ABIM Advanced HF study plan

Build a one-page decision map that distinguishes HFrEF, HFmrEF, HFpEF, and HFimpEF by ejection fraction cutoffs, diagnostic criteria, and initial therapy implications.

Reconstruct the four foundational GDMT pillars (ARNI/ACEi/ARB, evidence-based beta-blocker, MRA, SGLT2 inhibitor) and write the starting dose, target dose, key contraindications, and monitoring parameter for each.

Practice interpreting natriuretic peptide values in the context of obesity, atrial fibrillation, CKD, and age by working through 10 self-written clinical vignettes.

Explain the role of noninvasive and invasive testing (echo, cardiac MRI, right heart catheterization, endomyocardial biopsy) in defining HF etiology, and list which findings change management.

Define advanced (stage D) heart failure using NYHA class, INTERMACS profile, and objective criteria such as peak VO2, 6-minute walk distance, and recurrent hospitalization, and explain why each threshold matters.

Compare inotropic agents (dobutamine, milrinone, dopamine) on mechanism, hemodynamic effect, arrhythmia risk, and survival data, and state when each is preferred.

Sequence the evaluation of worsening congestion by applying the profile-based (wet/dry, warm/cold) framework to 8 self-generated scenarios.

List the referral triggers for advanced HF or transplant evaluation and justify each using guideline language paraphrased in your own words.

Differentiate durable LVAD devices and configurations (HM3, HeartMate II legacy concepts, RVAD, BiVAD, temporary percutaneous support such as Impella and ECMO) by indication, anticipated duration, and typical patient profile.

Map the preoperative candidate workup for MCS, including right ventricular assessment, frailty, psychosocial evaluation, and contraindication screening.

Catalog the major post-implant complications (bleeding, thrombosis, driveline infection, stroke, aortic insufficiency, right heart failure, arrhythmia) and describe the recognition and first-line management of each.

Explain the physiologic principles of LVAD speed optimization, ramp studies, and the difference between aortic valve opening and non-opening states.

Build a comparison of temporary versus durable MCS by hemodynamic support level, weaning potential, and bridge-to-decision strategy.

Review anticoagulation and antiplatelet protocols after durable MCS, including target INR ranges and the reasoning behind them.

Identify which patients with cardiogenic shock should be escalated to a shock team, and describe the timing and members of that team.

Consolidate domains 1 and 2 by completing 40 original board-style questions under timed conditions and reviewing every miss.

Outline the transplant candidate evaluation, listing criteria, and contraindications, distinguishing absolute from relative barriers.

Explain the purposes of HLA typing, panel-reactive antibody testing, and virtual and actual crossmatch in donor-recipient matching.

Describe the three forms of allograft rejection (hyperacute, acute cellular, antibody-mediated) by timing, mechanism, histology, and treatment.

Compare induction and maintenance immunosuppression regimens, including calcineurin inhibitors, antimetabolites, mTOR inhibitors, and corticosteroids, on toxicity profiles.

Interpret surveillance protocols after transplant, including the timing of endomyocardial biopsies, coronary angiography or IVUS for cardiac allograft vasculopathy, and donor-specific antibody monitoring.

Differentiate infection risk windows after transplant and match common opportunistic pathogens to their typical post-transplant period.

Compare long-term outcomes of transplant versus destination-therapy LVAD and identify which patient characteristics favor each strategy.

Explain the physiology behind post-transplant hypertension, renal dysfunction, and cardiac denervation, and describe the management implications of denervation.

Classify pulmonary hypertension using the five WHO groups with updated hemodynamic definitions, including the mean pulmonary artery pressure, pulmonary vascular resistance, and wedge pressure thresholds.

Interpret right heart catheterization data, distinguishing pre-capillary from post-capillary and combined PH using the diastolic pressure gradient and pulmonary vascular resistance.

Explain the pathophysiology of right ventricular failure, including ventricular interdependence and the rationale for avoiding systemic vasodilation in isolated RV failure.

Describe the management of pulmonary arterial hypertension, including the three therapeutic pathways (endothelin, nitric oxide, prostacyclin) and when to combine them.

Explain how left heart disease causes group 2 PH and describe the approach to distinguishing PH due to HFpEF from PAH.

Integrate all four domains by completing a timed 80-question mixed mock examination and reviewing every incorrect and uncertain item.

Re-drill the weakest three topics surfaced during weeks 1 through 7 using spaced repetition and explain each aloud from memory.

Construct a one-page synthesis linking left heart failure, group 2 pulmonary hypertension, right ventricular failure, MCS eligibility, and transplant candidacy.

Practice 15 rapid-fire clinical decision points covering drug interactions, anticoagulation reversal, and device alarms under time pressure.