Curriculum for Advanced Training in Heart Failure ...

Curriculum for Advanced Training in Heart Failure, Transplantation, Mechanical Circulatory Support

Devices and Pulmonary Artery Hypertension Fellowship Program

Educational Goals of the Advanced Heart Failure and Transplant Fellowship

The educational mission of the Advanced Heart Failure and Transplant Cardiology fellowship program is to train

individuals who will practice the highest standards of advance heart failure management. The main objective is to

provide an academically and clinically rigorous training program to give the trainee outstanding skills in advanced

heart failure treatment, managing pre & post-cardiac transplant patients and cardiovascular research. The aim of

the program is to provide the trainee with basic and clinical knowledge, procedural skills, clinical judgment,

professionalism and interpersonal skills required as an advanced heart failure and heart transplant specialist. This

training will prepare our fellow(s) to function not only as highly competent cardiologist and advanced heart failure

specialists, but also as an accomplished clinical investigator in the field of cardiovascular and heart failure research.

Program Duration and Requirements

The fellowship program includes one trainee per year for a minimum of one-year period. The goals of the program

also specifically include achieving high quality training in each of the areas as outlined in the Practice Guidelines for

Evaluation and Management of Chronic Heart Failure in the Adult published by the ACC and AHA. The trainee

(fellow) should be board eligible or board certified in internal medicine and board eligible or board certified in

cardiovascular diseases; having successfully completed post-graduate training from an accredited residency and

fellowship program.

Clinical Experience Overview

Following are the few basic patient characteristics which the advanced heart failure and transplant medicine fellow

will encounter during the training:

1) Patients admitted with a diagnosis of advanced heart failure (as primary or secondary diagnosis).

2) Patients admitted to the hospital or in-hospital patients admitted for any reasons with clinical signs of

advanced heart failure.

3) Patients enrolled in the advanced heart failure clinics, admitted with advanced heart failure or any other

diagnosis in addition to advanced heart failure, for which in-patient cardiology consultation is requested by

the primary team.

4) Patients admitted to the general cardiology in-patient service for whom specialized heart failure

management or transplant evaluation is requested.

5) Patients admitted to non-cardiology services for whom in-patient cardiology consultation is requested for

the primary diagnosis of heart failure and/or cardiomyopathy.

6) Patients admitted or referred for cardiac transplant evaluation.

7) Patients actively listed for cardiac transplantation, admitted with a primary cardiovascular or non-

cardiovascular diagnosis.

8) Patient’s status post cardiac transplantation, admitted for post-transplant management.

9) Patients status post-cardiac transplant, followed as an out-patient in the heart failure and transplant clinics.

10) Patients referred for evaluation for mechanical assist device placement.

Ambulatory Experience

The goals of the ambulatory experience are to provide exposure to out-patient cardiology practice, including both

consultative and continuity experiences, and to provide a means for clinical follow-up of patients recently

discharged from the hospital. The out-patient experience is comprised of the Advanced Heart Failure, Transplant &

Mechanical Assist Device Clinic. The fellow’s responsibility will be to participate in scheduled clinics and to assist in

managing patients.

The patient population in the clinics provides a diverse experience in terms of gender, socioeconomic status and

reason for referral. The spectrum of cases seen in these clinics also varies from routine management of common

cardiology problems to management of patients with advanced heart failure. Furthermore, evaluation of eligibility

for a cardiac transplantation and mechanical assist device implantation procedures, including pre & post-operative

assessments, requirement for bi-ventricular pacing and defibrillators implantation, follow-up of recently discharged

patients, and referrals for complex cardiology problems dealing with the failing heart are common in these clinics.

In-patient Experience

The in-patient Advance Heart Failure and Transplant Cardiology service will comprise of the heart failure/transplant

attending, the advance heart failure and general cardiology fellow, physician assistants and nurse practitioners, and

residents and medical students rotating through the service. The fellow will be caring for critically ill patients,

educating and supporting patients and families, and interacting with a wide variety of medical experts in the fields

of surgery, nursing, social work, biomedical engineering, and clinical research. This is a collaborative model in which

essential elements of patient care are suggested and implemented by experts in their respective fields and

integrated by the attending house staff and faculty.

The goals for in-patient advance heart failure & transplant service are as follows:

1. Stabilization of the patient’s acute situation

2. Appropriate assessment of the patient’s overall medical conditions and specific assessment of their cardiovascular

condition

3. Delineation of a chronic care plan

4. Initiation of chronic care plan

5. Patient education in self-care and assessment

6. Communication with the referring physician

Specialized Procedural Training Experience

The goal of specializing in Cardiac Catheterizations is beyond the scope of this limited, but specialized training

program. However, the fellow will be required to understand the appropriateness of procedure and indications for

right4 and left heart catheterizations, right ventricular endocardial biopsy5, and be able to estimate the risk and

benefits of the procedure performed for diagnostic reasons. As it is essential to understand hemodynamics in

evaluation and management of heart failure patients, the trainee will have to develop a high level of competence in

the interpretation of hemodynamic data collected by right heart cardiac catheterizations. Furthermore, the fellow

will need to be familiarized with the use of Intra-aortic balloon counter pulsation and all mechanical assist devices.

The fellow will acquire sufficient exposure to the indications, performance and management of complications

related to the above-mentioned procedures/devices. Fellows are expected to keep complete and accurate logs of

their procedures during their training.

Research Experience

Advanced Heart Failure and Transplant trainees take an active role in both clinical and basic science research. Our

program requires completion of either original research or substantial scholarly work related to heart failure,

transplant or mechanical support devices, as a requirement for completing the fellowship training. Guidance in

planning research directions with the trainee is provided by the cardiology faculty, and research is supervised

directly by the individual mentor. While it is not expected that every fellow’s project will result in publishable work, it

is expected that every fellow conduct and original research project with the guidance of appropriate faculty

members. Furthermore, the fellow will continue to work on various multi-central trials or local ongoing projects as

assigned by the heart failure faculty throughout the year. Fellow will be given allotted research discovery/work time

at the discretion of project(s) need and program director.

The ACGME Core Competencies and Competency Components and Curricular Milestones for Level III

Training in Advanced Heart Failure and Transplant Cardiology

1) Patient Care: Residents are expected to provide patient care that is compassionate, appropriate and effective

for the promotion of health, prevention of illness, treatment of disease and care at the end of life.

• Gather accurate, essential information from all sources, including medical interviews, physical examination,

records, and diagnostic/therapeutic procedures.

• Make informed recommendations about preventive, diagnostic, and therapeutic options and interventions that

are based on clinical judgment, scientific evidence, and patient preferences.

• Develop, negotiate and implement patient management plans.

• Perform competently the diagnostic and therapeutic procedures considered essential to the practice of

Cardiovascular Disease.

2) Medical Knowledge: Residents are expected to demonstrate knowledge of established and evolving

biomedical, clinical and social sciences, and demonstrate the application of their knowledge to patient care and

education of others.

• Apply an open-minded and analytical approach to acquiring new knowledge.

• Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of

Cardiovascular Disease.

• Apply this knowledge in developing critical thinking, clinical and technical problem solving, and clinical

decision-making skills.

• Access and critically evaluate current medical information and scientific evidence and modify knowledge base

accordingly.

3) Practice-Based Learning and Improvement: Residents are expected to be able to use scientific methods and

evidence to investigate, evaluate, and improve their patient care practices.

• Identify areas for improvement and implement strategies to improve knowledge, skills, attitudes, and processes

of care.

