Management of the advanced heart failure patient
- Develop cognitive knowledge
- Develop cardiovascular biology and physiology knowledge
- Demonstrate technical skills
- Understand when to refer for cardiac intervention (percutaneous/surgical)
- 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
- Understand indications/contraindications for transplant or mechanical circulatory support
- 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
- Demonstrate ability to evaluate sensitization and understand donor matching protocols
- 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)
- Understand the immunologic principles of immunosuppression
- Demonstrate the ability to recognize and manage side effects of immunosuppressive therapy
- Recognize the risks of malignancy development in the long-term post-transplant patients
- Know and demonstrate the ability to use the protocol for managing immunosuppression and performing surveillance biopsies for acute rejection
- Demonstrate understanding and appropriate use of non-invasive biomarker testing for acute cellular rejection
- Demonstrate ability to perform surveillance endomyocardial biopsy
- Manage both acute cellular and humoral allograft rejection
- Diagnose and manage cardiac allograft vasculopathy
- 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)
- Demonstrate understanding of the difference between pulsatile and continuous flow VAD pumps, as well as familiarity amongst different pumps
- Understand the importance of proper anticoagulation and thromboembolic prophylaxis
- Recognize the signs of VAD pump malfunction such as increasing pump power requirements or decreasing flow rates
- Recognize when patients who are managed as bridge-to-transplant are stable for transplant waitlist activation
Evaluation and management of pulmonary hypertension
- Demonstrate the ability to evaluate pulmonary hypertension and diagnose according to the World Health Organization classification scheme
- Demonstrate the ability to use history, examination, and test data to appropriate risk stratify patients
- 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
- Recognize when PH symptoms are progressing and require either treatment changes or referral for lung transplant evaluation
- Recognize and manage evidence of resultant right heart failure
End-of-life issues
- Assess the mortality risk factors and prognosis in advanced heart failure patients
- Demonstrate ability to conduct end-of-life and palliative care discussions with the patient and the family
- Demonstrate ability to incorporate patient/family wishes and end-of-life goals into the treatment plan