (Transplant Selection) occurs weekly.
2. Pathology Conference occurs monthly, in which the transplant cardiologist will review recent/interesting biopsies with the fellows and the pathologist.
3. Monthly didactic lectures presented by the transplant and pulmonary hypertension staff physicians that represent the core curriculum.
4. HF/T Fellow will be expected to participate at monthly Morbidity and Mortality conference.
5. Quarterly research meetings to review the progress of the fellows’ research projects and provide mentorship.
6. Monthly Heart Transplant and VAD QAPI meetings.
7. HF/T Fellow will present one Grand Rounds conference and is expected to attend quarterly cardiology grand rounds.
8. Journal Club will be offered quarterly.

It is expected that the trainee will submit at least one manuscript to a peer-reviewed journal or present an abstract or poster at a National or International Heart Failure-Transplant Cardiology meeting during their tenure of fellowship. The fellows are mentored in analyzing data and results of clinical trials or other published materials. Similarly, the fellows are expected to use these skills under the direct supervision of a staff attending in the preparation of materials for publications and oral presentations.