• Analyze and evaluate practice experiences and implement strategies to continually improve the quality of the

practice of Cardiovascular Disease.

• Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of

care.

• Use information technology or other available methodologies to access and manage information and support

patient care decisions and personal education.

4) Interpersonal Skills and Communication: Residents are expected to demonstrate interpersonal and

communication skills that enable them to establish and maintain professional relationships with patients, families,

and other members of health care teams.

• Provide effective and professional specialist consultation to other physicians and health care professionals and

sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues.

• Use effective listening, nonverbal, questioning, and narrative skills to communicate with patients and families.

• Interact with consultants in a respectful and appropriate fashion.

• Maintain comprehensive, timely, and legible medical records.

5) Professionalism: Residents are expected to demonstrate behaviors that reflect a commitment to continuous

professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude

toward their patients, their profession, and society.

• Demonstrate respect, compassion, integrity, and altruism in their relationships with patients, families, and

colleagues.

• Demonstrate sensitivity and responsiveness to patients and colleagues, including gender, age, culture, religion,

sexual preference, socioeconomic status, beliefs, behaviors and disabilities.

• Adhere to principles of confidentiality, scientific/academic integrity, and informed consent.

• Recognize and identify deficiencies in peer performance.

• Develop a clear understanding of the complex and challenging relationships in Cardiovascular Disease between

clinician/providers, hospitals and industry; understand the inherent conflicts of interest in many relationships

with industry and its representatives and develop strategies to ensure clear boundaries that are designed to

uncompromisingly prioritize high quality patient care.

6) Systems-Based Practice: Residents are expected to demonstrate an understanding of the contexts and systems

in which health care is provided and demonstrate the ability to apply this knowledge to improve and optimize

health care.

• Understand, access, and utilize the resources and providers necessary to provide optimal care.

• Understand the limitations and opportunities inherent in various practice types and delivery systems, and

develop strategies to optimize care for the individual patient.

• Given the high costs of many treatments, residents are expected to apply evidence-based, cost-conscious

strategies to prevention, diagnosis, and treatment selection in Cardiovascular Disease.

• Collaborate with other members of the health care team to assist patients in dealing effectively with complex

systems and to improve systematic processes of care.

Principal Teaching/Learning Activities

The following activities within the fellowship program provide learning and teaching opportunities for the trainee in

Advanced Heart Failure and Transplant Cardiology.

Direct Patient Care

The collaborative relationship between attending physician and trainee in the delivery of patient care is at the core

of this Program; the provision of high-quality patient care is the fundamental vehicle for teaching and learning of all

the required competencies. In the development of educational objectives direct patient care is broadly and

somewhat arbitrarily divided into those three loci of care where the particular skills required of the successful sub-

specialist in Advanced Heart Failure and Transplant Cardiology differ:

• Out-Patient Advanced HF, Transplant and MCSD Clinic (DPC-OP*)

• In-Patient Advanced HF & Transplant Service (DPC-H*)

• Cardiac Catheterization Laboratory (DPC-CATHL*)

Conferences

Teaching conferences are convened at the institutional, departmental and section level and all contribute to the

educational experience of the trainee.

• Advanced Heart Failure Education Seminar Series held every Tuesday from noon to 1pm. Attendance is

mandatory.

• Every Thursday afternoon at 3:00pm, we hold our Transplant and MCSD patient conference in concert with

the transplant staff and cardiovascular surgeons. Cases are presented for discussion and agreement

amount diagnostic and therapeutic options. Attendance is mandatory.

• Every Thursday at 2:00PM, we have inpatient rounds where the cardiology attending’s and support staff

discuss all in-patients and their plan of care which transpired over the past week/weekend. Attendance is

mandatory.

Competency Components and Curricular Milestones for Level III Training in Advanced Heart Failure and

Transplant Cardiology COCATS 4 Task Force 12: Training in Heart Failure

MEDICAL KNOWLEDGE

Heart Failure

1. Know the principles of excitation-contraction coupling and the contractile apparatus of the cardiomyocyte.

2. Know the pathophysiology of heart failure, including such concepts as ventricular remodeling, neurohormonal

activation, fetal gene expression, wall stress, signaling pathways (calcium, beta-adrenergic signaling, and nitric oxide),

myocardial energetics, electrical and mechanical dyssynchrony, and the role of the extracellular matrix.

3. Know common genetic underpinnings of both dilated and hypertrophic cardiomyopathy, their clinical phenotypes, and

the role of genetic testing for patients and their families.

4. Know important hemodynamic principles related to heart failure, including normal cardiac physiology,

contractility, preload, afterload, and interpretation of pressure-volume loops and ventricular performance (Frank-

Starling) curves.

5. Know the epidemiology and risk determinants of left ventricular dysfunction, ventricular hypertrophy, and heart failure

(both with reduced and preserved ejection fraction), including incidence and prevalence overall and in special

populations.

6. Know classification methods of heart failure including American College of Cardiology/American Heart Association

stages, New York Heart Association classes, and INTERMACS (Interagency Registry for Mechanically Assisted Circulatory

Support) profiles.

7. Know the risk factors, methods, and risk scores commonly used to stratify patients with heart failure, including their

limitations, and how these methods are used to evaluate the need for advanced therapies.

8. Know the epidemiology and pathophysiology of acute systolic or diastolic heart failure, including new-onset and acute-

on-chronic heart failure.

9. Know typical and atypical clinical presentations of patients with advanced heart failure (e.g., cachexia, worsening renal

function, cognitive impairment, medication intolerance, ventricular tachycardia) and their management.

10. Know the risks of arterial and venous thromboembolic complications in patients with heart failure.

11. Know the pathophysiology, clinical presentation, and differential diagnosis of heart failure with preserved ejection

fraction and its management.

12. Know the pathophysiology, clinical presentation, and methods of risk stratification of patients with hypertrophic

cardiomyopathy and its management.

13. Know the distinguishing features of and appropriate diagnostic studies for specific etiologies of heart failure, including

coronary artery disease, valvular heart disease, hypertension, myocarditis, infiltrative processes, toxins (e.g., illicit drugs),

chemotherapy, pregnancy, congenital heart disease, radiation, pericardial processes, endocrinopathies, high-output

states, stress cardiomyopathy, and inherited syndromes.

14. Know the indications for percutaneous and surgical intervention for valvular heart disease in patients with heart failure.

15. Know the evidence base, including randomized clinical trial data, supporting contemporary guideline-directed heart

failure therapy.

16. Know the pharmacology of common inotropes and vasopressors used in the management of low-output heart failure

and shock.

17. Know key principles regarding transitions of care between the outpatient and inpatient setting, and vice versa, including

indications for hospitalization and readiness for discharge for patients with heart failure.

18. Know the role of assays for natriuretic peptide and other biomarkers in the management of patients with heart failure.

19. Know the utility of noninvasive imaging (e.g., echocardiography, nuclear cardiology, cardiac magnetic resonance

imaging, and positron emission tomography) in assessment of patients with cardiomyopathy (including those related to

valvular heart disease) and heart failure.

20. Know the strengths and limitations of common quality-of-life tools (e.g., Minnesota Living with Heart Failure and

Kansas City Cardiomyopathy Questionnaire) used in patients with heart failure.

21. Know which lifestyle choices and comorbidities (e.g., obstructive sleep apnea, depression, anemia, diabetes,

hypertension, renal failure) contribute to the development of or clinical instability of patients with heart failure, as well

as potential management options for such comorbid conditions.

22. Know the roles of submaximal (including 6-minute walk) and maximal exercise testing, and cardiopulmonary stress

testing in patients with heart failure.

