Rotation: Heart Failure/Cardiac Transplantation. Director: Henry Ooi. Learning Objectives. Patient Care. Assessment Methods.

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1 Rotation: Heart Failure/Cardiac Transplantation or: Henry Ooi Learning s Patient Care Ability to obtain complete medical histories, including review of patient medical records, and perform accurate examinations with an emphasis on cardiac findings Evaluate and manage patients with heart failure, ventricular assist devices and heart transplantation, including the complications associated with these procedures To be able to interpret the results of left heart catheterizations, hemodynamics, cardiopulmonary stress testing, echocardiography, nuclear stress testing, cardiac CT/MR and endomyocardial biopsies Ability to risk stratify patients with heart failure Ability to participate in the education of patients and other care providers on the pathophysiology and management of heart failure, ventricular assist devices and heart transplantation,,,

2 Participation in discussions on end of life issues with patients, family members and other providers To be trained in the performance of relevant cardiovascular procedures including echocardiography, cardiopulmonary stress testing, right heart catheterization and the performance of endomyocardial biopsies To observe and participate in donor organ procurement, ventricular assist device implantation and heart transplantation Faculty Supervision Faculty Supervision Medical Knowledge Understand the pathophysiology of heart failure, ventricular assist devices and cardiac transplantation To have an excellent working knowledge of the medical literature on heart failure, ventricular assist devices and cardiac transplantation and ability to practice evidencebased medicine Have the ability to interpret the results of left heart catheterizations, hemodynamics, cardiopulmonary stress testing, echocardiography, nuclear stress testing, cardiac CT/MR and endomyocardial biopsies Familiarity with the concepts of organ transplantation and the role, structure and function of donor services and the Faculty Supervision,Attending Rounds,,

3 United Network of Organ Sharing (UNOS) Participate actively in the multiple ongoing research projects Faculty Supervision Professionalism Demonstrate accountability and professional behavior towards patients, family members, and members of the health care team and adherence to ethical principles Demonstrate compassion and respect for others, including patients from a diverse cultural, social, and religious backgrounds Role Models, Role Models,, from staff, from staff Interpersonal and Communication Skills Communicate effectively with patients, families, and members of the health care team, including findings and diagnoses when appropriate to both patients and consulting physicians Maintain timely and comprehensive medical records Patient Care, Patient Care,, from staff

4 Provide education to patients, family members and care providers Patient Care,, from staff Practice Based Learning and Improvement Identify both strengths and gaps in knowledge and expertise and set appropriate learning goals Utilize information technology to effectively locate, appraise, and utilize evidence based medicine with in current literature to improve patient care Utilize quality improvement methods to implement changes within the practice environment Systems Based Practice Work effectively as a member of the health care team, including coordination of patient care Understand the complexities of and work with the multidisciplinary resources necessary to care for patients with heart failure, ventricular assist devices and cardiac transplantation

5 Demonstrate understanding of cost effectiveness and riskbenefit analysis and incorporate these into patient care Advocate for and work towards patient safety and improved quality of care Identify system errors and implement systems solutions,, Rotation Format and Responsibilities: The inpatient service is composed of an Attending, Fellow, Resident, two Interns and a Case Manager. The service will admit the most critical HF patients daily from 7:00 AM-4:00 PM Monday through Friday, with a maximum of 20 patients on service at any time; any overflow is distributed to the Harrison Services Heart failure/transplant patients admitted overnight will be transferred back to the heart failure service the following morning from the on call team. Consult patients will be followed by the Attending and Fellow, including those heart failure/transplant patients admitted to the CVICU. The Fellow s responsibilities will include rounding with the HF team, performing and staffing all HF Consults from 7:00 AM to 5:00 PM. The Fellow may perform right heart caths at VHVI, conduct VO2 consumption studies, and become involved in the outpatient heart failure clinics as directed by the HF/Tx Attending. Weekend rounding will be performed by the Harrison Team fellow on call. The HF/Tx Fellow participates in the Primary Call System as scheduled and must adhere to all Work Hour Policies. Conferences

