Heart Failure Clinic
This site launched in 2007 when primary care providers in the San Francisco Health Network requested expertise for co-management of diuretic therapy and disease modifying agents such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), aldosterone inhibitors, and long-acting beta blockers for patients with chronic heart failure.
Such individuals require additional measures to prevent cardiovascular disease progression and death. Heart Failure Clinic thus coordinates echocardiograms, genetic tests, cardiac magnetic resonance imaging, cardiac positron emission tomography, and cardiac catheterization to identify causes of cardiomyopathy and monitor clinical responses guideline-directed medical therapy. The heart failure team also partners with primary providers to encourage lifestyle and dietary modifications to improve exercise capacity and reduce symptoms with major emphasis on reducing exposure to cigarette smoke, stimulants, ethanol, and all substances toxic to cardiovascular tissue. ZSFG patients who require advanced heart failure therapies are referred to UCSF for cardiothoracic surgery, advanced percutaneous interventions, formal electrophysiology studies, device implantation, and heart transplantation.
ZSFG recently identified reduction of 30-day all-cause readmissions for patients with an index heart failure admission as an organizational priority. Jonathan Davis, MD, MPHS joined the Division of Cardiology on 11/01/2018 as Heart Failure Program Director for the San Francisco Health Network:
Heart Failure Clinic is the core of a multidisciplinary team that is providing comprehensive, guide-line directed, and compassionate care for individuals across the spectrum of heart failure disease. Resources span hospital and ambulatory sites and foster the necessary analytic and academic infrastructure to both deliver and advance therapies. Patients are referred due to:
- new diagnoses of heart failure
- readmissions for heart failure regardless of their ejection fraction
- NYHA Class III or IV symptoms despite ongoing treatment efforts
- persistent hypotension
- worsening renal or other end-organ function attributed to heart failure
Physicians and nurse practitioners in Heart Failure Clinic receive intensive and humanistic support from registered nurses, social workers, clinical pharmacists, and case managers carried out in collaboration with primary care partners. Interactions with cardiac rehabilitation, mental health, addiction medicine, and palliative care professionals further improve the survival and well-being of chronic heart failure patients.