23. Know the roles of implantable cardiac electronic device therapy in patients with heart failure, including cardioverter-

defibrillators, pacemakers, and resynchronization devices.

24. Know the roles of coronary imaging, ischemia testing, viability testing, and revascularization in patients with heart

failure.

25. Know the role of invasive hemodynamic assessment in patients with decompensated heart failure.

26. Know the epidemiology and pathophysiology of the cardiorenal syndrome and its management.

27. Know the pathophysiology of cardiac dysfunction associated with cirrhosis and the hemodynamic consequences of

portal hypertension.

28. Know the role of implantable technology to allow monitoring of patients with heart failure, including from afar

(i.e., remote monitoring).

29. Know the definition of frailty, tools available for assessment of frailty, and how frailty influences diagnosis, prognosis,

and candidacy for advanced therapies in patients with heart failure.

30. Know the roles of palliative and hospice care in patients with heart failure and the steps needed to implement them.

31. Know the role of endomyocardial biopsy in the evaluation of myocarditis and infiltrative cardiomyopathies.

32. Know the various chemotherapy agents associated with heart failure and the management of cardiac complications

of chemotherapy.

33. Know the potential contribution of arrhythmias to development of heart failure and/or decompensation and

appropriate pharmacological and ablation options for therapy.

34. Know the roles of exercise training and cardiac rehabilitation in patients with heart failure with or without pulmonary

hypertension, cardiac transplantation, or mechanical circulatory support.

Pulmonary Hypertension

35. Know the World Heart Organization classification and etiologies of pulmonary hypertension.

36. Know the epidemiology, risk factors, prognostic factors, and natural history of pulmonary hypertension.

37. Know the functional classes and appropriate treatment of patients with each type of pulmonary hypertension.

38. Know the role of invasive hemodynamic assessment, including when to perform vasoreactivity testing to assess and

manage patients with pulmonary hypertension, including pre- and post-capillary components.

39. Know the classes of medications available to treat pulmonary hypertension and their use alone and in combination,

including management of side effects.

40. Know the roles of exercise and cardiopulmonary testing to assess and manage patients with pulmonary hypertension.

41. Know the indications for referral to a specialized pulmonary hypertension center.

42. Know the roles of balloon atrial septostomy, thromboendarterectomy, and lung transplantation in patients with

pulmonary arterial hypertension.

Mechanical Circulatory Support

43. Know indications for and contraindications to both temporary and durable mechanical circulatory support for bridging

and destination therapy.

44. Know the expected survival following use of durable mechanical circulatory support.

45. Know clinical determinants favoring mechanical circulatory support versus transplantation as durable strategies.

46. Know optimal anticoagulation strategies for patients with ventricular assist devices.

47. Know the management principles for patients with cardiogenic shock, including selection of temporary mechanical

circulatory support.

48. Know the management principles and potential complications of extracorporeal membrane oxygenation.

49. Know the anatomic, surgical, and comorbid conditions that may impact mechanical circulatory support strategies in

adult patients with congenital heart disease.

50. Know intraoperative and early postoperative complications of durable mechanical circulatory support.

51. Know the risk factors for and presentations and management of common complications of durable ventricular assist

devices, including right heart failure, stroke, driveline infections, device thrombosis, hemolysis, gastrointestinal bleeding,

and aortic insufficiency.

52. Know the risk scores that predict right heart failure in patients with left ventricular assist devices.

Cardiac Transplantation

53. Know the indications for and contraindications to heart transplantation.

54. Know when patients listed for heart transplant need mechanical circulatory support, and the potential benefits and

complications of this type of therapy.

55. Know current United Network for Organ Sharing allocation listing policies for heart transplantation.

56. Know the expected short- and long-term survival rates following heart transplantation.

57. Know the role of multiorgan (e.g., heart-lung, heart-kidney, heart-liver) transplantation.

58. Know the principles of immunology that pertain to heart transplantation, including sensitization and histocompatibility.

59. Know and understand the efficacy, risks, and limitations of currently available methods for desensitization of patients

awaiting heart transplantation.

60. Know the preoperative considerations applicable to potential heart transplant recipients.

61. Know the anatomic, surgical, and comorbid conditions that may impact transplant surgery planning and outcomes in

adult patients with congenital heart disease, necessitating evaluation at a transplant center with expertise in these

conditions.*

62. Know the intraoperative and early postoperative complications of heart transplantation and their management.

63. Know the process by which the heart procurement team interacts with teams procuring other organs from donors

64. Know the factors used to assess the suitability of a potential donor heart.

65. Know the mechanisms of action, side effects, and potential drug–drug interactions of immunosuppressant drugs.

66. Know how cardiac denervation impacts cardiac physiology, including response to exercise and pharmacological agents,

and clinical manifestations of myocardial ischemia.

67. Know the risk factors for, clinical presentations of, and treatment for hyperacute, acute cellular, and antibody-mediated

rejection.

68. Know the risk factors, clinical presentation, International Society for Heart & Lung Transplantation grading system, and

strengths and limitations of diagnostic tools for cardiac allograft vasculopathy.

69. Know when to consider cardiac re-transplantation.

70. Know common post-transplant complications and how to monitor them in the outpatient setting, including

hypertension, diabetes, malignancy, renal dysfunction, infection, obesity, and endocrinological and neurological

sequelae.

71. Know the strengths and limitations of strategies used to detect and monitor transplant rejection.

72. Know the grades of acute cellular and antibody-mediated transplant rejection, based on interpretation of an

endomyocardial biopsy.

73. Know the clinical presentation of common opportunistic infections in cardiac transplant recipients, as well as the

potential for donor transmission of infectious organisms.

EVALUATION TOOLS: chart-stimulated recall, direct observation

PATIENT CARE AND PROCEDURAL SKILLS

Heart Failure

1. Skill to oversee genetic testing of patients with cardiomyopathy, including selection of patients and collaboration with

genetic counselors.

2. Skills to optimize therapeutic regimens based on guideline-directed pharmacological and device-based therapies in

stable patients with heart failure with reduced ejection fraction.

3. Skill to estimate the jugular venous pressure by clinical examination.

4. Skills to optimize a diuretic regimen in both the inpatient and outpatient settings.

5. Skill to decide whether and when to hospitalize patients with heart failure.

6. Skill to optimize pharmacological therapies in patients with decompensated heart failure, including adjustments after

stabilization and prior to discharge.

7. Skills to assess left ventricular systolic and diastolic properties noninvasively in patients with heart failure.

8. Skill to select individualized diagnostic testing for patients with a new diagnosis of heart failure.

9. Skill to minimize the risk of hospital readmission following discharge for decompensated heart failure.

10. Skills to recognize and stabilize patients with cardiogenic shock.

11. Skills to recognize and stabilize noncardiogenic shock in patients with cardiomyopathy or a history of heart failure.

12. Skills to perform and interpret findings from right heart catheterization in patients with heart failure.

13. Skills to assess risk of patients with heart failure undergoing cardiac or noncardiac surgery, and to manage their

hemodynamic status perioperatively.

14. Skills to perform and interpret cardiopulmonary stress testing.

15. Skills to initiate palliative and supportive care and to address symptoms and goals of care for patients with advanced

heart failure across the care continuum.

16. Skills to manage supraventricular and ventricular arrhythmias in patients with stable or decompensated heart failure.

17. Skill to collaborate with cardiac electrophysiologists to stabilize patients with ventricular tachycardia storm complicating

cardiomyopathy, heart failure, or mechanical circulatory support.