6 The multi-disciplinary transplant team meets weekly at 7 am Monday mornings in Room 901 Oxford House to discuss the evaluation, status and listing of patients for transplant and device therapy. The CHF Fellow on the rotation is expected to attend. The Heart Failure meeting will take place every Monday at 12 pm in Room 5181 MCE North Tower. The topic of the meeting will be a rotating schedule of Journal Club/clinical case presentations, research meetings, M&M/Best practices and administrative meetings. The CHF Fellow on the rotation is expected to attend these meetings apart from Administrative meetings. The topic of each meeting will be sent out in advance by . There will also be occasional CME-approved transplantation-related didactic lectures that take place on Wednesdays at am in Room 901 Oxford House. The subject of these lectures will be announced prior to the date. Requirements for Certification (COCATS 3): Level 1: 1 month of training. Experience in the evaluation, management and prevention of heart failure (taken as part of 9 months of required non laboratory clinical practice rotation). Level 2: 6 months of training. In addition to satisfying all Level 1 curriculum requirements outlined, trainees will be required to have additional experiences in the interpretation of advanced heart failure patient hemodynamic data during both acute and chronic interventions and during the assessment of prognosis. One example of an additional curriculum at the Level 2 stage would be trainee rotations through outpatient electrophysiology clinics to focus on the interrogation, evaluation, and programming of implantable electrophysiologic devices used to treat and manage heart failure patients. Level 3: Additional 12 months of training. Demonstration of proficiency in the management of additional more challenging cohorts of heart failure patients (with the specified levels of exposure listed in parentheses if meeting UNOS criteria as a heart transplant physician is desired). 1. Patients requiring end of life hospice based care 2. Patients with hemodynamic compromise severe enough to warrant chronic inotropic drug infusion support 3. Patients with heart failure and noncardiac organ transplants 4. Patients who are being evaluated for cardiac transplant or mechanical assist devices (at least 30) 5. Patients who have undergone cardiac transplant (at least 30, of whom at least 5 are seen during initial transplant hospitalization) 6. Patients with heart failure on mechanical circulatory assist devices (at least 5, of whom at least 2 are being managed during perioperative hospitalization) 7. Patients with heart failure being evaluated for implantable cardioverter defibrillators (ICDs) (at least 50) and patients with heart failure being evaluated for cardiac resynchronization therapy (CRT) (at least 50) 8. Device interrogation and interpretation in patients with implanted ICD or ICD CRT devices (at least 100) Recommended Reading: HEART FAILURE Congestive Heart Failure, Third Edition, Jeffrey D. Hosenpud, Barry Greenberg. Lippincott, Williams and Wilkins.

7 Heart Failure: A Companion to Braunwald's Heart Disease, Douglas L. Mann. Saunders WB. Heart Failure: Pathophysiology, Molecular Biology, and Clinical Management, Second Edition, Arnold M Katz, Marvin A Konstam, Lippincott, Williams and Wilkins. Heart Failure: A Comprehensive Guide to Diagnosis and Treatment, G. William Dec, Marcel Dekker. Treatment of Advanced Heart Disease, Kenneth L. Baughman, William A. Baumgartner. Taylor & Francis. Surgical Management of Congestive heart Failure, James C. Fang, Gregory S. Couper. Humana Press. Mechanical Circulatory Support Therapy In Advanced Heart Failure, Mario C Deng, Yoshifumi Naka. Imperial College Press. Mechanical Circulatory Support. ISHLT Monograph series, Vol. 1, OH Frazier, James K. Kirklin. Elsevier. HEART TRANSPLANTATION Heart Transplantation, James K. Kirklin, James B. Young. Churchill Livingstone. Cardiac Transplantation, Niloo M. Edwards, Jonathan M. Chen, Pamela A. Mazzeo. Humana Press. Evaluation and : Fellows are evaluated at the end of the rotation with a competency based evaluation system Fellows are directly observed and given real time feedback on their performance Fellows participate in structured case discussions May 2009