Clinical Component

Navigating the Clinical Component

The Advanced Heart Failure program is already established, with an experienced advanced practice provider team, remote monitoring technology, and working relationships with regional transplant centers. The incoming physician joins a service that manages a substantial chronic heart failure population and has room to grow across LVAD, adult ECMO, pulmonary hypertension, and cardiogenic shock care.

Patient Population and Program Activity

The program manages a large active patient base with an established outpatient foundation. The figures below reflect current program activity.

Clinical Practice

The practice spans outpatient and inpatient care.

Outpatient

• Advanced Heart Failure Clinic
• Pulmonary Hypertension Clinic
• Longitudinal disease management
• CardioMEMS remote monitoring
• Collaboration with the APP team

Inpatient

• Heart failure consultation
• Cardiogenic shock management
• ICU and CVICU consultation
• Longitudinal LVAD management
• Participation in future adult ECMO development

Mechanical Circulatory Support

Current services support acute and chronic advanced heart failure care.

• Impella support
• CardioMEMS monitoring
• Cardiogenic shock management
• Longitudinal follow-up of approximately 19 LVAD patients implanted elsewhere
• Pulmonary hypertension care

There is not currently a formal Shock Team, which creates an opening for physician leadership and protocol development.

Areas of Focused Practice

The physician can concentrate the practice around specific clinical interests and help develop new service capabilities.

• Amyloid and hypertrophic obstructive cardiomyopathy programs
• Pulmonary hypertension
• CardioMEMS remote monitoring
• LVAD program development, including a long-term goal of destination therapy
• Adult ECMO and cardiogenic shock pathway development

Call

Call is structured to keep overnight burden manageable and evolves as the program grows.

• General cardiology call approximately 1:6 to 1:7
• Heart failure specific call expected to develop as recruitment continues
• Fellows provide first-call coverage for inpatient cardiology services
• Overnight attending burden is generally light due to in-house fellows
• STEMI call is managed by Interventional Cardiology
• Initial call participation depends on the chosen practice structure

Advanced Practice Provider Support

An experienced APP team supports the service across settings, and dedicated APP support is anticipated for the incoming physician.

• Independent outpatient clinic visits
• Shared physician visits
• Inpatient rounding
• Transitional care follow-up
• Remote patient monitoring
• Longitudinal chronic disease management

Regional Transplant Partnerships

Patients who need transplantation or LVAD implantation are referred to established regional centers, then commonly return to Sanford for ongoing longitudinal management.

• University of Minnesota, with an established outreach relationship with its Advanced Heart Failure team
• Mayo Clinic
• University of Iowa

Teaching and Research

The position is primarily clinical and offers academic involvement through Sanford's accredited General Cardiology and Interventional Cardiology fellowships.

• Teaching cardiology fellows
• Clinical trials and investigator participation
• Research collaboration
• Protected research time, negotiable