18. Skill to collaborate with cardiac surgeons, interventional cardiologists, or members of a structural heart care team to

determine whether percutaneous or surgical valve intervention is necessary for patients with heart failure.

19. Skills to work effectively with experts in adult congenital heart disease to assess and manage patients with these

conditions, including determining when to employ mechanical support or cardiac transplantation.

20. Skill to determine the indications for coronary revascularization in patients with ischemic cardiomyopathy.

21. Skills to interrogate implantable cardioverter-defibrillators, cardiac resynchronization pacemakers, and cardiac

resynchronization-defibrillator devices in patients with cardiomyopathy and/or heart failure to determine the burden of

arrhythmias, diagnostic information, and basic device functionality.

22. Skill to determine when patients are inotrope-dependent and to manage them in the outpatient setting.

23. Skill to work effectively with obstetricians in the care of pregnant patients with a cardiomyopathy and/or heart failure.

24. Skill to provide self-help tools to patients with heart failure to minimize the risk of decompensation.

25. Skills to educate heart failure patients about warning signs that signify or predict clinical instability, and to help them

develop action plans in the event warning signs appear.


26. Skill to evaluate patients with pulmonary hypertension to determine etiology.

27. Skill to recommend the initial pharmacological regimen for patients with pulmonary arterial hypertension.

28. Skills to assess functional capacity and risk stratify patients with pulmonary arterial hypertension.

29. Skills to perform serial noninvasive assessments of right ventricular function and pulmonary arterial pressure and

integrate these data in the management of patients with pulmonary hypertension.

30. Skills to detect clinical deterioration in patients with pulmonary hypertension and adjust treatment accordingly,

including determining when hospitalization is necessary.

31. Skill to stabilize patients with acute right ventricular failure in the setting of pulmonary hypertension.


32. Skill to identify appropriate options for temporary hemodynamic support for patients in cardiogenic shock.

33. Skill to identify appropriate candidates for durable ventricular assist devices.

34. Skills to interrogate, interpret, and manipulate pump parameters in patients with temporary and durable hemodynamic

assist devices.

35. Skill to recognize the indications for total artificial heart or right ventricular assist device rather than left ventricular

assist device alone.*

36. Skill to optimally set the speed of durable ventricular assist devices.

37. Skills to select and interpret noninvasive and invasive data to evaluate patients with temporary and durable ventricular

assist devices (e.g., ramp study, aortic valve opening, or right ventricular assessment).*

38. Skills to identify and manage right heart failure in patients with left ventricular assist devices.

39. Skill to manage long-term durable mechanical circulatory support in the outpatient setting.

40. Skills to recognize and manage complications of durable mechanical circulatory support, including stroke, device

thrombosis, right heart failure, hypertension, or arrhythmias.

41. Skills to recognize left ventricular recovery and assess patients with left ventricular assist devices for potential

explanation.*

42. Skill to determine whether and when to hospitalize patients with durable ventricular assist devices.

43. Skill to select management options (including hospitalization and diagnostic investigation) for patients with durable

ventricular assist devices and gastrointestinal bleeding.

44. Skills to collaborate with anesthesiologists and procedural specialists to optimize management during invasive

procedures or noncardiac surgery in patients with continuous flow, durable ventricular assist devices.

Cardiac Transplantation

45. Skill to determine whether and when patients warrant cardiac transplantation.

46. Skill to recognize comorbidities that preclude cardiac transplantation.

47. Skill to recognize irreversible pulmonary hypertension that precludes isolated heart transplantation.

48. Skill to assess the suitability of a given heart for transplantation in a potential recipient.

49. Skills to adjust immunosuppressant therapy to minimize the risk of rejection, while balancing competing risks of

infection, malignancy, renal failure, and other toxicities.*

50. Skill to collaborate with colleagues in the histocompatibility laboratory to assess a heart transplant recipient's reactive

antibody panel, preformed and post-transplant antihuman leukocyte antigen antibodies, and immunological

compatibility with a donor heart.

51. Skill to manage heart transplant recipients in the immediate post-transplant period, including those with complications,

in conjunction with a multidisciplinary team.

52. Skill to determine whether and when illness in heart transplant recipients requires hospitalization.

53. Skills to interpret with a pathologist the findings of endomyocardial biopsies to determine the need for treatment of

acute cellular or antibody-mediated rejection, and oversee treatment.

54. Skills to collaborate with other members of a multidisciplinary team in managing common comorbidities and

complications following heart transplantation, including hypertension, dyslipidemia, renal insufficiency, infection, and

cancer.

55. Skills to collaborate with invasive and interventional cardiologists in the prevention, recognition, and treatment of

transplant vasculopathy.

56. Skills to interpret noninvasive tests, including echocardiograms, gene expression profiling (e.g., Allomap testing), and

other biomarkers to evaluate for rejection in heart transplant recipients.

57. Skill to perform endomyocardial biopsy to assess for transplant rejection.

58. Skill to prescribe therapies to prevent opportunistic infections, including Cytomegalovirus, Nocardia, and Pneumocystis

Jiroveci pneumonia in heart transplant recipients.

59. Skill to oversee the use of immunizations in patients before and after cardiac transplantation.

EVALUATION TOOLS: chart-stimulated review, direct observation and multisource evaluation

SYSTEMS-BASED PRACTICE

1. Utilize appropriate care settings and teams for patients with various profiles and stages of heart failure before or after

mechanical circulatory support or transplantation.

2. Incorporate risk/benefit analysis and cost considerations in diagnostic and treatment decisions, including the adoption

of new technologies.

3. Utilize an interdisciplinary, coordinated team approach for patient management, including care transitions, palliative

care, and employment-related issues.

4. Effectively utilize an interdisciplinary transitional-care approach to monitor the progress of ambulatory patients with

heart failure to maintain stability and avoid preventable hospitalization.

5. Collaboratively work with all members of the advanced heart failure and transplant cardiology team, including cardiac

surgeons, palliative care specialists, other medical consultants, nurses, nurse practitioners, physician assistants, social

workers, dietitians, physical and occupational therapists, and pharmacists.

6. Identify the financial, cultural, social, and emotional barriers to successful outcomes after mechanical circulatory support

or transplantation.

7. Effectively utilize an interdisciplinary approach to care for patients with or at risk of advanced heart failure, pulmonary

hypertension, and mechanical circulatory support or cardiac transplantation

EVALUATION TOOLS: chart-stimulated recall, direct observation and multisource evaluation

PRACTICE-BASED LEARNING AND IMPROVEMENT

1. Identify knowledge and performance gaps and engage in opportunities to achieve focused education and performance

improvement.

2. Utilize decision support tools to access guidelines and pharmacological information at the point of care.

3. Incorporate feedback from faculty and staff to improve performance.

4. Develop habits of regular and critical reading of the heart failure/transplant literature to maintain current knowledge of

the field and promote lifelong learning.

EVALUATION TOOLS: conference presentation, direct observation, faculty evaluation, reflection, and self-assessment.

PROFESSIONALISM

1. Show compassion for and effective management of end-of-life issues, including discussions of death and dying, across

the spectrum of patients with heart failure, pulmonary hypertension, mechanical circulatory support, or heart

transplantation.

2. Clearly and objectively discuss available therapies for advanced heart failure, including palliative care, mechanical

circulatory support, or transplantation.

3. Interact respectfully with patients, families, and all members of the healthcare team, including ancillary and

support staff.

4. Demonstrate high ethical standards, including the recognition and management of overt and more subtle potential

conflicts of interest, when making diagnostic or therapeutic decisions.

