Cardiovascular Disease Fellowship

The outpatient clinical cardiology experience is directed by Eli V. Gelfand, MD, FACC, Section Chief of General Cardiology, and spans the three years of the Cardiovascular Fellowship.

At the beginning of the first fellowship year, each fellow is assigned an outpatient faculty preceptor. These are selected faculty members who have large, diverse and active patient panels, with diagnoses spanning the entire spectrum of cardiovascular medicine. Trainees attend weekly ambulatory sessions with their preceptor, where preference is given to new patient visits and consultations. Each case is reviewed with the preceptor, who then verifies the salient portions of the history and physical examination, and provides immediate feedback on the fellow's assessment and plan. The fellow takes leadership in following up on the results of the ordered tests and procedures, as well as communicating with the patient and referring physicians. If a return visit is indicated, the trainee follows the patient longitudinally, thus preparing them for postgraduate experience as skilled and busy independent clinicians.

Advance-level fellows (PGY 6-7) spend the last two years of their fellowship within a subspecialty clinic, such as the Arrhythmia and Device Center or the Vascular Medicine clinic.

Frequent feedback, informal and formal, is an integral part of the Ambulatory Cardiology experience, and includes evaluations completed by the preceptors, clinic nurses and patients.

Cardiovascular Health and Lipid Center

The Cardiovascular Health and Lipid Center is a multidisciplinary outpatient program that holds five sessions per week at BIDMC. The primary focus is on risk reduction and the diagnosis and management of complex lipid disorders. In addition to faculty, fellows and senior medical residents, a registered dietitian and a lipid nurse specialist staff the Lipid Center, which oversees approximately 1,000 patients.

The Lipid Center is also a forum for clinical research. All clinical information and laboratory results are incorporated into a longitudinal database that tracks patient responses to dietary and pharmacologic strategies. In addition, the Lipid Center's patient population serves as a resource for basic metabolic and genetic studies and provides fellows an opportunity to become familiar with the diagnosis and management of hyperlipidemia as it pertains to cardiovascular disease.

The Zoll Cardiology Firm (Intermediate Care Unit)

This rotation provides fellows with experience in the diagnosis and management of cardiac hospital patients. The cardiac fellow admits and follows all service patients of the attending cardiologist. He/she supervises and advises the interns and general medicine residents. The fellow makes rounds with the attending cardiologist and is present during clinical conferences when he/she may present relevant literature reviews. During this rotation, the fellow obtains experience in the management of cardiac patients who have been discharged from the CCU as well as newly admitted patients with cardiac problems that do not require CCU care.

In this experience, requests for cardiac consultation come from all services of the hospital including the emergency ward. The consult team is led by the attending and fellow but may include medical residents and students. The consultations are evaluated by the fellow who later presents them to the attending physician; he or she then reviews patient history and physical exam results and joins in a consultative opinion. Cases are then followed by the fellow and attending until specialized cardiac opinion is no longer necessary.

During this rotation, the cardiology fellow is responsible for supervising the medical resident team under the direction of the cardiology attending. Critically ill patients who require circulatory assist devices, invasive monitoring, and temporary pacemakers are cared for in this unit. Consultative services are provided for the Cardiothoracic Intensive Care Unit, Surgical Intensive Care Unit, and Medical Intensive Care Unit.

Fellows spend approximately six months of their first year and two months of their second year on these services.

Between the first and second years of fellowship training, cardiac fellows spend five months in the Cardiac Catheterization Laboratory. First and second year fellows play a pivotal role, performing peri-procedure evaluation of the patient and scrubbing in on all diagnostic catheterization cases including off-hours procedures. Fellows also participate in emergency cases for patients with ST elevation MI or hemodynamic compromise and in specialized procedures such as intra-aortic balloon pump placement, pericardiocentesis and hemodynamic assessment for valvular disease, congenital heart disease and pulmonary hypertension. Each fellow performs between 300 and 400 procedures during his or her time in the Cardiac Catheterization Laboratory, under the direct supervision of a senior staff attending.

Those interested in advanced training in Interventional Cardiology are encouraged to participate in research projects with division faculty. A select group of fellows (chosen for invasive skills and research potential) will have the opportunity to acquire advanced training in Interventional Cardiology during a third and fourth year of study.

The Clinical Electrophysiology service conducts daily teaching conferences and participates actively in the general clinical cardiology conference program. There are eight full-time and one part-time faculty in the electrophysiology section.

The electrophysiology service is involved in multiple research studies, the majority of which are initiated by investigators at BIDMC. Currently active areas of investigation include:

• Noninvasive high resolution ECG analyses to detect persons at risk for ventricular tachyarrhythmias
• Studies of investigational mapping systems
• Investigation of both noninvasive and invasive methods to identify persons likely to benefit from ICD therapy
• Evaluation of mechanisms of atrial and ventricular arrhythmias

Clinical research is supplemented by an active preclinical (animal) research program that includes state-of-the-art mapping and imaging systems.

General cardiology fellows spend a minimum of two months rotating through the service. The goals are for fellows to learn an approach to managing patients with arrhythmias and to understand the role of the clinical EP lab and implanted cardiac electrical devices (pacemakers and defibrillators). General cardiology fellows perform in-house consults on patients with arrhythmias. They are responsible for managing a busy cardioversion service. They learn to interrogate and program permanent pacemakers, loop recorders and defibrillators. There are also opportunities for fellows participate in the clinical electrophysiology lab, if desired.

Advanced Heart Failure encompasses the rapidly growing subspecialty involved with managing patients with refractory (AHA/ACC Stage D) heart failure. Fellows rotate for one- or two-month long blocks on the advanced heart failure service. The rotation fellow is responsible for rounding on and managing the inpatient heart failure service. Patients on the inpatient service include decompensated chronic heart failure patients, de novo cardiomyopathies, refractory heart failure patients undergoing evaluation for transplant and/or ventricular assist device support, post-transplant patients with rejection or other complications, and patients on extracorporeal life support (veno-arterial, veno-venous ECMO). Fellows will actively participate in the management of straightforward heart failure admissions as well as advanced cases and those patients on mechanical support. Fellows will be expected to round on post-operative durable LVAD patients. Fellows may optionally attend LVAD implant surgeries, LVAD outpatient clinic, and regular HF outpatient clinic.

Under the direction of Michael Lanzberg, MD, the Boston Adult Congenital Heart Disease (BACH) rotation is devoted to providing you with exposure to the diagnosis and management of patients with adult congenital heart disease and pulmonary vascular disease. The BACH program is integrated into both Children’s Hospital and Brigham and Women’s Hospital. The fellows admit to and round with the inpatient service, participate in one or two half-day clinic sessions per week and participate in numerous weekly conferences. The fellows are also exposed to the diagnostic modalities important to the management of patients with adult congenital heart disease including: electrocardiography, echocardiography, nuclear cardiology, cardiac catheterization, and cardiac MR and CT.

The Division of Cardiovascular Medicine at BIDMC offers advanced training in multiple subspecialties for those who have completed a general cardiovascular disease fellowship. Accredited programs are available in Advanced Cardiac Imaging, Advanced Structural Heart Disease, Cardio-Oncology, Clinical Cardiac Electrophysiology, Interventional Cardiology, and Vascular Medicine. Each fellowship provides specialized clinical and research training, helping physicians deepen their expertise in these disciplines.