Heart Failure And Transplantation

Clinical Training Environment

Training in the area of heart failure and cardiac transplantation is an integral part of the cardiology fellowship and furthers the trainees understanding of the pathophysiology, clinical evaluation, and management of patients with heart failure. The program is based at Yale New Haven Hospital and outpatients are seen at the adjacent clinic at 135 College Street.

Patients are seen under the direct supervision of the attending on the heart failure/transplant service. Fellows develop proficiency in right ventricular endocardial biopsy and perform a minimum of twenty biopsies during this rotation . One clinic session per week is also devoted to outpatient congenital heart disease. Fellows attend meetings in pre-transplant evaluation and post treatment management and are expected to develop a good understanding of these areas and immunosuppressive therapy. Fellows are instructed in cardiopulmonary exercise testing and receive training to develop expertise in physical rehabilitation for patients with heart failure. Advanced training is available for fellows who wish to pursue a career in heart failure and transplantation, and requires at least one dedicated year. This involves further training and certification in cardiac transplantation and the use of left ventricular assist devices.

Research Interests

Heart failure represents an important focus of the program and provides continuity of care to a clinic of more than 700 outpatients. The major research foci include:

• Inotropic reserve in patients with severe left ventricular dysfunction
• Beta-adrenergic blockade in chronic heart failure
• Pharmacologic therapy of congestive heart failure

Recents Papers

Vaccarino V, Chen Y-T, Wang Y, Vaccarino V, Radford MJ, Krumholz HM. Sex differences in the clinical care and outcomes of congestive heart failure in the elderly. Am Heart J (in press).

Krumholz HM, Chen Y-T, Wang Y, Vaccarino V, Radford MJ, Horwitz RI. Predictors of readmission among elderly survivors of admission with heart failure. Am Heart J (in press).

Clark DJ, Cleman MW, Rollins SA, Caulin-Glaser T, Pfau SE, Ramahi T, Daher E, Kosiborod M, Bell L, Setaro JF: Serum complement is activated in patients with severe heart failure. Submitted for publication.

Krumholz HM. Time to focus on the more typical heart-failure patients. Lancet 1998;352:3-4.

Krumholz HM. B-blockers for mild to moderate heart failure. Lancet 1998;353:2-3.