EVALUATION TOOLS: conference presentation, direct observation, multisource evaluation, reflection, and self-assessment.

INTERPERSONAL AND COMMUNICATION SKILLS

1. Communicate with and educate patients and families across a broad range of cultural, ethnic, and socioeconomic

backgrounds.

2. Engage in shared decision making, including the potential role of palliative care and discussing the risk of death, with

patients and their families considering mechanical circulatory support and/or transplant.

3. Effectively lead the interdisciplinary heart failure team to promote comprehensive and balanced decision making with

respect to the selection of mechanical circulatory support versus heart transplantation.

4. Skill to discuss the potential for donor transmission of infectious agents to the recipient, and ability to use a shared

decision-making approach with recipients when assessing a donor at risk.

5. Skill to provide emotional support to patients and their families before and after mechanical circulatory support or

cardiac transplantation.

EVALUATION TOOLS: direct observation and multisource evaluation.

*Additional competencies that extend beyond the core expectations and that may be achieved by some advanced heart failure

and transplant cardiology (AHFTC) specialists based on career focus, either during or following formal AHFTC fellowship training.

Educational Material

During fellowship duration, fellow will be expected to have read pertinent literature listed as follows:

GUIDELINES AND POLICY STATEMENTS:

American College of Cardiology/American Heart Association

1) 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2016;():. doi:10.1016/j.jacc.2016.05.011 http://content.onlinejacc.org/article.aspx?articleid=2524644

2) 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology

Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;June 5: S0735‐1097

http://circ.ahajournals.org/content/early/2013/06/03/CIR.0b013e31829e8776

3) Prevention of Heart Failure: A Scientific Statement from the American Heart Association Councils on Epidemiology and Prevention,

Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research

Interdisciplinary Working Group; and Functional

4) Genomics and Translational Biology Interdisciplinary Working Group. Circ 2008;117:2544‐2565

http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.188965.pdf

5) 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of

Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(22):e57‐e185

http://content.onlinejacc.org/article.aspx?articleid=1838843

6) Transitions of Care in Heart Failure: A Scientific Statement From the American Heart Association on behalf of the American Heart

Association Complex Cardiovascular Patient and Family Care Committee of the Council on Cardiovascular and Stroke Nursing, Council

on Clinical Cardiology, and Council on Quality of Care and Outcomes Research, Circ: Heart Failure. 2015;8:384‐409

http://circheartfailure.ahajournals.org/content/8/2/384.full

ACC/AHA and ESC

1) ACC/AHA/ESC Guidelines for the Management of Patients with Atrial Fibrillation Executive Summary (2006) Circ 2006;114:700‐752

http://circ.ahajournals.org/cgi/reprint/114/7/700

2) The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease: A Scientific Statement from the American Heart

Association, the American College of Cardiology, and the European Society of Cardiology. Circ 2007;116:2216‐2233


ACC/AHA and Heart Rhythm Society

1) ACC/AHA/HRS 2008 Guidelines for Device‐Based Therapy of Cardiac Rhythm Abnormalities

http://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/Device-Based-Therapy-for-Cardiac-Rhythm-

Abnormalities/2008-Guidelines-for-Device-Based-Therapy-of-Cardiac-Rhythm-Abnormalities-Executive-Summary (Executive

Summary)

http://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/Device-Based-Therapy-for-Cardiac-Rhythm-

Abnormalities/2008-Guidelines-for-Device-Based-Therapy-of-Cardiac-Rhythm-Abnormalities

2) A Practical Guide for Clinicians Who Treat Patients with Amiodarone (2007) See under heading for “Arrhythmias, CRM Devices, and

Leads” Heart Rhythm 2007;4:1250+090‐1259

http://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/A-Practical-Guide-for-Clinicians-Who-Treat-Patients-with-

Amiodarone2/2007-A-Practical-Guide-for-Clinicians-Who-Treat-Patients-with-Amiodarone

3) Resynchronization Therapy for Heart Failure (2005)

http://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/2005-Expert-Consensus-Statement-Resynchronization-

Therapy-for-Heart-Failure



























http://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/Device-Based-Therapy-for-Cardiac-Rhythm-Abnormalities/2008-Guidelines-for-Device-Based-Therapy-of-Cardiac-Rhythm-Abnormalities-Executive-Summary




http://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/Device-Based-Therapy-for-Cardiac-Rhythm-Abnormalities/2008-Guidelines-for-Device-Based-Therapy-of-Cardiac-Rhythm-Abnormalities




http://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/A-Practical-Guide-for-Clinicians-Who-Treat-Patients-with-Amiodarone2/2007-A-Practical-Guide-for-Clinicians-Who-Treat-Patients-with-Amiodarone




http://www.hrsonline.org/Policy-Payment/Clinical-Guidelines-Documents/2005-Expert-Consensus-Statement-Resynchronization-Therapy-for-Heart-Failure




Heart Failure Society of America

1) Heart Failure Society of America (HFSA) 2010 Comprehensive Heart Failure Practice Guideline J Cardiac Fail 2010;16:e1‐e194

http://www.hfsa.org/heart-failure-guidelines-2/

2) HFSA 2010 Comprehensive Heart Failure Practice Guideline Executive Summary J Card Fail 2010:16;175‐539


3) The Genetic Evaluation of Cardiomyopathy: A Heart Failure Society of America Practice Guideline J Card Fail 2009;25:83‐97

http://www.sciencedirect.com/science/article/pii/S1071916409000281

International Society for Heart and Lung Transplantation

1) 2015 ESC/ERS Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension European Heart J 2009;30:2493‐2537

https://www.ncbi.nlm.nih.gov/pubmed/26320113

2) Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac

Transplant Candidates; 2006 J Heart Lung Transplant 2006;25:1024‐42

http://www.jhltonline.org/article/S1053-2498(06)00460-8/abstract

3) Heart Rhythm Considerations in Heart Transplant Candidates and Considerations for Ventricular Assist Devices: International Society

for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates; 2006 J Heart Lung Transplant

2006;25:1043‐1056

http://www.jhltonline.org/article/S1053-2498(06)00457-8/pdf

4) Optimal Pharmacologic and Non‐pharmacologic Management of Cardiac Transplant Candidates: International Society for Heart and

Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates; 2006 J Heart Lung Transplant 2006:25:1003‐1023

http://www.sciencedirect.com/science/article/pii/S1053249806004591?via%3Dihub

5) The International Society of Heart and Lung Transplantation Guidelines for the Care of Heart Transplant Recipients. Costanzo MR

(Chair) et al. J Heart Lung Transplant 2010; 29: 914‐56.

http://www.sciencedirect.com/science/article/pii/S105324981000358X?via%3Dihub

KEY ARTICLES:

Acute Heart Failure

1. Emerging therapies for the management of decompensated heart failure: from bench to bedside. deGoma EM, Vagelos RH, Fowler MB,

Ashley EA. J Am Coll Cardiol. 2006 Dec 19;48(12):2397‐409. Epub 2006 Nov 28. Review.


