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Advanced Heart Failure + Transplant Cardiology Fellowship

The Division of Cardiology at Tufts Medical Center in Boston offers advanced fellowship training in Heart Failure and Cardiac Transplantation for board-eligible/certified cardiovascular specialists.

About this program

The fellowship year consists of inpatient and outpatient care for patients with advanced heart failure and clinical research. Fellows will be exposed to pre- and post-transplant issues, mechanical ventricular assist devices, endomyocardial biopsies, novel drug therapies and innovative patient care. This fellowship program is accredited by the Accreditation Council for Graduate Medical Education (ACGME).

The Heart Failure and Cardiac Transplantation Service at Tufts Medical Center (Tufts MC) consists of 5 staff cardiologists and several nurses dedicated to caring for these medically complex patients in a tertiary, referral-based setting. In recent years, Tufts MC has become one of New England's highest volume transplant centers, accompanied by a substantial growth in mechanical assist devices. Our Cardiomyopathy Center, a 14-bed intermediate care unit, is dedicated to highly specialized nursing care for advanced heart failure, heart transplant and ventricular assist device patients. A regional referral network also allows for collaboration among local heart failure specialists.

Contact info
David DeNofrio, MD
Medical Director, Heart Failure and Cardiac Transplantation Program
Division of Cardiology
Tufts Medical Center
800 Washington St., Box 5931
Boston, MA 02111

How to apply

Interested applicants can apply using the Electronic Residency Application Service (ERAS) for the Advanced Heart Failure and Transplant Cardiology fellowship offered under the December application cycle.

This cycle runs from December to May. For more information regarding this process, please refer to the HFSA ERAS Resource page.

Requirements + eligibility

Prospective fellows are encouraged to apply provided they have completed the necessary training to become ABIM board-eligible in cardiovascular medicine.

Clinical opportunities

Upon completion of the Advanced Heart Failure and Transplant Cardiology Fellowship, each of our fellows will be proficient in the evaluation and management of patients with heart failure in both an inpatient and outpatient setting.

Throughout their time in our program, the fellows are given increasing responsibility for patient care and procedures. The program provides supervised procedural experience so that our fellows can gain the expertise required of a heart failure and cardiac transplantation specialist.

Inpatient experience

During the inpatient experience, each fellow will:

  • Become familiar with the differential diagnosis of dilated cardiomyopathy and the means by which a diagnosis is established, if necessary. This includes a working knowledge of indications for endomyocardial biopsy.
  • Learn the various therapeutics in the acute setting including the use of oral medications such as diuretics, ACE inhibitors, beta-blockers, digoxin, nitrates and other vasodilators.
  • Understand the use of and indications for intravenous inotropic and vasodilator therapy, including dobutamine, nesiritide, dopamine and milrinone.
  • Gain and understand the indications for mechanical support in heart failure patients such as intra-aortic balloon counterpulsation and ventricular assist device therapy.
  • Become familiar with the appropriate work-up and management of patients with heart failure and coronary artery disease who may benefit from surgical revascularization and/or mechanical ventricular assist devices.
  • Gain a working knowledge of the risks and benefits of cardiac transplantation, including the appropriate pre-transplant evaluation and the absolute and relative contraindications to cardiac transplantation.
  • Participate in the care of patients immediately post-transplant, including the use of complex hemodynamic monitoring, inotropic and mechanical device support when needed.
  • Become familiar with the use and actions of immunosuppressive drugs in the cardiac transplant recipient, including cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil, sirolimus and prednisone.
  • Develop a working knowledge of the treatment of both acute and chronic allograft rejection.
  • Understand the diagnosis and management of other post-transplant complications, including bacterial, viral and fungal infections, malignancy and late graft vasculopathy.
  • Gain extensive experience in the selection and management of patients with mechanical circulatory assist devices.
  • Develop extensive experience in the performance of endomyocardial biopsy.
Outpatient experience

Fellows attend weekly heart failure clinics where they participate in caring for patients who are established patients and those newly referred patients. These clinics are aimed at caring for patients with chronic heart failure, those being considered for cardiac transplantation, those following cardiac transplantation and those following left ventricular assist devices. During their outpatient experience, fellows will:

  • Become proficient in the outpatient evaluation of patients with heart failure including the physical exam, differential diagnosis of their particular condition (systolic vs. diastolic dysfunction) and appropriate pharmacologic therapy.
  • Understand the appropriate counseling and emotional support of these often chronically ill patients, including maximizing the patient’s own participation in their care (i.e., dietary and medical compliance, self-monitoring, etc.)
  • Understand predictive variables that indicate a bad prognosis in the timing of a cardiac transplantation.
  • Participate in the outpatient evaluation and counseling of those patients referred for cardiac transplantation. The fellow should understand factors that make a patient suitable or unsuitable for cardiac transplantation. Fellows will attend biweekly meetings of a multidisciplinary transplant team, during which new patients are presented and discussed. In addition, the status of all inpatients (either pre or post-transplantation) is discussed.
  • Participate in the outpatient care of patients in the pre-transplant phase.
  • Care for patients following cardiac transplantation, including managing and adjusting the immunosuppressive regimen depending on the results of periodic endomyocardial biopsies. The heart failure/transplant service holds weekly meetings to review hemodynamic, biopsy and other clinical data about individual patients. During these meetings, fellows present and evaluate data and formulate patient treatment plans.
  • Develop a working knowledge of the outpatient care of transplant patients suffering from various complications of immunosuppressive therapy, including cyclosporine-induced hypertension and renal dysfunction and prednisone-induced diabetes. Fellows will also learn the appropriate diagnosis and management of infectious complications in non-acutely ill patients in the outpatient setting.
  • Attend monthly meetings of the New England Consortium of Cardiac Transplantation, which is made up of transplant cardiologists, surgeons and nurses from New England hospitals performing cardiac transplants.

Research opportunities

Fellows are encouraged to become involved in clinical research during their advanced heart failure training. They will be exposed to a wide range of research opportunities, including basic science, translational and clinical research. Most fellows also become involved in ongoing heart failure clinical trials.

The Molecular Cardiology Research Institute and the Division of Cardiology offer a variety of research areas related to heart failure and ventricular function. Fellows will work closely with mentors from these groups to design a curriculum and research program that is both educational and productive.


Our outstanding faculty members are among the nation’s leaders in bringing the latest advances in heart failure into clinical practice. All are on the academic staff of Tufts University School of Medicine.

  • David DeNofrio, MD
  • Michael S. Kiernan, MD
  • Marvin A. Konstam, MD 
  • Ayan R. Patel, MD
  • James E. Udelson, MD

Resources for fellows

A full range of inpatient, outpatient, clinical and research laboratory facilities are available to the cardiology fellows at the Medical Center. Fellows work with the highest quality, latest technology equipment. In addition, a complete medical library is available at Tufts University School of Medicine.

Fellows have a centrally-located, dedicated, quiet workspace (Shapur Naimi Fellowship Room) equipped with desks, computers and a lounge area. Fellows can also access cardiology conference space, including the Modestino Criscitiello Library and the Herbert J. Levine Conference Room. These fellow spaces are named for three superb cardiologists who helped establish cardiology at Tufts MC.

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