Cardiovascular Medicine
Heart Failure/Heart Transplant Section
The heart failure/heart transplant program is a combined effort connecting the Shands Transplant Center with cardiovascular specialists from the Divisions of Cardiovascular Medicine and Cardiovascular Surgery aimed at providing multiple treatment options for patients with advanced heart disease throughout the Southeastern U.S. As one of the largest heart transplant programs in the country, we have a busy inpatient service and daily heart failure clinics dedicated to the care of advanced heart failure patients. In addition to 4 cardiologist heart failure specialists, we are staffed by 5 physician extenders (4 nurse practitioners and 1 physician assistant) specializing in advanced heart failure management, 5 posttransplant nurse specialists, and 6 administrative support staff. All services necessary for state-of-the-art heart failure management are available. These services include evaluation for cardiac transplant, complex medical management of heart failure, pacing and implantable cardioverter-defibrillator (ICD) device implantation and management, left ventricular assist device (LVAD) implantation (both for destination therapy and bridge to transplant), complex cardiac surgery, and access to investigational mechanical support devices and pharmacologic agents.
Training program
All cardiology fellows rotate on the heart failure/heart transplant service several times during their 3 years of training. In addition to inpatient and outpatient management, they gain expertise with related invasive procedures such as endomyocardial biopsy, intra-aortic balloon pump (IABP) placement, and LVAD management. Traditionally, our fellows have received high scores on the American Board of Internal Medicine (ABIM) subspecialty examination in cardiovascular disease in the area of heart failure and heart transplantation as a result of their participation in our program. In addition, we offer a year of advanced training in advanced heart failure and transplant leading to United Network for Organ Sharing (UNOS) qualification as a cardiac transplant specialist. Graduates from our advanced heart failure fellowship training program have gone on to lead heart transplant programs at academic medical centers.
Research
We participate in multiple Phase III clinical trials of pharmacologic and diagnostic agents and various new devices designed for heart failure and transplant patients. A sample of recent or ongoing trials includes the NIH-sponsored STICH, ESCAPE, and HF-ACTION trials, the ACORN and PARACOR cardiac restraint device trials, the CHRONICLE and CHRONICLE-ICD trials of implanted hemodynamic monitoring in heart failure, the HeartMate II trial of advanced next generation LVAD therapy in end-stage heart failure, and the RAD trials of everolimus immunosuppression in post-cardiac transplant patients. In addition to these sponsored trials, the cardiac transplant program supports investigator-initiated research efforts in a number of areas including vascular reactivity, quality of life, cardiopulmonary and neuroendocrine responses to exercise in the posttransplant patient, and genetic characterization of various aspects of cardiomyopathies. We are beginning a program investigating myocyte transformation and subsequent implantation as a therapeutic option for advanced heart failure with expected initiation of enrollment by the end of 2007. In addition, we have a large database of patients with heart failure and transplantation providing readily available clinical inquiry. These studies involve close collaboration with a number of investigators throughout the health center.
Faculty
- Juan M. Aranda, Jr., M.D.
- James A. Hill, M.D., M.S.
- Daniel F. Pauly, M.D., Ph.D
- Richard S. Schofield, M.D.