2. Acute heart failure syndromes. Gheorghiade M, Pang PS. J Am Coll Cardiol. 2009 Feb 17;53(7):557‐73. Review.


3. Can We Predict and Prevent the Onset of Acute Decompensated Heart Failure? Eugene E. Wolfel Circulation 2007;116;1526‐1529

http://circ.ahajournals.org/cgi/content/full/116/14/1526

4. Transition From Chronic Compensated to Acute Decompensated Heart Failure: Pathophysiological Insights Obtained From Continuous

Monitoring of Intracardiac Pressures. Michael R. Zile, MD; Tom D. Bennett, PhD; Martin St. John Sutton, MD; Yong K. Cho, PhD; Philip

B. Adamson, MD; Mark F. Aaron, MD; Juan M. Aranda Jr,MD; William T. Abraham, MD; Frank W. Smart, MD; Lynne Warner Stevenson,

MD; Fred J. Kueffer, MS, MD; Robert C. Bourge, MD. Circulation 2008, 118:1433‐1441

http://circ.ahajournals.org/content/118/14/1433

5. Decision Making in Advanced Heart Failure: A Scientific Statement from the American Heart Association. Allen LA, Stevenson LW,

Grady KL, et al. (March 2012 Circulation)

http://tinyurl.com/74uuafq

6. Effect of Nesiritide in Patients with Acute Decompensated Heart Failure. C.M. O’Connor, R.C. Starling, A.F. Hernandez, P.W.

Armstrong, K. Dickstein, V. Hasselblad, G.M. Heizer, M. Komajda, B.M. Massie, J.J.V. McMurray, M.S. Nieminen, C.J. Reist, J.L.

Rouleau, K. Swedberg, K.F. Adams, Jr., S.D. Anker, D. Atar, A. Battler, R. Botero, N.R. Bohidar, J. Butler, N. Clausell, R. Corbalán, M.R.

Costanzo, U. Dahlstrom, L.I. Deckelbaum, R. Diaz, M.E. Dunlap, J.A. Ezekowitz, D. Feldman, G.M. Felker, G.C. Fonarow, D. Gennevois,

S.S. Gottlieb, J.A. Hill, J.E. Hollander, J.G. Howlett, M.P. Hudson, R.D. Kociol, H. Krum, A. Laucevicius, W.C. Levy, G.F. Méndez, M.



























Metra, S. Mittal, B.‐H. Oh, N.L. Pereira, P. Ponikowski, W.H. Wilson, S. Tanomsup, J.R. Teerlink, F. Triposkiadis, R.W. Troughton, A.A.

Voors, D.J. Whellan, F. Zannad, and R.M. Califf. N Engl J Med 2011;365:32‐43.

http://www.nejm.org/doi/full/10.1056/NEJMoa1100171

Arrhythmias and Implantable Devices

1. Atrial fibrillation and acute decompensated heart failure. DiMarco JP. Circ Heart Fail. 2009 Jan;2(1):72‐3. Review. No abstract available.

http://circheartfailure.ahajournals.org/cgi/reprint/2/1/72.pdf

2. The efficacy of implantable cardioverter‐defibrillators in heart transplant recipients: results from a multicenter registry. Tsai VW, Cooper

J, Garan H, Natale A, Ptaszek LM, Ellinor PT, Hickey K, Downey R, Zei P, Hsia H, Wang P, Hunt S, Haddad F, Al‐Ahmad A. Circ Heart

Fail. 2009 May;2(3):197‐201. Epub 2009 Apr 30.

http://circheartfailure.ahajournals.org/cgi/reprint/2/3/197.pdf 3. Resynchronization therapy for the treatment of heart failure. Saxon LA, Ellenbogen KA. Circulation. 2003 Sep 2;108(9):1044‐8. Review.

No abstract available.

http://circ.ahajournals.org/cgi/reprint/108/9/1044.pdf

4. Heart failure and sudden death in patients with tachycardia‐induced cardiomyopathy and recurrent tachycardia. Nerheim P, Birger‐Botkin

S, Piracha L, Olshansky B. Circulation. 2004 Jul 20;110(3):247‐52. Epub 2004 Jun 28. http://circ.ahajournals.org/cgi/reprint/110/3/247.pdf

5. Management of atrial fibrillation in patients with heart failure. Neuberger HR, Mewis C, van Veldhuisen DJ, Schotten U, van Gelder IC,

Allessie MA, Böhm M.Eur Heart J. 2007 Nov;28(21):2568‐77. Epub 2007 Sep 13. Review.

http://eurheartj.oxfordjournals.org/content/28/21/2568.full.pdf

6. Rhythm control versus rate control for atrial fibrillation and heart failure. Roy D, Talajic M, Nattel S, Wyse DG, Dorian P, Lee KL,

Bourassa MG, Arnold JM, Buxton AE, Camm AJ, Connolly SJ, Dubuc M, Ducharme A, GuerraPG, Hohnloser SH, Lambert J, Le Heuzey

JY, O’Hara G, Pedersen OD, Rouleau JL, Singh BN, Stevenson LW, Stevenson WG, Thibault B, Waldo AL; Atrial Fibrillation and

Congestive Heart Failure Investigators. N Engl J Med. 2008 Jun 19;358(25):2667‐77.

http://content.nejm.org/cgi/reprint/358/25/2667.pdf

7. Use of traditional and biventricular implantable cardiac devices for primary and secondary prevention of sudden death. Klein MH, Gold

MR. Cardiol Clin. 2008 Aug;26(3):419‐31, vi‐vii. Review.

http://www.ncbi.nlm.nih.gov/pubmed/18538188

8. Problems with implantable cardiac device therapy. Kowalski M, Huizar JF, Kaszala K, Wood MA. Cardiol Clin. 2008 Aug;26(3):441‐58,

vii. Review.


9. Troubleshooting pacemakers and implantable cardioverter‐defibrillators. Scher DL. Curr Opin Cardiol. 2004 Jan;19(1):36‐46. Review.


10. Pathobiology of cardiac dyssynchrony and resynchronization. Kass DA. Heart Rhythm. 2009 Nov;6(11):1660‐5. Epub 2009 Aug 14.

Review.


11. A Meta‐Analysis of Remote Monitoring of Heart Failure Patients. Catherine Klersy, Annalisa De Silvestri, Gabriella Gabutti, François

Regoli, and Angelo Auricchio J. Am. Coll. Cardiol. 2009;54;1683‐1694

http://content.onlinejacc.org/cgi/content/full/54/18/1683

12. Supraventricular tachycardia after orthotopic cardiac transplantation. Vaseghi M, Boyle NG, Kedia R, Patel JK, Cesario DA, Wiener I,

Kobashigawa JA, Shivkumar K.J Am Coll Cardiol. 2008 Jun 10;51(23):2241‐9. http://www.onlinejacc.org/content/51/23/2241

13. Catheter ablation of supraventricular tachycardia in the transplanted heart: a case series and literature review. Magnano AR, Garan H.

Pacing Clin Electrophysiol. 2003 Sep;26(9):1878‐86. Review.

http://onlinelibrary.wiley.com/doi/10.1046/j.1460-9592.2003.00284.x/epdf

Biomarkers

1. Biomarkers in heart failure. Braunwald E. N Engl J Med. 2008 May 15;358(20):2148‐59. Review. No abstract available.


2. Rapid measurement of B‐type natriuretic peptide in the emergency diagnosis of heart failure.



























http://www.onlinejacc.org/content/51/23/2241






Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg

PG, Westheim A,Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA; Breathing Not Properly Multinational Study

Investigators. N Engl J Med. 2002 Jul

18;347(3):161‐7.

http://content.nejm.org/cgi/reprint/347/3/161.pdf Cardiac Surgery in Heart Failure Patients

1. Coronary artery bypass grafting in patients with low ejection fraction. Topkara VK, Cheema FH, Kesavaramanujam S, Mercando ML,

Cheema AF, Namerow PB, Argenziano M, Naka Y, Oz MC, Esrig BC. Circulation.2005 Aug 30;112:I344‐50.

http://circ.ahajournals.org/cgi/reprint/112/9suppl/I‐344.pdf

2. The use of contrast‐enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. Kim RJ, Wu E, Rafael A, Chen

EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM. N Engl J Med. 2000 Nov 16;343(20):1445‐53.


