Education & Training

Program Overview

Advanced Heart Failure and Transplant Cardiology (AHFTC) fellows will have extensive exposure to the entire spectrum of patients with heart failure, from ambulatory (Stage B-C HF) to end-stage heart failure (Stage D HF). Fellows will acquire an understanding of the clinical presentation and pathophysiology as well as diagnostic and treatment strategies of patients with heart failure. They will care for patients with newly diagnosed cardiomyopathy and learn to formulate a differential clinical and diagnostic strategy. They will also follow patients with chronic heart failure in the outpatient setting where they will learn evidence-based pharmacological therapy and decide when to refer patients for CRT and ICD therapies. Fellows will care for patients in the inpatient hospital setting when they present with acutely decompensated heart failure, and require further care which could include inotropic therapy, intravenous diuretics, vasodilators and ultrafiltration, in addition to deciding when invasive hemodynamic monitoring with a Swan-Ganz catheter is warranted. Fellows will learn how to interpret Swan-Ganz catheter derived hemodynamic tracings. Fellows will rotate in the pulmonary hypertension clinic, under supervision of a pulmonary hypertension specialist, to acquire the knowledge required to treat these patients. They will gain proficiency in managing patients with advanced heart failure (Stage D HF), and an understanding of the criteria used to select patients for temporary or permanent mechanical circulatory support (MCS) devices. Fellows will also learn how to manage long term post-implantation complications of MCS. In addition, they will be involved in the cardiac transplantation evaluation and will become familiar with immunosuppression and rejection therapies used post-cardiac transplantation. Fellows will be a vital member of the multidisciplinary team involved in providing compassionate palliative and end-of-life care for those unfortunate patients who exhaust the currently available pharmacologic and device strategies.

Setting

University Hospitals Health System is an integrated, not-for-profit, academic health system, and a major affiliate hospital of Case Western Reserve University School of Medicine. Fellows spend the majority of their time at University Hospitals Cleveland Medical Center, the System’s flagship quaternary academic medical center. AHFTC fellowship rotations include an advanced heart failure ICU-based rotation, an LVAD/transplant rotation, a cardiogenic shock rotation, and an elective rotation where a variety of consultative, ambulatory based-care, and research activities can be pursued. Fellows will have extensive exposure to catheterization laboratory procedures including advanced heart failure hemodynamic studies and endomyocardial biopsies.

Formal teaching

The AHFTC fellowship offers a comprehensive curriculum of AHFTC lectures that are given by both internal and invited expert faculty. Additionally, fellows have access to a variety of lectures and seminars offered throughout University Hospitals and Case Western Reserve University.

Fellows participate actively in the weekly Advanced Heart Failure Therapeutics Committee, where all candidates for advanced therapies including transplantation and mechanical support are presented and discussed.

Research opportunities

University Hospitals and Case Western Reserve University are recognized among the premier academic and research institutions in the United States. A variety of research opportunities exist, with access to faculty mentors. Prior fellows have completed projects using existing institutional databases, quality improvement initiatives, large national databases, NIH-funded studies, and industry-sponsored trials. Case Western Reserve University offers formal epidemiology, biostatistics, and research methods courses.