Education

Training goals:

Allegheny General Hospital offers a one-year non-traditional subspecialty fellowship training in Heart Failure/Transplantation. Upon successful completion of this fellowship, the trainee should meet all of the requirements needed to be certified as a UNOS approved cardiac transplant physician.  The primary goal heart failure, natural history of this syndrome, currently accepted treatment strategies for both acute and chronic heart failure and device based therapies for the treatment of heart failure.  In addition, the trainee should develop a good understanding of both the indications and contraindications for cardiac transplantation, selection criteria for transplantation and the management of UNOS status I candidates awaiting transplantation. The trainee should develop knowledge of the selection criteria for left ventricular and right ventricular assist device insertion, selection of device and management of patients on device support.  Also, the trainee should obtain experience in the perioperative care after cardiac transplantation including knowledge of various immunosuppressive regimens, early and late complications after cardiac transplantation and their management. Finally, the trainee should develop an understanding of the pathogenesis of pulmonary hypertension, including diagnosis and treatment options in this syndrome.

Fellowship curriculum:

The Heart Failure/Transplantation Program cares for a large volume of patients with varying severity of heart failure.  It has both an outpatient and an inpatient service.  The outpatient service which is located in the Center for Cardiovascular Medicine comprises of a heart failure clinic, a pulmonary hypertension clinic, and a cardiac replacement clinic.  The fellowship trainee will attend clinic three half days a week.  In the heart failure clinic, new referrals as well as follow up patients are seen.  In addition, patients enrolled in various clinical trials are seen as well. Approximately 3-5 new referrals and 20 follow up patients are seen weekly.  In the pulmonary hypertension clinic, new referrals and follow-up patients along with patients participating in clinical trials are seen. Approximately 2 new referrals and 10 follow up patients are seen weekly. In the Cardiac replacement clinic, the patients who have undergone cardiac transplantation or implantation of a mechanical device receive their follow up.  Approximately 5-7 patients are seen weekly in this clinic.  One of the faculty will precept the fellowship trainee in these clinics.

The inpatient service comprises approximately 10-15 patients at any given time.  About 3-5 patients are admitted weekly to this service.  This includes patients who are awaiting cardiac transplantation, patients with new onset congestive heart failure, patients with chronic heart failure who suffer acute decompensation, patients who have undergone recent as well as remote transplantation and finally patients who are on or referred for left ventricular assist device support.  The fellowship trainee rounds on all of the inpatients along with the attending assigned to the inpatient service on a daily basis.  A first year fellow in Cardiology also rotates through the inpatient service.  The fellowship trainee is expected to teach both the house staff and the nurse practitioners who also care for these patients, review all of the diagnostic studies such as echocardiograms, radionuclide angiograms, thallium perfusion scans and cardiac catheterizations and discuss the findings with the attending physician.  In addition, the fellowship trainee attends on any consultation that the service may receive from other cardiologists or internists in the medical center.  The trainee also reviews the hemodynamic data in patients who are on continuous hemodynamic monitoring and discusses these data in detail with the house staff.  The trainee is expected to have a full knowledge of all of the clinical trials that the Heart Failure/Transplantation Section is involved in so that he/she can facilitate recruitment of patients into these trials.

The fellowship trainee spends one half day a week in the Cardiac Catheterization Laboratory performing right heart catheterizations and endomyocardial biopsies in patients with congestive heart failure as well as those who have undergone cardiac transplantation.  By the completion of the fellowship training, the trainee should have gained adequate experience in performing these invasive procedures independently.  The trainee is also expected to develop expertise in histologic interpretation of the biopsy samples and have a full knowledge of the Dallas criteria for the diagnosis of myocarditis and ISHLT criteria for the diagnosis of acute cardiac rejection.

The Heart Failure/Transplantation Section also operates an exercise laboratory in which patients with congestive heart failure undergo exercise testing with online analysis of respiratory gas exchange.  Approximately, 5-10 exercise studies are performed weekly in this laboratory.  The fellowship trainee is expected to develop a full understanding of the indications for functional testing in congestive heart failure, interpretation of gas exchange data and an understanding of the relationship of functional capacity to prognosis in heart failure.

During the fellowship year, the trainee will not perform any procedures independently without faculty supervision.

The fellowship trainee is also expected to attend a number of clinical and research conferences weekly.  These conferences include the Cardiac Transplantation Candidate Selection Conference, Cardiology Grand Rounds, Cardiovascular Research Conference and Hemodynamic Conference.  It is also expected that the fellowship trainee write at least one new clinical research protocol during the year of training.  It is expected that the trainee completes the protocol, analyze the results and submit the data for presentation in a national cardiovascular meeting and publication.  Research opportunities in basic cardiovascular research are also available should any of the trainees is interested.