3. Comparison of coronary artery bypass grafting versus medical therapy on long‐term outcome in patients with ischemic cardiomyopathy (a

25‐year experience from the Duke Cardiovascular Disease Databank). O'Connor CM, Velazquez EJ, Gardner LH, Smith PK, Newman MF,

Landolfo KP, Lee KL, Califf RM, Jones RH. Am J Cardiol. 2002 Jul 15;90(2):101‐7.


4. Revascularization for heart failure. Phillips HR, O'Connor CM, Rogers J. Am Heart J. 2007 Apr;153(4 Suppl):65‐73. Review.


5. Mitral valve surgery in heart failure: insights from the Acorn Clinical Trial. Acker MA, Bolling S, Shemin R, Kirklin J, Oh JK, Mann DL,

Jessup M, Sabbah HN, Starling RC, Kubo SH; Acorn Trial Principal Investigators and Study Coordinators. J Thorac Cardiovasc Surg. 2006

Sep;132(3):568‐77, 577.e1‐4. Epub 2006 Jul 31.


Cardiac Transplantation (Also see ISHLT guidelines and articles under "Immunosuppression")

1. Transplant coronary artery disease. Zimmer RJ, Lee MS. JACC Cardiovasc Interv. 2010 Apr;3(4):367‐77.


2. Use of rapamycin slows progression of cardiac transplantation vasculopathy. Mancini D, Pinney S, Burkhoff D, LaManca J, Itescu S,

Burke E, Edwards N, Oz M, Marks AR.Circulation. 2003 Jul 8;108(1):48‐53. Epub 2003 May 12.


3. Tacrolimus versus cyclosporine microemulsion for heart transplant recipients: a meta‐analysis. Ye F, Ying‐Bin X, Yu‐Guo W, Hetzer R. J

Heart Lung Transplant. 2009 Jan;28(1):58‐66. Epub 2008 Dec 4.


Clinical Assessment

1. Value of Clinician Assessment of Hemodynamics in Advanced Heart Failure: The ESCAPE Trial

Drazner MH, Hellkamp AS, Leier CV, Shah MR, Miller LM, Russell SD. Circ Heart Fail. 2008; 1: 170–177

http://circheartfailure.ahajournals.org/content/1/3/170.long

Disease Management and End‐of‐Life Care

1. The heart failure clinic: a consensus statement of the Heart Failure Society of America. Hauptman PJ, Rich MW, Heidenreich PA, Chin J,

Cummings N, Dunlap ME, Edwards ML, Gregory D, O’connor CM, Pezzella SM, Philbin E; Heart Failure Society of America. J Card Fail.

2008 Dec;14(10):801‐15. Review.

http://download.journals.elsevierhealth.com/pdfs/journals/1071‐9164/PIIS1071916408010129.pdf

2. Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A

meta‐analysis. Roccaforte R, Demers C, Baldassarre F, Teo KK, Yusuf S. Eur J Heart Fail. 2005 Dec;7(7):1133‐44. Epub 2005 Sep 29.

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0021940/

3. Efficacy and safety of exercise training in patients with chronic heart failure: HF‐ACTION randomized controlled trial. O’Connor CM,

Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, Leifer ES, Kraus WE, Kitzman DW, Blumenthal JA, Rendall DS, Miller NH, Fleg

JL,Schulman KA, McKelvie RS, Zannad F, Piña IL; HF‐ACTION Investigators. JAMA. 2009 Apr 8;301(14):1439‐50.



http://circ.ahajournals.org/cgi/reprint/112/9_suppl/I‐344.pdf

http://circ.ahajournals.org/cgi/reprint/112/9_suppl/I‐344.pdf





















http://www.jefferson.edu/content/dam/university/research/lab-assets/Whellan%20Pub%201.pdf

4. Muscle oxygen transport and utilization in heart failure: implications for exercise (in)tolerance

David C. Poole, Daniel M. Hirai, Steven W. Copp, and Timothy I. Musch. Am J Physiol Heart Circ Physiol 2012; 302: H1050 http://ajpheart.physiology.org/content/ajpheart/302/5/H1050.full.pdf

5. Role and benefits of exercise in the management of patients with heart failure. Keteyian SJ1, Fleg JL, Brawner CA, Piña IL. Heart Fail

Rev. 2010 Nov;15(6):523‐30.


6. Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure: HF‐ACTION Randomized Controlled Trial. Christopher

M. O’Connor, MD, David J. Whellan, MD, MHS, Kerry L. Lee, PhD, Steven J. Keteyian, PhD, Lawton S. Cooper, MD, MPH, Stephen J.

Ellis, PhD, Eric S. Leifer, PhD, William E. Kraus, MD, Dalane W. Kitzman, MD, James A. Blumenthal, PhD, David S. Rendall, PA‐C,

Nancy Houston Miller, RN, BSN, Jerome L. Fleg, MD, Kevin A. Schulman, MD, Robert S. McKelvie, MD, PhD, Faiez Zannad, MD, PhD,

and Ileana L. Piña, MD, for the HF‐ACTION Investigators. JAMA.2009;301(14):1439‐1450.

http://jama.jamanetwork.com/article.aspx?articleid=183708

7. Temporal Trends and Factors Associated With Cardiac Rehabilitation Referral Among Patients Hospitalized With Heart Failure: Findings

From Get With The Guidelines‐Heart Failure Registry.

Golwala H, Pandey A, Ju C, Butler J, Yancy C, Bhatt DL, Hernandez AF, Fonarow. J Am Coll Cardiol. 2015 Aug 25;66(8):917‐26.


8. Consensus Statement: End‐of‐life care in patients with heart failure. Whellan DJ, Goodlin SJ, Dickinson MG et al. J Card Failure

2014;20(2):121‐134


9. Compendium of Treatment of End Stage Non‐Cancer Diagnoses: Heart Failure. Fahlber BB, Panke JT. 2011. 2ND Edition by Hospice and

Palliative Care Nurses Association.Pittsburgh, PA

http://www.hpna.org/HPNA_Item_Details.aspx?ItemNo=978‐1‐934654‐24‐8

10. Palliative care in congestive heart failure. Goodlin SJ. J Am Coll Cardiol. 2009 Jul 28;54(5):386‐96. Review.


11. Palliative care in the treatment of advanced heart failure. Adler ED, Goldfinger JZ, Kalman J, Park ME, Meier DE.Circulation. 2009 Dec

22;120(25):2597‐606. Review. No abstract available.

http://circ.ahajournals.org/cgi/content/extract/120/25/2597

12. Structured telephone support or telemonitoring programmes for patients with chronic heart failure.

Inglis SC, Clark RA, McAlister FA et al. Cochrane Database Syst. Rev 2010:CD007228.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1865411/pdf/bmj-334-7600-res-00942-el.pdf

13. A meta‐analysis of remote monitoring of heart failure patients. Klersy C, De Silvestri A, Gabutti G, Ragoli F, Auricchio A. J Am Coll

Cardiol 2009;54:1683‐94. http://www.onlinejacc.org/content/54/18/1683

14. Do heart failure disease management programs make financial sense under a bundled payment system? Eapen ZJ, Reed SD, Curtis LH,

Hernandez AF, Peterson ED. Am Heart J 2011;161:916‐22.


