Cardiovascular Disease Curriculum and Site Affiliations
The Cardiovascular Fellowship Program is sponsored by Creighton University School of Medicine - Phoenix. It is a comprehensive program that includes clinical rotations at St. Joseph’s Hospital and Medical Center, Valleywise Health, and Phoenix Children’s Hospital. The clinical experience involves all aspects of cardiology including outpatient and inpatient care, coupled with diagnostic and therapeutic myocardial imaging (echocardiography, computerized tomography angiography, magnetic resonance imaging, and nuclear).
At St. Joseph’s Hospital and Medical Center, rotations include the Cardiac Intensive Care Unit supervised by cardiologists who specialize in heart failure and are trained in the application of mechanical support devices. Cardiac catheterization exposes fellows to the conventional diagnostic techniques of right and left heart catheterization, selective coronary angiography, together with exposure to nonsurgical therapeutic structural techniques such as replacement of the aortic valve or insertion of the MitralClip. Exposure to electrophysiology includes one-on-one teaching in the outpatient clinics together with observation and active involvement in a variety of diagnostic and therapeutic procedures in the electrophysiology laboratory. These procedures range from the insertion of a simple pacemaker to that of ablation for atrial fibrillation.
The mandatory rotation through Phoenix Children’s Hospital provides a unique exposure to the management of Adult Congenital Heart Disease. The fellows are exposed and expected to participate in a variety of didactic lectures given daily throughout the three years that cover all subjects in the ABIM blueprint in preparation for the cardiovascular board exam.
Program Components
- Molecular Biology, Genetics and Preventive Cardiology
- Non-invasive Diagnostic Imaging
- Advanced Diagnostic Imaging
- Invasive Diagnostic and Therapeutic Procedures
- Cardiology Grand Rounds
- Electrophysiology
- Echocardiography
- Heart Failure
- Inpatient Consultations and Management
- Outpatient Consultations and Follow Up
- Heart Failure Inpatient and Out Patient Clinic
- Cardiac Intensive Care Unit (CICU)
- Electrophysiology – Consultations and Procedures
- Cardiac Catheterization – Diagnostic and Therapeutic
- Nuclear Diagnostic Imaging
- Echocardiography – Diagnostic and Therapeutic
- Cardiac Computerized Tomographic Angiography (CCTA)
- Cardiac Magnetic Resonance Imaging (MRI)
- Ambulatory Longitudinal Follow Up Out Patient Clinic
- Research / Quality
Observation and Hands-On Procedures
Hospital Affiliations
Our program is a collaborative effort of Creighton University School of Medicine, Valleywise Health and St. Joseph's Hospital and Medical Center.
Affiliations with the following institutions round out a program that provide a balanced experience encompassing managed care, private practice, critical care, ambulatory and primary/preventive care.
St. Joseph's Hospital and Medical Center (553 beds) is a referral center for 5 other hospitals in the Phoenix Metropolitan area as well as several outlying community hospitals. SJHMC has extensive experience in difficult and unusual cases, as well as advanced therapies and devices required in the management of patients, such as advanced heart failure and cardiogenic shock. This is further complemented by being the referral center for advanced cardiac surgery performed by our cardiac surgeons. The fellowship rotations provide the training necessary to become competent in all six of the Core Competencies outlined in COCATS 4.
The rotations include faculty supervision of outpatient and inpatient management together with exposure to diagnostic and therapeutic procedures. Longitudinal follow-up patient care is actively pursued in the general cardiovascular outpatient clinic and the specialized heart failure clinic. Patient management within the cardiovascular clinics include the care of comprehensive preventive and risk factor management as well as full diagnostic and therapeutic management of a broad array of cardiovascular disorders . Exposure to general inpatient cardiac conditions is provided through consultation rotations throughout the various hospital wards.
Competency in the care of the critically ill patient such as with myocardial infarction, heart failure, or shock is achieved by rotating on the CV-ICU and Advanced Heart Failure services. This includes procedures such as the Swan Ganz cardiac catheterization, Intra aortic balloon pump, Impella, Tandem Heart, and VA-ECMO. The fellows also have exposure to advanced therapies patients including those with durable LVADs.
The rotations through the cardiac catheterization laboratories will include exposure to diagnostic cardiac catheterization, therapeutic percutaneous cardiac intervention, and various specialized and research procedures such as TAVR and MitraClip Therapy. In the electrophysiology laboratories, the fellows will be exposed to a wide range of procedures including the insertion of pacemakers and defibrillators, cardioversion, ablation, and devices such as the WATCHMAN.
The variety of imaging labs present at the medical center allow fellows to be trained in comprehensive diagnostic and therapeutic myocardial imaging that includes performing and interpreting echocardiograms, nuclear rest and stress myocardial imaging techniques, computerized tomographic angiography (CTA), and cardiac MRI. Initially, the fellows work under the direct supervision of the faculty and receive stepwise autonomy in concordance with graded competency. The myocardial images obtained by the various imaging techniques (CTA, MRI, etc.) can be visualized and interpreted at any secured monitor whether it be in the outpatient clinic, the CV-ICU, the Cath labs, or on the Wards. In addition to routine patient activity, multiple clinical trials evaluating drugs and devices will be available throughout all of the rotations.
Valleywise Health Medical Center is housed in a new 673,000 square-foot, 10-story medical center with 230 beds. As the Maricopa County safety net hospital, it serves a diverse population and exposes the fellows to varying patient populations. It is located within 15 minutes of driving time from the main site (SJHMC). Dr. Raina Roy, the Valleywise Site Director and the Associate Program Director, is responsible for the overall supervision of the training of the fellows.
The cardiovascular service performs diagnostic and therapeutic catheterization, diagnostic and therapeutic electrophysiology (ablation of supra ventricular & ventricular arrhythmias), together with routine and advanced diagnostic echocardiography. The Intensive Care Unit is a combined medical and surgical unit of 20 beds. The training at Valleywise Health Medical Center is uniquely enhanced by the exposure to a large clinical outpatient and inpatient population that compliments the patient population at SJHMC. The fellowship rotations provide exposure to all 6 of the Core Competencies recommended by COCATS-4 in the diagnosis and management of inpatient/outpatient cardiovascular diseases. The fellows are exposed to a wide range of cardiac and vascular diseases including routine ischemic heart disease, cardiomyopathies both inherited and acquired, aortic and peripheral vascular diseases, as well as less common diseases such as HIV cardiac diseases, and Rheumatic Heart Disease. All faculty are salary-based and highly qualified cardiologists. Two of the cardiologists are certified for level III echocardiography. This expertise enables fellowship rotations in routine and advanced echocardiography throughout their training years.
Phoenix Children's Hospital is one of the largest freestanding pediatric hospitals in the United States. The hospital maintains affiliations with multiple academic medical institutions and is home to a comprehensive Center for Heart Care that spans the full spectrum of cardiac care, from fetal cardiology through adulthood. Phoenix Children's is the only Adult Congenital Heart Association (ACHA) Accredited Comprehensive Care Center in Arizona. The ACHD program offers a robust clinical experience including cardiac imaging, electrophysiology, pulmonary hypertension management, cardiac catheterization, and congenital heart surgery. Fellows rotating at Phoenix Children’s will be provided with hands-on exposure to the diagnosis and management of Adult Congenital Heart Disease in both the inpatient and outpatient settings. Fellows will develop competency across all six ACGME Core Competencies as applied to the care of patients with a wide variety of congenital cardiac conditions. The breadth and complexity of the patient population offers a distinctive training environment that bridges pediatric and adult cardiology, reflecting the evolving landscape of ACHD care.
