Advanced heart failure encompasses the rapidly growing subspecialty involved with managing patients with refractory (AHA/ACC Stage D) heart failure. Fellows rotate for one- or two-month long blocks on the advanced heart failure service. The rotation fellow is responsible for rounding on and managing the inpatient heart failure service. Patients on the inpatient service include decompensated chronic heart failure patients, de novo cardiomyopathies, refractory heart failure patients undergoing evaluation for transplant and/or ventricular assist device support, post-transplant patients with rejection or other complications, and patients on extracorporeal life support (veno-arterial, veno-venous ECMO). Fellows will actively participate in the management of straightforward heart failure admissions as well as advanced cases and those patients on mechanical support. Fellows will be expected to round on post-operative durable LVAD patients. Fellows may optionally attend LVAD implant surgeries, LVAD outpatient clinic, and regular HF outpatient clinic.