15. Diuretic Strategies in Patients with Acute Decompensated Heart Failure. G. Michael Felker, Kerry L. Lee, David A. Bull, Margaret M.

Redfield, Lynne W. Stevenson, Steven R. Goldsmith, Martin M. LeWinter, Anita Deswal, Jean L. Rouleau, Elizabeth O. Ofili, Kevin J.

Anstrom, Adrian F. Hernandez, Steven E. McNulty, Eric J. Velazquez, Abdallah G. Kfoury, Horng H. Chen, Michael M. Givertz, Marc J.

Semigran, Bradley A. Bart, Alice M. Mascette, Eugene Braunwald, and Christopher M. O’Connor, for the NHLBI Heart Failure Clinical

Research Network. N Engl J Med 2011;364:797‐805.


Epidemiology and Risk Factors

1. Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical

Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working

Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Schocken DD, Benjamin EJ, Fonarow GC,

Krumholz HM, Levy D, Mensah GA, Narula J, Shor ES, Young JB, Hong Y; American Heart Association Council on Epidemiology and



http://ajpheart.physiology.org/content/ajpheart/302/5/H1050.full.pdf

http://ajpheart.physiology.org/content/ajpheart/302/5/H1050.full.pdf























Prevention; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Nursing;

American Heart Association Council on High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working

Group; FunctionalGenomics and Translational Biology Interdisciplinary Working Group. Circulation. 2008 May 13;117(19):2544‐65. Epub

2008 Apr 7.

http://circ.ahajournals.org/cgi/reprint/117/19/2544.pdf 2. Disease‐specific health‐related quality of life questionnaires for heart failure: a systematic review with meta‐analyses. Garin O, Ferrer M,

Pont A, Rué M, Kotzeva A, Wiklund I, Van Ganse E, Alonso J.

Qual Life Res. 2009 Feb;18(1):71‐85. Epub 2008 Dec 4. Review.


3. Multivariate risk scores and patient outcomes in advanced heart failure. Ketchum ES, Levy WC. Congest Heart Fail. 2011

Sep‐Oct;17(5):205‐12

http://tinyurl.com/743opgb

Hypertrophic Cardiomyopathy

1. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic CM: executive summary: a report of the American College of

Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer

MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW. J Thorac Cardiovasc

Surg. 2011 Dec;142(6):e153‐203. https://www.ncbi.nlm.nih.gov/pubmed/22068435

2. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. Elliott PM, Poloniecki J, Dickie S, Sharma S, Monserrat

L, Varnava A, Mahon NG, McKenna WJ. J Am Coll Cardiol. 2000 Dec;36(7):2212‐8. http://www.onlinejacc.org/content/36/7/2212

3. Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy: past, present and future.

Ommen SR, Shah PM, Tajik AJ. Heart. 2008 Oct;94(10):1276‐81. Epub 2008 Jul 24. Review. No abstract available.


4. Hypertrophic cardiomyopathy: a systematic review. Maron BJ. JAMA. 2002 Mar 13;287(10):1308‐20.

http://www.geraldlawriemd.com/sections/hocm/Clinical_Cardiology_HOCM.pdf

Imaging

1. 2013 ACCF/ACR/ASE/ASNC/SCCT/SCMR appropriate utilization of cardiovascular imaging in heart failure: an executive summary: a

joint report of the ACR Appropriateness Criteria ® Committee and the ACCF Appropriate Use Criteria Task Force. White RD, Patel MR,

Abbara S, Bluemke DA, Herfkens RJ, Picard M, Shaw LJ, Silver M, Stillman AE, Udelson J. J Am Coll Radiol. 2013 Jul;10(7):493‐500.

http://www.acr.org/~/media/ACR/Documents/AppCriteria/AUI%20Heart%20Failure%20Manuscript%20Final%202013JUNE13.pdf

Immunosuppression

1. Drug therapy in the heart transplant recipient: part I: cardiac rejection and immunosuppressive drugs.

Lindenfeld J, Miller GG, Shakar SF, Zolty R, Lowes BD, Wolfel EE, Mestroni L, Page RL 2nd, Kobashigawa J. Circulation. 2004 Dec

14;110(24):3734‐40. Review. No abstract available.


2. Drug therapy in the heart transplant recipient: part II: immunosuppressive drugs. Lindenfeld J, Miller GG, Shakar SF, Zolty R, Lowes BD,

Wolfel EE, Mestroni L, Page RL 2nd, Kobashigawa J. Circulation. 2004 Dec 21;110(25):3858‐65.

Review. No abstract available.


3. Drug therapy in the heart transplant recipient: Part III: common medical problems. Lindenfeld J, Page RL 2nd, Zolty R, Shakar SF, Levi

M, Lowes B, Wolfel EE, Miller GG.Circulation. 2005 Jan 4;111(1):113‐7. Review. No abstract available.


4. Drug therapy in the heart transplant recipient: Part IV: drug‐drug interactions. Page RL 2nd, Miller GG, Lindenfeld J. Circulation. 2005

Jan 18;111(2):230‐9. Review. No abstract available.



1. Evaluation for a ventricular assist device: selecting the appropriate candidate. Wilson SR, Mudge GH Jr, Stewart GC, Givertz MM.

Circulation. 2009 Apr 28;119(16):2225‐32. Review. No abstract available. Full article:




























2. The Fourth INTERMACS Annual Report: 4,000 implants and counting. Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD,

Miller MA, Baldwin JT, Young JB. J Heart Lung Transplant. 2012;31:117‐26.

http://tinyurl.com/6qmppnr

Mechanical Circulatory Support: Post‐operative Management

1. Clinical management of continuous‐flow left ventricular assist devices in advanced heart failure.

Slaughter MS, Pagani FD, Rogers JG, Miller LW, Sun B, Russell SD, Starling RC, Chen L, Boyle AJ, Chillcott S, Adamson RM, Blood MS,

Camacho MT, Idrissi KA, Petty M, Sobieski M, Wright S, Myers TJ, Farrar DJ; HeartMate II Clinical Investigators. J Heart Lung Transplant.

2010 Apr;29(4 Suppl):S1‐39. Epub 2010 Feb 24.


Mitral Regurgitation

1. SCAI/AATS/ACC/STS Operator and Institutional Requirements for Transcatheter Valve Repair and Replacement. Part II. Mitral Valve.

Carl L. Tommaso, David A. Fullerton,Ted Feldman, Larry S. Dean, Ziyad M. Hijazi,Eric Horlick, Bonnie H. Weiner, Evan Zahn, Joaquin E.

Cigarroa, Carlos E. Ruiz, Joseph Bavaria, Michael J. Mack,Duke E. Cameron, R. Morton Bolman, III, D. Craig Miller, Marc R. Moon,

Debabrata Mukherjee, Alfredo Trento,Gabriel S. Aldea, Emile A. Bacha. J Am Coll Cardiol. 2014;64(14):1515‐1526


2. Transcatheter Therapies for Mitral Regurgitation A Professional Society Overview From the American College of Cardiology, the

American Association for Thoracic Surgery, Society for Cardiovascular Angiography and Interventions Foundation, and The Society of

Thoracic Surgeons. O’Gara PT1, Calhoon JH, Moon MR, Tommaso CL. 2014;83(6):849‐63


Other Causes of Cardiomyopathy

1. Myocarditis. Cooper LT Jr. N Engl J Med. 2009 Apr 9;360(15):1526‐38. Review. No abstract available. Full article:

http://content.nejm.org/cgi/content/extract/360/15/1526

2. Update on myocarditis. Kindermann et al. J Am Coll Cardiol. 2012;59:779‐792.


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