Management of the advanced heart failure patient

1. Develop cognitive knowledge
2. Develop cardiovascular biology and physiology knowledge
3. Demonstrate technical skills
4. Understand when to refer for cardiac intervention (percutaneous/surgical)
5. Understand the risks of non-cardiac surgery and demonstrate ability to perform perioperative risk assessment in the HF patient

Evaluation of patients for cardiac transplant or mechanical circulatory support

1. Understand indications/contraindications for transplant or mechanical circulatory support
2. Evaluate the risks of transplant/mechanical support and weigh the risks with the patients’ heart failure status to justify proceeding with transplant/mechanical support surgery
3. Demonstrate ability to evaluate sensitization and understand donor matching protocols
4. Recognize psychosocial factors that increase the risk of adverse transplant outcomes

Management of the post-cardiac transplant patient (at least 30 patients of whom at least 5 are seen during initial transplant hospitalization)

1. Understand the immunologic principles of immunosuppression
2. Demonstrate the ability to recognize and manage side effects of immunosuppressive therapy
3. Recognize the risks of malignancy development in the long-term post-transplant patients
4. Know and demonstrate the ability to use the protocol for managing immunosuppression and performing surveillance biopsies for acute rejection
5. Demonstrate understanding and appropriate use of non-invasive biomarker testing for acute cellular rejection
6. Demonstrate ability to perform surveillance endomyocardial biopsy
7. Manage both acute cellular and humoral allograft rejection
8. Diagnose and manage cardiac allograft vasculopathy
9. Prevent and manage CMV and other opportunistic infections

Management of the post-VAD implant patients (at least 10 of whom at least 2 are being managed perioperatively)

1. Demonstrate understanding of the difference between pulsatile and continuous flow VAD pumps, as well as familiarity amongst different pumps
2. Understand the importance of proper anticoagulation and thromboembolic prophylaxis
3. Recognize the signs of VAD pump malfunction such as increasing pump power requirements or decreasing flow rates
4. Recognize when patients who are managed as bridge-to-transplant are stable for transplant waitlist activation

Evaluation and management of pulmonary hypertension

1. Demonstrate the ability to evaluate pulmonary hypertension and diagnose according to the World Health Organization classification scheme
2. Demonstrate the ability to use history, examination, and test data to appropriate risk stratify patients
3. Demonstrate the ability to treat patients with pulmonary vasodilator medications appropriately, and demonstrate recognition of side effects or evidence of drug intolerance and manage these symptoms appropriately
4. Recognize when PH symptoms are progressing and require either treatment changes or referral for lung transplant evaluation
5. Recognize and manage evidence of resultant right heart failure

End-of-life issues

1. Assess the mortality risk factors and prognosis in advanced heart failure patients
2. Demonstrate ability to conduct end-of-life and palliative care discussions with the patient and the family
3. Demonstrate ability to incorporate patient/family wishes and end-of-life goals into the treatment plan