The Division of Cardiology at Tufts Medical Center offers advanced fellowship training in Heart Failure and Cardiac Transplantation for board-eligible/certified cardiovascular specialists. The fellowship year consists of inpatient and outpatient care for patients with advanced heart failure, as well as clinical research. Fellows will be exposed to pre- and post-transplant issues, mechanical ventricular assist devices, endomyocardial biopsies, novel drug therapies and innovative patient care. This fellowship program is accredited by the Accreditation Council for Graduate Medical Education (ACGME).
The Heart Failure and Cardiac Transplantation Service at Tufts Medical Center consists of five staff cardiologists and several nurses dedicated to the care of these medically complex patients in a tertiary, referral-based setting. In recent years, Tufts Medical Center has become one of the highest volume transplant centers in New England, accompanied by a substantial growth in the number of mechanical assist devices. Our Cardiomyopathy Center, a 14-bed intermediate care unit, is dedicated to highly specialized nursing care for advanced heart failure, heart transplant and ventricular assist device patients. A regional referral network also allows for collaboration among local heart failure specialists.
Upon completion of the Advanced Heart Failure and Transplant Cardiology Fellowship, each of our fellows will be proficient in the evaluation and management of patients with heart failure in both an inpatient and outpatient setting.
Throughout their time in our program, the fellows are given increasing responsibility for patient care and procedures. The program provides supervised procedural experience so that our fellows can gain the expertise required of a heart failure and cardiac transplantation specialist.
During the inpatient experience, each fellow will:
- 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
- Understand the use of, and indications for intravenous inotropic and vasodilator 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 ventricular assist devices
- Gain a working knowledge of the risks and benefits of cardiac transplantation, including the appropriate pre-transplant evaluation and 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 cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil, sirolimus 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 and management of patients with mechanical circulatory assist devices
- Develop extensive experience in the performance of endomyocardial biopsy
Fellows attend weekly heart failure clinics where 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, those following cardiac transplantation and those following left ventricular assist devices. During their outpatient experience, fellows will:
- 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 indicate a bad prognosis in timing of a 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
- Care for patients following cardiac transplantation, including 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, including cyclosporine-induced hypertension and renal dysfunction and prednisone-induced diabetes. Fellows will also learn the appropriate diagnosis and management of infectious complications in non-acutely ill patients in the outpatient setting.
- Attend monthly meetings of the New England Consortium of Cardiac Transplantation which is made up of transplant cardiologists, surgeons and nurses from New England hospitals performing cardiac transplants
Fellows are encouraged to become involved in clinical research during their advanced heart failure training. They will be exposed to a wide range of research opportunities, including basic science, translational and clinical research. Most fellows also become involved in ongoing heart failure clinical trials.
The Molecular Cardiology Research Institute and the Division of Cardiology offer a variety of research areas related to heart failure and ventricular function. Fellows will work closely with mentors from these groups to design a curriculum and research program that is both educational and productive.
A full range of inpatient, outpatient, clinical and research laboratory facilities are available to the cardiology fellows at the Medical Center. Fellows work with the highest quality, latest technology equipment. In addition, a complete medical library is available at Tufts University School of Medicine.
Fellows have a centrally-located, dedicated, quiet workspace (Shapur Naimi Fellowship Room) equipped with desks, computers and a lounge area. Fellows also have access to cardiology conference space, including the Modestino Criscitiello Library and the Herbert J. Levine Conference Room. These fellow spaces are named for three superb cardiologists who helped establish cardiology at Tufts MC.
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
Michael S. Kiernan, MD
Marvin A. Konstam, MD
Ayan R. Patel, MD
James E. Udelson, MD
Prospective fellows are encouraged to apply provided they have completed the necessary training to become ABIM board-eligible in cardiovascular medicine.
Interested applicants are encouraged to apply in the fall, no later than November 1. Please send a curriculum vitae to the address below.
Applicants will also be required to have three reference letters sent. A thorough review is undertaken of each application and a select number of applicants are invited for an interview to meet with staff and to tour the facilities.
David DeNofrio, MD
Medical Director, Heart Failure and Cardiac Transplantation Program
Division of Cardiology
Tufts Medical Center
800 Washington Street, Box 5931
Boston, MA 02111
Tel: 617-636-8068; Fax: 617-636-5913