Heart Failure Fellowship

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Faculty

Our outstanding faculty members are among the nation’s leaders in bringing the latest advances in heart failure into clinical practice. All are on the academic staff of Tufts University School of Medicine

David DeNofrio, MD

Marvin A. Konstam, MD

Rajan Krishnamani, MD, MRCP (UK)

Ayan R. Patel, MD

James E. Udelson, MD 

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Goals

Inpatient Experience

To become proficient in the evaluation and management of patients with heart failure in the acute, hospital setting:

• Become familiar with the differential diagnosis of dilated cardiomyopathy and the means by which a diagnosis is established, if necessary; this includes a working knowledge of indications for endomyocardial biopsy.
• Learn the various therapeutics in the acute setting including the use of oral medications such as diuretics, ACE-inhibitors, beta-blockers, digoxin, nitrates, and other vasodilators. In addition, fellows should understand the use of, and indications for intravenous inotropic therapy including dobutamine, nesiritide, dopamine, and milrinone.
• Gain and understand the indications for mechanical support in heart failure patients such as intra-aortic balloon counterpulsation and ventricular assist device therapy.
• Become familiar with the appropriate work up and management of patients with heart failure and coronary artery disease who may benefit from surgical revascularization and / or mechanical assist.
• Gain a working knowledge of the risks and benefits of cardiac transplantation, including the appropriate pre-transplant evaluation. Fellows should also learn the absolute and relative contraindications to cardiac transplantation.
• Participate in the care of patients immediately post-transplant, including the use of complex hemodynamic monitoring, inotropic and mechanical device support when needed.
• Become familiar with the use and actions of immunosuppressive drugs in the cardiac transplant recipient including cyclosporin, FK506 (Tacrolimus), azothioprine, celcept, and prednisone.
• Develop a working knowledge of the treatment of both acute and chronic allograft rejection.
• Understand the diagnosis and management of other post-transplant complications including bacterial, viral, and fungal infections, malignancy, and late graft vasculopathy.
• Gain extensive experience in the selection of patients for and the management of patients with mechanical circulatory assist devices
• Develop extensive experience in the performance of endomyocardial biopsy

Outpatient Experience

• Fellows attend weekly heart failure clinics. During this continuity experience, they participate in the care of patients who are both established in the clinic as well as those newly referred. These clinics are aimed at caring for patients with chronic heart failure, those being considered for cardiac transplantation, and those following cardiac transplantation.
• Become proficient in the outpatient evaluation of patients with heart failure including the physical exam, differential diagnosis of their particular condition (systolic vs. diastolic dysfunction), and appropriate pharmacologic therapy.
• Understand the appropriate counseling and emotional support of these often chronically ill patients including maximizing the patient’s own participation in his or her care (i.e., dietary and medical compliance, self monitoring etc.).
• Understand predictive variables which portend a bad prognosis for the purpose of timing of cardiac transplantation.
• Participate in the outpatient evaluation and counseling of those patients referred for cardiac transplantation. The fellow should understand factors that make a patient suitable or unsuitable for cardiac transplantation. Fellows will attend biweekly meetings of a multidisciplinary transplant team, during which new patients are presented and discussed. In addition, the status of all inpatients (either pre or post-transplantation) is discussed.
• Participate in the outpatient care of patients in the pre-transplant phase while on the cardiac transplant list.
• Care for the patient in the outpatient setting following cardiac transplantation. This includes managing and adjusting the immunosuppressive regimen depending on the results of periodic endomyocardial biopsies. The heart failure/transplant service holds weekly meetings to review hemodynamic, biopsy, and other clinical data pertaining to individual patients. During these meetings, fellows will present and evaluate data and formulate treatment plans for patients.
• Develop a working knowledge of the outpatient care of transplant patients suffering from various complications of immunosuppressive therapy that include cyclosporine-induced hypertension and renal dysfunction, prednisone-induced diabetes, etc. Fellows will also learn the appropriate diagnosis and management of infectious complications in non-acutely ill patients in the outpatient setting.
• Fellows will attend monthly meetings of the New England Consortium of Cardiac Transplantation attended by transplant cardiologists, surgeons, and nurses from New England hospitals performing cardiac transplants.

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